As Breast Cancer Awareness Month comes to a close, my staff and I want to extend our thanks and appreciation to all of those committed to finding a cure for Breat Cancer, and to express our support for all those battling breast cancer. As a plastic surgeon, I have been able to meet many amazing women during their breast cancer journey, and help them with their reconstructive needs. I feel very strongly about the importance of woman having all of the necessary information to make an informed decision regarding all of their reconstruction options. While some women may not want any reconstruction, many women are not even told of their options for reconstruction. The decision to proceed with reconstruction is a personal one. Again, some women may not be interested in any form of reconstruction. However, many women feel differently, and desire to reconstruct their breasts following mastectomy and even possibly a lumpectomy in effort to feel "whole" again and to help move forward with their lives following the cancer diagnosis. Many of those women are also candidates for immediate breast reconstruction, which can be performed at the time of the cancer operation, ie the mastectomy.
Reconstruction options can be braodly divided between implant reconstruction, which simply means tissue taken from one area of the body and moved to the chest to recreate a breast. Implants can afford excellent results in many cases, and typically involve shorter surgeries than surgeries that involve autologous tissue, or flaps. With any form of reconstruction, women have to be prepared for the likely need for multiple operations, or a "staged approach". This is true of implant or flap reconstruction, as the flaps often require revisions. With implants, the stages may involve placement of a tissue expander, or an implant that is filled in the office after surgery before placing a permanent implant, either saline or silicone gel filled. Nipple and areolar reconstructions are also typically performed after the breast mount has been recreated, unless a nipple and/or areolar sparing mastectomy approach was chosen by the General Surgeon. Implants have been criticized that they can become hard, a phenomenon called a capsular contracture, and the risks of contractures are higher in those women requiring radiation. While it is true that complication rates with implants are higher in the face of radiation, it is not true that implant reconstruction cannot be attempted, and even yield excellent results, if radiation treatment is necessary. Flap surgery, or autologous tissue reconstruction, typically involves more lengthy and technically demanding surgeries, though may be more suited in patients with severe radiation damage. Flaps of tissue can be rotated from one area of the body to the chest to create a breast mound, but unfortunately, this involves creating scars on another area of the body. Flaps can also be transplanted to the chest, as opposed to rotating the tissues. Those surgeons who specialize in this form of surgery feel that this form of reconstruction helps spare muscle tissue, which is typically taken with the more traditional rotation flap surgeries. However, to "transplant" the tissue requires microsurgery, which is technically challenging, and as such, is associated with significant complication risks, including flap loss. Flaps involve scars on the donor areas of the body, such as the buttocks, thighs, and the abdomen, but with regards to the abdomen, there may be a secondary benefit of removing unwanted excess abdominal tissue, almost like a "tummy tuck". Flaps are typically not performed at this time of a mastectomy if radiation is likely, as it is less than ideal to irradiate a precious flap of tissue.
The above broadly reviews the various reconstruction options available to women, and it is hoped that this information may be helpful to those affected, including family and friends, by breast cancer. As always, my staff and I are committed to helping those with breast cancer, and are available to answer any questions. Our fight continues on, even after Breast Cancer Awareness Month comes to a close.
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