Article by Jeffrey Roth, MD
Las Vegas Plastic Surgeon
We are all aware that Breast Cancer remains a significant disease, affecting 1 in 8 American women. At this time there are about 2.5 million breast cancer survivors in the United States. (This includes both women still being treated and those who have completed treatment.) (1)
Great strides have been made in the prevention, early detection, and treatment of the disease. Surgery continues to be the main treatment. What is often not known is that great strides have also been made in reconstruction after surgery. More than 57,000 breast reconstruction procedures were performed in 2007. (2)
Immediate vs. Delayed Reconstruction
Reconstruction can be immediate, (at time of the mastectomy), or delayed until after the mastectomy wound has healed. Advantages of immediate reconstruction are that the patient wakes up with a breast mound. Delayed reconstruction also occurs frequently, as women complete adjuvant treatments, (i.e.; radiation, chemotherapy), or women who have had mastectomies years ago find out about new options they may not have had when they were going through the process.
Seventy-five percent of women who have mastectomies go on to have surgical reconstruction of one or both breasts. The majority of women who are given the choice ask for immediate breast reconstruction. Some women who have lumpectomies also choose breast reconstruction to restore a more balanced look. (3)
Expander/Implant vs. Autogolus (One’s own tissue)
There are a few ways of making a new breast. One way entails placing an expander in the breast pocket at the time of the mastectomy. The expander is much like an implant, but it has a port attached to it. This port allows the plastic surgeon to fill the expander with more fluid. The skin and soft tissue are expanded until the size is right. Then the plastic surgeon will typically take out the expander and place an implant.
Using one’s own tissue is another option. This is where tissue can be rotated from one area of the body to another to make a breast mound. There is now an expanding interest in free tissue transfer. This is where the tissue to be used is dissected from one area of the body and then “plugged in” to another area, (artery to artery, vein to vein, etc).
Roughly half of patients decide on implants. Most of the rest choose a surgery called the TRAM flap, which uses their own body tissue to rebuild the breast. (3)
This is usually one of the last stages in breast reconstruction. A popular way is to make a little flap from surrounding tissue to make a nipple. The new nipple and areola can later be colored in to match the other side. There are personnel specifically trained to do this.
How to find a Reconstructive Surgeon
Your breast surgeon may have a plastic surgeon that he often works with. You can ask him for a recommendation. Also, it may be a good idea to get more than one opinion.
Look to see if your reconstructive surgeon is Board Certified by the American Board of Plastic Surgery. All of the members of The American Society of Plastic Surgeons are Board Certified and have been trained in breast reconstruction. They have a convenient surgeon finder feature: www.plasticsurgery.org
Breast cancer continues to be a significant disease. Great strides have been made in the prevention, early detection, and treatment of the disease. Likewise, improvements in reconstructive surgery continue to improve and give patients options to become more whole again.
(1) American Cancer Society
(2) Procedural Statistics Trends 2000-2007. American Society for Plastic Surgery.