About one out of every eight women will develop some form of breast cancer within their lifetime. In 2010 approximately 207,000 cases of invasive breast cancer were diagnosed, with another 54,000 non-invasive cases diagnosed. Although breast reconstruction is an optional process after mastectomy, with over 2.5 women who have beat this disease, more and more women are choosing to have breast reconstruction as a part of breast cancer treatment. In fact, over 93,000 breast reconstruction procedures were performed in 2010, an increase of almost 20% from the year before (1). In fact, breast reconstruction has been seen as being so critical to a woman's recovery that in 1988, the Women's Health and Cancer Rights Act (WHCRA) was passed. This law actually requires all insurance companies who offer mastectomy coverage to also provide for reconstructive surgery, including any adjustments to the opposite breast to achieve symmetry and revision surgeries to refine the breast shape and recreate the nipple.
For most women, the treatment of breast cancer really consists of three parts. The first part of treatment is Physiological and involves the physical surgical removal of the tumor. A general surgeon performs either lumpectomy surgery, which removes the tumor and a small amount of surrounding tissue, or a mastectomy, which removes all breast tissue from the chest. Sometimes radiation therapy is used in combination with lumpectomy or mastectomy to treat any cancer cells that potentially remain. The choice of either surgery is usually determined by the size of the tumor, the size of the breast, and the patient's personal choice. The use of radiation is determined by the size of the tumor, tumor characteristics on biopsy, and what type of surgery is performed.
The second part of treatment is Pharmacological and includes chemotherapy in IV and/or pill form. Medications that modulate hormones are also sometimes used to reduce the risk of recurrence. This portion of the treatment can take anywhere from a few months to a year depending on chemotherapy drug choice, and tumor characteristics.
The final component of treatment is Psychosocial and includes all activities and treatments that help women to deal with their cancer and recovery. Studies have shown that breast reconstruction is important to helping women cope with cancer[2]. Because of this fact, breast reconstruction is a legally protected optional third part of treatment chosen by many women every year in the United States.
Breast reconstruction can be performed immediately after mastectomy or in a delayed manner, even months or years after mastectomy. There are several methods that can be used to reconstruct the breast, but they all fall under two main types - Flap reconstruction, which uses tissue from another part of the body, and Implant reconstruction, which uses a breast implant to recreate the breast. Sometimes a combination of both methods is used to get the best result possible.
Flap reconstruction uses muscle and fatty tissue from the back, tummy and occasionally other areas to create the breast mound. Skin can be transferred along with the other tissue when the chest skin has been damaged by infection, radiation, or a superficial tumor. Flap surgery requires a hospital stay of 3-7 days, leaves scars both on the breast and where the tissue was borrowed, and full recovery can take 2-3 months. Flap surgery has the benefit of avoiding an implant, but for patients who are very overweight or whose health is in poor condition, flap surgery may not be safe. Many women like that borrowing the tissue from the tummy is almost like having a tummy-tuck and that using tissue from the back can remove excess tissue that hangs over the bra straps.
Implant reconstruction has typically required two stages. During the first stage, a temporary implant (called a tissue expander) is inserted under the chest muscle. It is gradually filled with saline (IV fluid) after surgery through a needle that's inserted into a special part of the expander. In order to get more fluid into the expander at the time of the first surgery, tissue grafts called Allografts are sometimes sewn to the bottom of the muscle to make more room. The allograft also provides more coverage for the bottom of the implant. Complications of implant reconstruction with radiation are almost 50%, and the allograft can decrease some of these complications ( capsular contracture, exposure of the implant, and wound healing problems).
Using the allograft, sometimes an implant can be placed at the time of surgery (single stage reconstruction). This can only be done if the skin is in good condition after mastectomy. If the blood flow to the skin is poor, the traditional technique of slowly inflating the implant will need to be used.
If radiation is going to be needed, tissue expanders can be placed followed by flaps or implants, depending on how the skin recovers from radiation.
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[1] Report of the 2010 Plastic Surgery Statistics. Annual SASPS Procedural Statistics represent procedures performed by ASPS member surgeons certified by The American Board of Plastic Surgery® as well as other physicians certified by American Board of Medical Specialties-recognized boards. ©ASPS, 2011
[2] Rowland, Julia H. "Psycological Impact of Treatments for Breast Cancer", Surgery of the Breast, 2nd Edition, p. 382, 2006
Dana M. Goldberg M.D. is one of the fastest growing cosmetic plastic surgeons in West Palm Beach Florida. Dr. Goldberg was trained at the Ohio State university in plastic and reconstructive surgery. After completing her training she moved to Florida to create the thriving medical practice she enjoys today. Dr. Dana works with patients throughout the world, and is happy to answer questions for patients.
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