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BREAST INTENTIONS: KNOW YOUR OPTIONS

11-29-17 | Posted by


At long last, there is some good news for women.

Death rates from female breast cancer fell by close to 40% from 1989 to 2015, largely due to earlier diagnosis and improved treatments including targeted therapies, according to the American Cancer Society. One area where we are making great strides is access to breast reconstruction. The American Society of Plastic Surgeons and The Plastic Surgery Foundation are leading the Breast Reconstruction Awareness USA Campaign or BRADAYUSA campaign. To date, this campaign has raised more than $931,000 to support research, projects, programs and the charitable surgical care of women in need of post-mastectomy breast reconstruction. In short, this movement – and the companion legislation that is being introduced and advanced — puts a plastic surgeon at the table when a woman is diagnosed with breast cancer and reviewing her treatment options, he says.

“We are not there yet though. Not all women eligible for breast reconstruction following cancer surgery are informed of their options, but we are making progress, that’s for sure, says Mark H. Schwartz, MD, FACS, Clinical Assistant Professor of Plastic Surgery at Weill Cornell Medical College in New York City. When meeting with a plastic surgeon, women can learn about some of the exciting innovations in breast reconstruction such as direct-to-implant breast reconstruction. “In the past, women who wanted to have breast reconstruction with implants required a two-stage reconstruction,” Schwartz says.  Not anymore.

“With certain patients, we are able to go direct to a permanent implant and thus save the patient an extra surgery and going through the process of tissue expansion,” he says. Only your breast reconstruction surgeon can tell you if you are a candidate for direct-to-implant reconstruction, but optimal candidates have sufficient breast skin, no history of previous radiation to the breast or chest wall and are height/weight proportionate.

There have also been dramatic advances in the use of fat to the breast following mastectomy, he says. Fat can be used to edit minor differences in the shape, balance, or position of the implant or as a standalone for natural breast reconstruction, he says. “This is all really exciting and welcome news for many women faced with breast cancer,” he says.

Another game changer is the advent of Air Expanders, he says. “These very new type of tissue expanders are placed at the time of the mastectomy and have an integrated CO2 cartridge which allows the patient to control the expansion with a remote control device at home,” he says.  This means fewer visits to the surgeon for saline injections into the expander, which is a huge convenience bonus, especially for women who want to put the cancer and all of the doctor’s appointments behind them and focus on the future, he says.

“Choosing the most advanced procedures available in breast reconstruction can help women restore their bodies and return to their lives much more quickly,” says Dr. Schwartz. Breast reconstruction may be performed immediately after a mastectomy, or it can be delayed for weeks or even years. Immediate reconstruction can involve the placement of an implant or tissue expander that will eventually be replaced by an implant. The advantages are that the process will begin at the time of your breast removal which is cost effective, however, the initial operation and recovery may be longer. If your skin is very tight you may need tissue expansion prior to reconstruction. A balloon expander may be placed under the skin and chest muscle, to be gradually filled with salt-water to stretch the skin. The process takes several weeks to months, at which point either the expander will be left in, or a permanent implant will be placed, and the nipple areola can be reconstructed.  If there is adequate skin available, a single stage reconstruction may be done by placing a silicone gel implant in the breast at the time of mastectomy.

(42 year old woman who was BRCA positive and had bilateral direct to implant reconstruction. This means that immediately after her bilateral mastectomies, silicone implants were placed into the breast pocket).

“Your breasts can be reconstructed using an implant, your own tissue or a combination of both. Most patients go through a 2 stage procedure where a partially inflated tissue expander is inserted at the time of the mastectomy.  Over the course of the next month or so, saline is injected in the  office to get the skin expanded.  At a second surgical procedure, the tissue expander is removed and exchanged for the permanent implant,” he says.

“Commonly performed procedures using your own tissue from the torso area to create a skin flap include TRAM flap and Latissimus flap reconstruction that may or may not involve reconnecting blood vessels contained in the tissue to the grafting site. The advantage of this surgery is that your own skin is used, but it is more complex and involves considerable scarring and recovery since there are two surgical sites to heal.  If only one breast is affected, cosmetic work on the opposite breast may be done at the same time so your breasts appear symmetrical,” explains Dr. Schwartz.

Get Screened

Early detection dramatically increases the odds of survival, and yearly mammograms (breast x-rays) is the best way to find a breast cancer early. Women aged 40 to 44 should have the choice to start annual breast cancer screening with mammograms, and women age 45 to 54 should get mammograms annually, the American Cancer Society recommends. After age 55, women can switch to mammograms every 2 years, or continue yearly screening. Performing monthly breast self-exams at home can also help spot breast cancer early.  Many women undergo preventive mastectomies – or removal of healthy breasts – due to a significantly elevated risk for breast cancer and the presence of a mutated copy of one or two of the breast cancer genes, he adds. This surgery may be able to reduce the risk of developing breast cancer by 95%. Knowing your family history and seeking genetic counseling can help you make a decision.

When performed by an experienced reconstructive plastic surgeon, your breasts can be beautifully restored so that you can fully return to your life with barely any signs of treatment.  “I look forward to the day when all of the reconstructions I do are all preventive because we have put an end to breast cancer,”  says Dr. Schwartz.

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