October is National Breast Cancer Awareness Month, and, as a plastic surgeon and a breast cancer survivor, Emily McLaughlin, MD, offers a unique perspective on the way that breast reconstruction surgery has evolved over the years. The Fort Worth, Texas-based surgeon is double board certified in plastic and general surgery and fellowship trained in craniofacial surgery. She took some time to chat with Beauty in the Bag about breast cancer, breast reconstruction and why she loves what she does.
BreastReconstructionMatters.com1. How has breast reconstruction changed over the past decade?
“There have been SO many changes in breast reconstruction over the past decade. In the time I have been in practice and since my training, several techniques have largely fallen out of favor. Tissue expanders and implant reconstruction are mainstays and the most common techniques I use in my practice. Tissue reconstruction with flaps is now focused on perforator flaps, commonly referred to as DIEP flaps. This results in an easier recovery for the patients for many reasons and produces a very good aesthetic outcome. The most exciting change in the past year or so is forward thinking about the tissue plane that the expanders and flaps are placed in. Historically all breast reconstruction was completed beneath the pectoralis muscle. By definition, after a mastectomy, only a skin flap remains which is not generally thick enough to cover the expander and, eventually, the implant. The problem with reconstruction in the sub-pectoral plane is the muscle still functions, even if it is partially draped over the implant. This can result in something called ‘animation deformity.’ This means when the muscle contracts-pushing with your arms to get up out of a chair, lifting, working out-it can flatten out the underlying implant. In the past year or so, more surgeons are performing reconstruction in the pre-pectoral plane: over the muscle. Even after a mastectomy when the breast tissue has been removed and if the skin flap is relatively thin, there are options to make this technique a reality. Fat grafting is a technique where liposuction is done to harvest a patient’s own fat from any area of concern and that fat is then injected into the upper part of the breast to help cover the implant. Pre-pectoral reconstruction can be done as a revision of sub-pectoral reconstruction or, in some cases, as a primary technique for reconstruction.”
2. Tell us about your experience with breast reconstruction as a patient.
“I had a double mastectomy in June 2016 for left breast cancer. My reconstruction was subpectoral because of that recently that was the preferred technique at that time. I was very unhappy with the degree of animation once I had recovered and pursued revision of my reconstruction to the pre-pectoral plane. As a plastic surgeon and breast cancer patient, I was able to approach my surgeon-who is a friend and colleague to declare ‘this is not OK’ and decisions were made. Educating patients on their options is essential before, during and after reconstruction. ”
3. What is the most rewarding part of working with breast cancer patients and survivors?
“The most rewarding part of working with breast cancer patients and survivors is, essentially, putting Humpty Dumpty back together. Cancer of any kind takes away part of your body. For breast cancer, the single most identifying physical characteristic of being a female-breasts – are gone. The effect this has on your emotional state cannot be overstated. To utilize modern techniques for better reconstruction results in better aesthetics and better restoration of a sense of ‘normal’ for patients. As a fellow survivor of breast cancer, I can discuss options with any patient facing this reality.”