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Each October, pink ribbons come out of the woodwork, but women at high risk for breast cancer, those living with breast cancer and the doctors who treat them – including reconstructive plastic surgeons – think pink all year long.
October is National Breast Cancer Awareness Month and serves as a good time to reflect on advances in treating breast cancer over the past year.
There have also been some major innovations in breast reconstruction techniques and technologies in 2018 including a movement to save the breast, when possible, says Margaret S. Roubaud, MD, Assistant Professor, Department of Plastic Surgery at MD Anderson Cancer Center in Houston. Growing numbers of ‘oncoplastic surgeons’ can “re-arrange” the tissue that’s left in the breast at the time of the cancer removal surgery to camouflage any indentations. In addition, a breast lift or breast reduction can also mask these defects. A balancing procedure on the other breast may be needed for symmetry, she says.
“We can also do microvascular surgery and use free tissue from another part of the body to recreate a breast,” she says. “In the past, this was done with abdomen tissue, but now we can take it from other areas such as the buttock or thighs, where some women have more fat,” she says. “It’s a much bigger operation up front than implant reconstruction surgery, but women seem to be happier in the long term and their breasts grow and age with them.”
Fat grafting to the reconstructed breast has also been a game changer. “We can correct small asymmetries in the breast with fat,” she says. There were concerns fat could obscure mammogram readings and miss cancers, but radiologists at a cancer center like MD Anderson can tell the difference between breast tissue and fat, she says.
Expansion is another part of two-stage breast reconstruction process, and up until recently, it has been uncomfortable and inconvenient for many women who had to repeatedly visit their surgeon for injections of saline to grow the pocket where the breast implant will be placed. During this process, expanders are gradually inflated with either saline or air to stretch the pocket tissues and make room for a breast implant, which is placed at a second stage, usually 6-8 weeks after the first procedure.
Air Expanders are a new type of tissue expander which are placed at the time of the mastectomy. They have an integrated CO2 cartridge which allows you to control the expansion with a remote-control device at home, meaning fewer visits to the surgeon.
“In the right patient, this is a great idea,” says Dr. Roubad. “You can basically control expansion with a remote device and your doctor can supervise. This reduces the number of times you have to go to the hospital – which is a big advantage especially for people who live in rural communities or far away from their breast surgeon.”
There have also been some advancements in single-stage or direct-to-implant breast reconstruction. “Historically, the first stage of most immediate breast reconstructions was performed by placing the tissue expander beneath the pectoralis (chest) muscle,” says New York City plastic surgeon Mark H. Schwartz, MD, FACS, Clinical Assistant Professor of Plastic Surgery Weill Cornell Medical College.
This coverage helped to reduce complications such as capsular contracture, especially in patients who will need to undergo radiation treatment, but it was more painful, and could result in animation deformity, a common condition marked by the excessive movement of a breast implant or implants.
“In 2018, the first stage of immediate breast reconstructions often places the tissue expander and thus final implant in the prepectoral space (above the muscle), which may allow for a more natural shape, less pain, and less time in the operating room,” he says. This is made possible by with the advent of new technology such as Alloderm (Allergan) an acellular dermal matrix, fat grafting to improve contours and thicken the mastectomy flaps, and the SPY device, an intraoperative imaging device which helps to determine the health of mastectomy skin, he says. Alloderm is a biologic sheet-like material that shrouds the implant not covered by muscle and also acts as a sling to help secure the implant in position.
Another novel product that is improving women’s lives hails from Acelity. The PREVENA™ Incision Management System is a portable, disposable system that uses negative pressure (like a vacuum) to help protect surgical incisions and helps to reduce excess fluid and improve the healing process. The innovation can speed recovery for many women post mastectomy.
Breast Reconstruction Awareness Still Lacking
All of these advances only matter if women are aware of their breast reconstruction options, and unfortunately, many women are not. The good news is that this awareness gap is narrowing thanks to the Breast Cancer Patient Education Act, which requires the Secretary of Health and Human Services to plan and implement an education campaign about the availability and coverage of breast reconstruction and other available alternatives after mastectomy.
There has been a huge push to raise awareness regarding reconstructive options after a breast cancer diagnosis and to make sure that women understand these options, says. Part of this effort is the annual Breast Reconstruction Awareness Day that takes place across the country and seeks to educate women on their reconstructive options.
This year BRA Day will take place on October 17, 2018. Get involved. Keep an eye out for the Breast Reconstruction Awareness Day Campaign in your community and if you can’t find one, plan your own. There is a free Event Starter Guide to help you plan Breast Reconstruction Awareness Day activities.