SPOTLIGHT ON BREAST RECONSTRUCTION

10-13-11 | Posted by Denise Mann

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Each year during October – National Breast Cancer Awareness month – there are numerous walks and runs for a cure, pink ribbons and all sorts of pink promotions to help raise money and awareness for breast cancer.

And all of these efforts seem to be making a difference. Fewer women are dying from breast cancer, largely because of advances in screening and treatment.  In 2011, an estimated 230,480 women will be diagnosed with breast cancer, and about 39,520 women will die from the disease in 2011, according to the American Cancer Society.

Alongside with strides in the diagnosis and treatment of breast cancer, there has been an increased acceptance of breast reconstruction as an option following mastectomy (the surgical removal of the breast/s). Today plastic surgeons also have a host of more natural-looking and feeling options to offer women who have had a mastectomy.

“Thirty years ago, breast reconstruction was a rare event,” recalls Carlin Vickery, M.D, a New York City-based plastic surgeon. “The surgeons were so concentrated on treating the cancer that they were not very focused on reconstruction.”

Breast surgeons were removing a lot of skin during a mastectomy, and their main aesthetic goal was a nice neat scar across the chest wall.

Not anymore.

Now there are many options including nipple- and skin-sparing mastectomies that allow doctors to preserve more of the natural breast skin and place an implant as they would in cosmetic breast augmentation. Some are even using injections of fat to touch up and perfect the cosmetic result. And most of the time, breast reconstruction takes place right after the mastectomy.

The real driving force behind this change was the women themselves – a virtual legion of breast cancer survivors that now total about 2.6 million.

Today, breast surgeons and plastic surgeons are teammates. They discuss many variables before the mastectomy including incision placement and how much skin will be removed. All of this planning will aid the reconstruction process and improve the cosmetic results.

Three New Approaches to Breast Reconstruction

The DIEP Flap

During flap-based breast reconstruction, surgeons use tissue skin, fat, blood vessels and muscle from the stomach, back, thighs or buttocks to reconstruct your breast.  Flaps can either remain attached to their original blood supply and tunneled under the skin to the breast area or cut from the area and reattached.

The deep inferior epigastric artery perforator (DIEP) flap allows surgeons to leave the muscle in the abdomen alone, and is quickly becoming popular. “You are not changing the architecture of the abdomen,” says Vickery.  Women look as if they have also had a tummy tuck after DIEP flap reconstruction.

Nipple-Sparing Mastectomy

Robert Grant, MD, Chief of Plastic Surgery at New York-Presbyterian Hospital in New York City, says that breast reconstruction following a nipple-sparing mastectomy also has changed the playing field for many women diagnosed with breast cancer as well as those who test positive for the breast cancer genes and opt for prophylactic mastectomy.

In early breast cancers, “the breast cancer surgeon can save all of the skin and do biopsies of the undersurface of the nipple and areola and allow many women to keep their own nipple and areola,” he says.

This makes breast reconstruction a lot more like a cosmetic breast augmentation, he says.

Loss of sensation in the nipple may still be an issue, Grant said.

Fat Grafting to the Breast

Another advance in breast reconstruction is the use of fat to contour the edges of the implant, he says. In these cases, fat is extracted from places on your body where it is plentiful and injected into your breasts. “We had hoped to use fat grafts and stem cells to replace an entire breast, but there is normal trepidation about trying to stimulate the cells in someone who already has cancer,” he says.

If you have been diagnosed with breast cancer or tested positive for the breast cancer genes and are considering a mastectomy, discuss your options with a board-certified plastic surgeon, who has experience in breast reconstruction. He or she should be part of a team that also includes a gynecologist, radiologist, breast surgeon, and medical oncologist. 

To find a board certified plastic surgeon who performs breast reconstruction  plasticsurgery.org