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Restore Self-Confidence

Nearly 180,000 women in the USA will be diagnosed with breast cancer this year. Many will undergo a partial or total mastectomy. The loss of any body part is distressing. When it is closely linked with a woman’s femininity and sexuality, the result on self-esteem can be devastating.

Breast reconstructive surgery helps restore self-confidence and divert attention away from a traumatic mastectomy. “For cancer patients, breast reconstruction is a positive part of the entire recovery,” said plastic surgeon Dr Margarita Bernett.

A woman considering breast reconstruction has two options: a tissue expander replaced by an implant; or a tissue graft from her own body. Within these two categories, there are different techniques and methods used. Dr Michael McGuire launched and oversees the Foundation for Surgical Reconstruction in Santa Monica. The Foundation assists women who cannot afford insurance, or who’s insurance will not cover a breast reconstruction after mastectomy. “In the old days some surgeons used to make women wait for up to 5 years before having reconstruction, “said Dr McGuire. Now it is mandatory that breast reconstruction is covered by insurance.

Implant reconstruction

One method of reconstruction uses an implant. First, a tissue expander is inserted to stretch the skin after a mastectomy. In some cases this can be done during the mastectomy operation. The expander is like an empty balloon, inflated weekly with saline injections under local anesthetic to stretch the skin. Once the skin has been stretched adequately, a second procedure replaces the expander with an implant.

Depending on how tight the skin was, and how much it needed to be stretched, the expander is left in for 2-3 months before it is replaced with the implant.

While implants can be the least traumatic of breast reconstruction techniques, these are some restrictions that may make it necessary for women to consider other options. If the patient has undergone radiation therapy after mastectomy, often the skin is too tight and scarred to stretch to create space for the implant. Women who have a large remaining breast who don’t want any surgery done to it are also not good candidates for the implant technique. However, Dr Bernett explained that a combination surgery, using an implant and a TRAM flap, can compensate for large breasts.

The risks include: bleeding or infection, through these are generally minimal; and possible capsular contracture when the body forms a scar around the implant. “These aren’t tremendous risks using the expander technique, “said Dr McGuire.

If the insertion of the expander is performed in the same procedure as the mastectomy, Dr McGuire feels there is also a benefit to the patient: “They have something there when they wake up and there is a psychological benefit to having something immediate.”

Tissue graft reconstruction

Called the ‘flap’ technique, one popular method is the TRAM flap (Transverse Rectus Abdominus Musculocutaneous). A new breast is made from surplus tissue in the lower abdomen – the skin and fat that would be discarded during an abdominoplasty. Grafts can also be taken from the back or buttock area.

There are two methods of transferring tissue using the TRAM flap. The more traditional approach is known as the Pedicled TRAM. A connection is always kept where the transfer was taken from, providing nutrition to the new breast. The skin and fat below the belly button and above the pubic hairline can be left connected to one of the muscles of the stomach wall (Rectus Abdominus Muscle) and then tunneled beneath the skin and into the mastectomy region, where it is shaped and stitched into place.

The health of the tissue and blood supply is integral in the survival of the new breast. Therefore very heavy smokers are not good candidates, nor are people with very weak or flabby tissue. Diabetics or people with other diseases that may impair healing or blood supply are also not good candidates. If blood supply and general health are not good, it may compromise the health of the transfer and result in the tissue being lost.

The risks, although uncommon, include: partial or total loss of the graft; and weakening of the abdomen, which could affect athletic abilities and the lower back.

Nipple reconstruction

The nipple is made from tissue at the site. The surgeon determines where it needs to be positioned in relation to the opposite side. A flap of tissue is taken, but left attached to the breast, and some skin wrapped around it. “In this way it is possible to make a nipple with good projection and reasonable shape and symmetry with the other side, “said Dr McGuire.

The areola is made by tattoo. Two or three procedures may need to be done to get to optimal color. “The advantage of tattooing is that you can match the color to the other side. With all the pigments now available from the medical tattoo companies, you can make a very natural looking nipple, “said Dr McGuire. “Tattooing has been a tremendous asset to breast reconstruction.”

Surgeons who specialize in breast reconstruction all agree it is an extremely gratifying procedure. “Women are devastated by the loss, “explained Dr Mc Guire, “but if you can give them hope, and if you can show them pictures of what can be done and what they can expect, I think it is of psychological benefit to the patient.”

“The entire purpose of reconstructive surgery is to allow patients to have the self-esteem they would normally not have, “explained Dr Bernett. “If someone goes through a disease process that could be fatal and has a mastectomy and a high chance of a cure, along with a chance to beautify their body, and the outcome is a very positive person, then this has to be one of the most fantastic inventions of plastic surgery.”

Assessing The Patient

The relationship between patient and surgeon is always significant, but with breast reconstruction it becomes even more important. “Plastic surgeons involved with breast reconstruction are very empathetic and compassionate, “said Dr Margarita Bernett. “They are the patient’s advocate and will guide them through the reconstructive process that is a positive part of their cure.” Dr Bernett assesses which procedure is best for patients individually on the basis of these factors:
  • Anatomy
  • Lifestyle
  • State of health prior to diagnosis of cancer
This ensures the patient undergoes the procedure that will give them the best results.

  • In October 1998 a federal bill was passed with one of the sections requiring coverage for reconstructive surgery following mastectomy. Previously only a few states had this requirement.
  • In 1998 there were 68,000 breast reconstructions using implants.
  • McGhan Medical, a world leader in breast implants, sells approximately 2/3 of their implants for augmentation purposes and 1/3 for use in breast reconstruction.

To view Before and After photos of Breast Reconstruction surgery, Click Here.

If you have any more questions about this topic or would like more information Click Here.

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