Recent Mammography Recommendations

Recently, the United States Preventive Services Task Force (USPSTF) has recently released recommendations for screening mammography for women. Their recommendations state that such mammograms should be every other year beginning at age 50yo, instead of the current guidelines of beginning at age 40yo (35yo for high-risk women). Mammography has unquestionably saved many lives, especially in women younger than 50yo. At least 10-20% of all breast cancers are diagnosed in these younger women. Breast cancer in younger women is always a more aggressive tumor, and overall, usually a more deadly tumor, especially when not caught early. When detected early and in its earliest and most treatable stage, the recurrence and survival rate is MUCH lower. Women over 74yo are not given specific guidelines for mammography, as they state that their risk of dying from other medical conditions is far greater than that of breast cancer, despite the fact that breast cancer (1 in every 8 women will develop) clearly increases with age.

The current recommendations by the USPSTF are based on old research from 1992-2001. The medical technology, especially in diagnostics, imaging (including digital mammography and breast MRI, breast cancer research (billions of dollars over the past few years alone, and treatment modalities have made huge advances, which accounts for the massive decrease in mortality rate over these past 8 years from the USPTF quoted studies. Regular mammographic screening began in 1990 - the mortality rate of breast cancer, previously unchanged over the past half century prior, has significantly decreased by mre than 30% since its inception. Clinical breast exams are not recommended prior to mammography, as they state that a clinical exam adds no additional benefit from that given by a mammogram. Lastly, this task force has not made any specific recommendation for monthly self-breast exams. As known, many breast tumors are found by women during self breast exams, prompting earlier medical evaluation, or by an experienced physician who may catch many masses not found by the woman.

The USPSTF has blatantly refused to data and research (and arguably, common sense), when these recommendations were made. No physician of the specialties that should have been involved (breast surgery, radiology, or oncology), had any input on theses recommendations. In fact, the American College of Radiology (ACR) and other Boards still stick to the current guidelines of beginning yearly screening mammograms beginning at age 40yo. Their claims of the "hazzards" of mammograms are unwarranted: discomfort, anxiety from false positives and need for possible surgery/treatment, and radiation exposure. Undoubtedly, a life saved from early detection far outweighs any of these concerns. Discomfort and anxiety is overshadowed by catching a breast cancer in its earliest stage. The radiation exposure from a mammogram is minimal. In fact, the radiation given off from the earth itself is much greater. The money saved by not performing mammograms between ages 40-49 will most likely be the opposite effect - with the more aggressive treatments, surgery, and battling of late-stage breast cancer will cost much more in money, time, and lives lost. This potential money savings in health care does not make sense as evidenced by current research and data/statistics in breast cancer research. My fear is that women that can afford to pay out-of-pocket for mammograms at an earlier age will get them and those who don't have these means will ultimately suffer. Saving women's lives and detecting/treating breast cancer at its earliest stages should be of utmost importance. The ACR still supports monthly self-breast exams, yearly physician breast exams, and annual screening mammograms beginning at age 40yo (age 35yo in high-risk women) - these are the best modalities that we have today.

Acellular dermal matrix - breast reconstruction applications

The use of the acellular dermal matrix has grown in its applications and use in plastic & reconstructive procedures, and growing. It has truly been a remarkable addition for breast reconstruction.

The acellular dermal matrix is a tissue that is specially-prepared, which comes from cadaveric skin. It has been processed in such a way that the basement membrane and cellular matrix remain intact, while removing all other cellular components that may lead to both rejection and infection. Packages as a sterile tissue product, due to its preparation, the chance of acquiring viruses and such is nearly absent.

Its applications for breast reconstruction alone include its use in tissue expander/implant reconstruction, to act as a "hammock" at the inferior portion of the breast for which the implant lies within. This creates a natural "sling" which mimics the ptosis (sag) of the breast, while supporting it in place. By suturing this matrix to its exact position of the breast margins, the plastic surgeon is able to precisely recreate an excellent contour for your breast, especially at the inferior, medial, and lateral positions. This also minimizes migration of the implant, as sometimes seen with "bottoming out" inferiorly or its displacement into the axilla (armpit). In addition to its increased aesthetic results, the acellular dermal matrix provides additional coverage over your implant. This is especially useful in those instances of dehiscence (your incision opening up), thus protecting the implant from exposure, and threatening its necessity for removal. Furthermore, in cases where the overlying mastectomy flaps are thin or damaged, leading to partial flap necrosis, the tissue matrix again provides a coverage over your implant, which can heal over time or a graft placed over the are or simply closed. Lastly, the additional coverage lessens implant visibility and palpability and is a great adjunct for revisionary breast surgery. The use of this matrix, along with the advantages listed above, has reduced the time of the reconstructive portion of the procedure as well. There is less pectoralis muscle retraction and eliminates the need to raise any other surrounding muscles in order to achieve complete implant coverage.

Additional benefits seen with the acellular dermal matrix are numerous. There has been a significantly decreased incidence (almost none) of capsular contracture around the implant at the area of the tissue matrix. Reasons are unknown as of yet, but contracture has been a huge problem in cases of implants used for reconstruction and augmentation. Also, there are tissue regeneration properties of the matrix in which rather than inciting a scarring response, the dermal matrix begins a regenerative process in which it acts as a biologic scaffold and unbelievably, vessels incorporate into matrix and the surrounding cells differentiate into surrounding tissue that it is incorporated into (an amazing concept).

Overall, the use of the acellular dermal matrix in breast reconstruction has been revolutionary. Its applications for tissue expander reconstruction, possibility to use in immediate implant reconstruction (going directly to implants rather than the use of a tissue expander first), revisionary breast surgery, capsular contracture complications, and nipple reconstruction have been great.