Preference of Silicone Over Saline Implants Following Mastectomy

A recent published study in the Journal Cancer reports that women who received silicone implants after her mastectomy were generally happier with her results than women who chose saline implants. This is one of few studies who report on patient preference following reconstructive surgery.

This study looked at 472 women who had breast reconstruction following mastectomy - 176 women stated that they were more pleased with the look and feel of her silicone implants. They also reported that they felt more natural to the touch and preferred the look both in and out of clothing.

Insurance reimbursement is equal for either silicone or saline implants and their is no financial incentive benefit either way.

October

October - Breast Cancer Awareness Month

Breast Cancer/Reconstruction - New Law Passed!

A tremendous step forward in breast cancer/breast reconstruction! A recent law was passed in New York state, which requires that women be informed of breast reconstruction options and the Women's Health and Cancer Rights Act (WHCRA) of 1998 prior to her breast cancer surgery.

Even today, only a minority of women are actually informed of breast reconstruction by her surgeon. Although the fight against breast cancer continues, women are still rarely offered a discussion on this topic.

A previous post outlining this topic as well as the WHCRA act was in an earlier post.

The full attached article from the New York Times:

http://www.nytimes.com/2010/08/19/nyregion/19surgery.html?_r=1

Aesthetic outcomes following lumpectomy

The diagnosis of breast cancer certainly is a traumatic experience, and the management of the disease is just as daunting a decision that must be made, often expeditiously. A lumpectomy, usually followed by radiation therapy, is a treatment modality that has been shown to be safe and effective. Your general surgeon will speak to you about the risks and benefits of this type of treatment for your breast cancer. Women who choose to save their breast by a lumpectomy, with the thought of avoiding any additional reconstructive surgery in the future.

The aesthetic outcome following lumpectomy has been researched heavily. Several reports show that approximately 1/3 of all patients who underwent breast-conserving therapy ) for their cancer are unhappy with their aesthetic result. 28% of these breast cancer patients were dissatisfied with their overall result. Of those polled, 46% felt that their physical appearance was worse, or much worse, following lumpectomy, and were now considering reconstructive surgery. Only 9% of these patients were ultimately satisfied with their outcome, however, would consider reconstruction if it were offered. “I have patients walking into my office saying lumpectomy was supposed to save their breast but what’s left doesn’t look like a breast to them,” said Howard Wang, ASPS Member Surgeon and co-author of the study. “Conservation is believed to be an acceptable way of saving a woman’s breast. But many of these women are coming to plastic surgeons for help, saying it isn’t so.”

An interesting finding was that 26% of these patients were unhappy with their physical appearance after their BCT, but had an improved sense of body image. One thought is that patients are ultimately relieved of treating her cancer above anything else. The oncologic management should precede anything else in importance. There are manners in which to reconstruct partial breast defects following lumpectomy, but especially the radiation changes, which cause much of the breast distortion following lumpectomy. Earlier posts comment on radiation effects to the breast - such treatment often prohibits certain implant-based reconstruction in the future. Overall, many oncoplastic resections may be employed during the lumpectomy, which not only treats the cancer, but brings forth the best aesthetic outcomes following BCT. Otherwise, your plastic surgeons may discuss several treatment options for partial breast defects, which have been shown to obtain excellent results.

Broccoli derivative limits breast cancer growth

A derivative from the vegetable broccoli has been linked to treatment and the halt of spread of breast cancer stem cells. A recent study from the University of Michigan has associated the component of broccoli, sulforaphane, in preventing the spread of cancer cells and destroying these cells. This has been injected into animal studies with very promising results.

"Sulforaphane has been studied previously for its effects on cancer, but this study shows that its benefit is in inhibiting the breast cancer stem cells. This new insight suggests the potential of sulforaphane or broccoli extract to prevent or treat cancer by targeting the critical cancer stem cells," says study author Duxin Sun, Ph.D., associate professor of pharmaceutical sciences at the U-M College of Pharmacy and a researcher with the U-M Comprehensive Cancer Center.

Thus far, although preliminary results are favorable, it has not been tested in human studies. At this time, there is no recommendation in increasing the amount of broccoli in one's diet. But current research continues.

DIEP flap

With the advent of microsurgical perforator flaps, this form of reconstruction has revolutionized plastic surgery. Along with them, the application in breast reconstruction has been tremendous. By the replacement of the skin and soft tissue that is removed during the mastectomy with viable, well-vascularized, excess skin and soft tissue from the lower abdomen, a beautiful breast reconstruction may be achieved that is completely your own tissue. This DIEP has gained much notoriety for breast reconstruction today.

The tissue is taken from the lower abdomen, much like that removed during a tummy tuck. Utilizing the excess tissue from this area and hiding the incision low on the abdomen, well-hidden within the panty line, the donor site is an excellent option for borrowing tissue for a breast reconstruction. This skin, fat, and soft tissue, along with its blood supply is taken and moved into the breast area. These small blood vessels are then reattached via assistance of a microscope to vessels in the breast area. This tissue is then shaped and molded to reconstruct an aesthetically pleasing breast reconstruction.

With this new advent of perforator flap techniques, it is the most innovative and state-of-the-art technique used today in breast reconstruction, let alone plastic surgery as a whole. Unlike the traditional way of reconstructing a breast utilizing this tissue (aka TRAM flap), the DIEP spares the muscle of the abdominal wall, by carefully dissecting the blood vessel from within the abdominal musculature and leaving the muscle in place. This muscle-sparing, perforator flap type of reconstruction is beneficial for these reasons. There is less donor site morbidity from the abdomen, since the muscle is left intact. Along with that, there is less postoperative pain. The function of the muscle remains, so abdominal wall integrity remains intact and there is less chance of hernias or bulges, since the muscle remains. These problems are much increased with the conventional TRAM flap, but unlike it, the aforementioned benefits are obtained with the DIEP microsurgical free tissue transfer breast reconstruction.

Unlike conventional TRAM flap reconstructions, use of our refined perforator flap techniques allow for collection of this tissue without sacrifice of underlying abdominal muscles. This tissue is then surgically transformed into a new breast mound. The abdomen is the most common donor site, since excess fat and skin are usually found in this area. In addition to reconstructing the breast the contour of the abdomen is often improved much like a tummy tuck. This well-vascularized flap reconstruction also is also completely your own tissue, and often resembles, moves, looks, and feels more like a natural breast than reconstructions using implants. Other perforator flaps used for breast reconstruction include the SIEA (Superficial Inferior Epigastric Artery), SGAP (Superficial Gluteal Artery Perforator), IGAP (Inferior Gluteal Artery Perforator), and TAP (Thoracodorsal Artery Perforator) flaps, among others.

If you're interested in an advanced reconstructive procedure as such, very few surgeons have been trained to perform these and even fewer offer these procedures due to its complexity and skill involved. It may be difficult to find an experienced surgeon to perform this type of surgery with many patients, unfortunately, having to travel away to obtain such reconstruction. A few helpful resources to find an experienced DIEP microsurgeon are to search websites or listed below is a database of listed surgeons:

www.breastrecon.com

www.diepbreastreconstruction.com

www.diepsisters.com

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Quick Breast Reconstruction Info

For a quick informative of breast reconstruction info/options - visit either our website or The Center for Reconstructive & Plastic Surgery:

http://aaaplasticsurgery.com/

http://www.jcl.com/content/plasticsurgery/default.htm