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The truth about breast reconstruction

The truth about breast reconstruction

By Lisa M. Mayers

For a woman, breast cancer is about as personal as it gets. More than just an appendage, a woman's breast is part of what makes her who she is - part of her feminine being, a symbol representing her capacity to nurture. A woman's self image can also be dramatically affected by breast cancer and the loss of a breast, impacting not only the woman herself, but her intimate relationships as well.

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Fortunately, advances in surgical techniques and cancer treatments are giving women more options than ever to regain their health, appearance, and positive self image. Plastic surgeons working side-by-side with breast oncology surgeons can begin breast reconstruction during the same surgical procedure. This gives women the psychological advantage of waking up with a new breast already in place - something that experience has shown to be very beneficial to the healing process.

Decisions about breast reconstruction are intensely personal and individual. Choosing the type of reconstruction surgery, whether to have the surgery immediately or to delay it, and even whether to have breast reconstruction at all, are decisions that can only be made by a woman, together with her team of health care providers. Not all women are candidates for every type of surgery. The specific course of treatment for her breast cancer can influence recommendations, as can her body type, overall health and lifestyle, and personal preferences.

"If a woman chooses breast reconstruction surgery, our goal is to give her a result that leaves her feeling good about how she looks in clothing, as well as without clothing," says Mark Walker, MD, F.A.C.S., a Board Certified Plastic Surgeon and Board Certified General Surgeon in Binghamton, NY. "While a reconstructed breast will never be the same as the breast she lost or have the same sensation, a reconstructed breast will look and feel very natural."

There are two primary differences in breast reconstruction surgery - one uses the woman's own tissue to form the breast and the other uses an implant. There are advantages and disadvantages to both.

Surgery that uses a woman's own tissue, called a "flap" technique, repositions muscle, fat, and skin from another site on her body - generally either the abdomen or the upper back - to form the breast.

Tissue expansion is a much simpler surgery, where an implant pocket is created under the healthy skin and muscle conserved from a mastectomy. A temporary implant, with a port attached, is placed in the pocket and gradually expanded with saline injections over the next several months. When the expansion process is complete, the same incision is reopened, usually in a simple outpatient surgical procedure, and the temporary implant is replaced by the permanent one.

Women who have undergone breast conserving surgeries such as lumpectomies or partial mastectomies may also choose some form of breast reconstruction after treatment. Cosmetic issues may arise for a woman directly as a result of surgery, or after time passes as a result of radiation treatments, which can cause a contracture of the breast tissue. In this case, options such as a breast lift or even breast reduction in the opposite breast may be offered to correct issues of symmetry.

A newer, less invasive procedure called lipo-grafting (or fat grafting) is also available to women who want to correct cosmetic damage caused by breast cancer treatments. Lipo-grafting "transplants" fatty tissue from one area of the body to another - in this case, to fill and sculpt the breast.

"With lipo-grafting, fatty tissue is carefully removed using a small device, from a selected site on the woman's own body - generally the abdomen, thigh, or buttocks. Once collected, the fat cells are separated out and re-injected into very specific, targeted areas of the breast in thin strands. These strands of fat cells integrate with the healthy tissue and develop their own blood supply," explains Dr. Walker. "The result is added volume, better symmetry, and a more sculpted natural look, with a minimally invasive technique and no added scarring."

The fat that is collected and grafted into the breast also contains stem cells, which stimulate growth and healing. A small percentage of the cells that are injected will die, so initially more cells will be injected to accommodate that anticipated loss, while still providing the desired cosmetic outcome. Healing is complete and the results are final after about six months.

"Lipo-grafting can be done at any time after breast surgery or breast cancer treatments and can be an ideal solution for issues of contracture and symmetry," says Dr. Walker. "As with any kind of breast reconstruction, the decision is an intensely personal one and as a plastic surgeon, I am honored to be able to assist women with this very important part of their healing process."

As techniques continue to evolve, it is expected that lipo-grafting may someday be used to completely reconstruct breasts in a natural and minimally invasive way.

Contributor:
Mark A. Walker, MD, F.A.C.S.
Binghamton, NY
www.drmarkwalker.com