Better than Ever Options in Breast Reconstruction

Written on December 12, 2013 at 5:30 pm

Advancements in Breast Reconstruction – written by Dr. Jeremy Pyle

Breasts are important. They are a part of who you are.  The effect of hearing that you or a loved one has breast cancer carries many layers of emotional complexity. Very commonly the first concern is in hearing the word “Cancer”. Then there is the realization that you will require surgery.  Then that your surgery will be to remove some or all of an organ that is central to the feminine figure.  The whole process can be exceptionally hard to wrap one’s head around.  As time goes on, and as the reality sets in that most women with breast cancer get better, that most live long happy lives, the cloud of life or death concern gets replaced with uncertainty about what you are going to look like.  That’s when a good plastic surgeon becomes important but the planning starts at the very beginning.

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Breast reconstruction is an ever evolving field. In the last 20 years, dramatic improvements have been made both in how breasts can be reconstructed and in the materials that make the end result better than ever.  It used to be that the goal in reconstruction was to make a woman look more or less normal in clothes. Shape was of secondary importance if the volume in a bra was close.  Those days, thankfully, have been replaced with a higher standard.  In most women, the goal is to provide a good volume match in a good location on the chest with a soft feel and the appearance of a breast.  These advances have helped make women more comfortable in the decision to undergo mastectomy on one or both sides.  It is also, I believe, why many women who underwent reconstruction in the past now seek further refinement.  The tools available are better than they have ever been. 

Here’s an overview of the most common types of breast reconstruction in America:

1.       Implant based reconstruction:  This is what Angelina Jolie had for her reconstruction and it is usually done in two stages.  The first stage typically begins at the time of mastectomy with the plastic surgeon placing a hollow silicone balloon called a tissue expander that can be gradually filled with saline in the surgeon’s office to make room for the eventual implant. When that expander is at a volume that the patient desires, the expanders are removed and replaced with breast implants.  These implants, typically filled with cohesive silicone (think: consistency of the material inside a gummy bear), feel soft, not unlike natural breasts.  This option is chosen in about 2/3rds of breast reconstructions in America and the results are better than ever.

2.      Autologous Reconstruction:  This means reconstruction using only tissue in your own body. Usually this is tissue from the abdomen, using skin and fat and sometimes muscle.  This is the second most common type of reconstruction. It has the benefit of using only one’s own tissue but the detriment of requiring that the person have an appropriate amount of tissue (not too little or too much) and that the person be comfortable with a fairly significant surgery on another part of her body. This is the go to reconstruction in patients who have already had radiation.

3.      Combination:  Sometimes the tissues on a person’s body are not, by themselves, enough to make an adequate breast. When that is the case, an implant can be added to an autologous reconstruction. 

4.      Revision Reconstruction:  Among all other areas in reconstruction, our ability to improve previous reconstructions has made the most dramatic strides. The use of autologous micro-fat transfer, or fat-grafting, coupled with better implants and additional tools can dramatically improve results, even years after the initial reconstruction.  This is as true after lumpectomy surgery as it is after mastectomy.

5.      Matching Procedures:  Women who have had breast cancer surgery on one side frequently ask what happens to the other breast.  I have the pleasure of telling them that their insurance company is, by law, required to cover reconstruction of the unaffected breast to balance the results.  Many women need a lift or a little more volume on the unoperated side and this is provided as part of a reconstruction.

Which of these is right for each individual patient is very dependant upon a thorough discussion with a qualified board certified plastic surgeon.  It is not uncommon that a person comes in to my office wanting a specific type of reconstruction when another option may suit them better.  Trusting and respecting your surgeon is critical to allowing the back and forth that can help guide you through this process. If you don’t like your surgeon, move on until you find one you like and trust. If you do, feel free and comfortable to share with him or her your questions, concerns, fears and desires.

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I and our staff at Davis Plastic Surgery have the exceptional opportunity to help people dealing with the difficult diagnosis of breast cancer.  We get to lighten the mood, open the shades on a challenging process and provide hope.  Breast cancer is a difficult diagnosis, to be sure, but the light at the end of the tunnel is far brighter than it may first appear and reconstruction has never been better.

Dr. Jeremy Pyle spent six years in plastic and reconstructive surgery training at Wake Forest University, Bowman Gray School of Medicine, before joining Davis Plastic Surgery in Raleigh.  He is board certified by the American Board of Plastic Surgery.  To learn more about Dr. Pyle or breast reconstruction, call (919) 785-1220 or email info@drgmdavis.com

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