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Atlanta mastectomy

Will I Be Happy with My Breast Reconstruction in Ten Years?

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For a woman who has been diagnosed with breast cancer, deciding on a treatment plan is extremely complex because she has several key priorities to keep in mind—trying to eliminate all the cancer without risking her safety or sacrificing her ability to feel beautiful. Between lumpectomy, mastectomy with implant reconstruction, mastectomy with autologous reconstruction (using the patient’s own tissue, like the abdominal TRAM flap), it can be overwhelming for a patient to have so many options and to know that her decision will have a life-long effect. After working with breast reconstruction patients for 30 years, I’ve developed an understanding of these patients’ needs, and many of them worry about whether they’ll still be happy with their decision long-term.

breast-reconstruction-alpharetta-gaA recent study in the Annuls of Surgical Oncology focused on just that—how satisfied women were with their breast cancer treatment choice. The study surveyed more than 7,000 breast cancer survivors, ranging from those whose surgery was less than a year ago to those whose surgery was more than 20 years ago. This study came to several conclusions that can help women to be happier with their results long-term:

  • Patients who are more active in the decision-making process tend to be more satisfied with their results. The best way for a patient to take an active role in her treatment is to do her research—learn about the options and the pros and cons of each treatment choice, and discuss extensively with her plastic surgeon before making a decision.
  • Patients who opted for abdominal flap reconstruction (like the TRAM flap) are typically happier with their results than patients who chose implant reconstruction, the Latissimus Dorsi flap, a lumpectomy, or mastectomy without reconstruction. Patients who had autologous breast reconstruction ( like the TRAM flap) also tended to retain their satisfaction better over time than implant reconstruction patients and lumpectomy patients, as well as patients who have a complex history of several different procedures. This may be because when the breasts are made using natural tissue, they can more easily change with the patient’s body throughout years of weight fluctuations, pregnancy, and more. As the authors of the study point out, when only one breast is being reconstructed, abdominal flaps also tend to have better symmetry than breast reconstruction results with implants.
  • The earlier breast cancer was found and treated, the happier patients tend to be with their breast reconstruction results. This points out once again why regular screenings are so important—early detection could not only save a patient’s life, but help her to regain her confidence and get back to her life after treatment more easily than if the cancer had progressed further.

The process of breast cancer diagnosis, decision, and treatment is never easy—patients are, after all, facing a powerful disease and striving to come out the other side feeling strong and beautiful again. But information like what we found in this study can help breast reconstruction patients navigate their decision using the input of real women who have been in a similar position. My advice for any breast cancer patient is to take in as much information as possible, learn about the options available, and choose the one that feels right to you. For women who have already had breast reconstruction and are unhappy with their results, breast revision surgery can be a way to improve the appearance of your chest even years later. To start discussing your options and learning about which reconstructive option is the best fit for you, schedule a consultation with me, Dr. Franklyn Elliott. Or, to learn more about the other procedures I offer, follow me on Facebook, Twitter, and Google+.

Breast Reconstruction Awareness Day Sheds Light on Post-Mastectomy Options

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As a board-certified plastic surgeon, I have always felt strongly that every breast surgery patient should be thoroughly educated on all of the available options for treatment before committing to one. When it comes to breast reconstruction, a surgery that too frequently comes on the heels of a medically necessary mastectomy or lumpectomy, patients may be feeling particularly overwhelmed and unsure. It’s crucial that these patients are able to make an informed decision after having weighed each option against their needs and preferences.

Breast Reconstruction Awareness (BRA) Day on October 15 is an excellent opportunity to review the options available to patients preparing to undergo breast reconstruction surgery. I have performed all of the available options on many patients over three-plus decades as a board-certified plastic surgeon and believe that while there is no “best” reconstruction procedure, some are more appropriate than others for certain patients. Below is a brief explanation of some of the most common breast reconstruction techniques. It is best and most understandable to divide them into two basic choices – using the patient’s own tissue to build a new breast or using an implant to build the breast. We will first discuss using the patient’s own tissue.

  • TRAM flap: The TRAM stands for transverse rectus abdominis, a lower abdominal muscle above the pubic bone. In this procedure, I use a ‘flap’ – the skin, fat, and occasionally a portion of the muscle – to reconstruct the breasts. The muscle is not removed, but instead “rerouted” to the chest wall as it is the blood supply to the transferred lower abdominal fat. This fat is then shaped into a new breast. The result is replacement of breast tissue with the patient’s own fat and a tightening of the lower tummy like a tummy tuck.
  • Free TRAM: This is a variation on the TRAM flap procedure; instead of being rerouted, the flap is actually detached and reconnected to the chest.
  • DIEP flap: Different from other flap techniques, a DIEP flap does not require the use of abdominal muscles and instead utilizes blood vessels called deep inferior epigastric perforators (DIEP) and the connecting fat and skin to reconstruct a breast. However, this operation takes significantly more operating time and has more risk for blood transfusions and flap loss.
  • Breast implants: Unlike flap procedures, which make use of a patient’s own tissue, breast implants are made from either silicone or saline and placed directly into the chest following a mastectomy.
  • Latissimus dorsi flap: I use skin, muscle, fat, and blood vessels from the upper back to help create a new breast. This procedure is usually combined with breast implants in order an appropriate shape and size to the new breast. The implant provided the volume to the new breast and the latissimus Doris muscle provides the coverage. The latissimus dorsi muscle flap can also be performed without leaving a scar on the back.
  • Supplemental fat transfer: Fat transfer during breast reconstruction is used to add volume to the new breasts and give them a more natural look and feel. Fat transfer is not necessarily part of reconstruction, however.

Each of these breast reconstruction options comes with its own set of advantages, disadvantages, potential risks, and possible benefits. I always encourage my patients to ask as many questions as necessary to help them feel confident and prepared to undergo surgery.

If you’ve recently undergone a mastectomy and are considering breast reconstruction, please contact our office today to schedule a consultation. Don’t forget to connect with me, Dr. Franklyn Elliott, on Facebook, Twitter, and Google+ for the latest breast surgery news and information.

 

 

Prophylactic Nipple-Sparing Mastectomy and Methods of Reconstruction

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Though once popular in the 70s and 80s, the prophylactic mastectomy fell out of favor with doctors and patients in the 90s. However, the advances of mammography in the 90s and beyond have lessened the number of women who are choosing to have one or both of their breasts removed to prevent the advent or spread of breast cancer.

Fewer people are as supportive of preventative mastectomies nowadays because of the potential complications and reports of low patient satisfaction. Thinner skin used over implants can cause capsular contracture  or hardening of the tissue lining surrounding the implant.

In a chapter written for the textbook Surgery of the Breast, Dr. Franklyn Elliott writes regarding patient satisfaction:

Patients did not believe they were properly prepared for some of the results of these major surgical procedures, and because they did not have frank breast cancer, were not in the mind-set to deal properly with major surgical extirpation and reconstruction.

However, in a recent study only 5% of patients regretted undergoing prophylactic mastectomy and reconstruction surgery. Many felt that were inadequately prepared for the pain and incapacitation of the recovery period.

For this reason, it’s important that a plastic surgeon is one of the many consulting surgeons who advise a potential mastectomy and breast reconstruction patient.

Many women who are at a high risk for potential breast cancer and those who’ve had one breast removed because of cancer seek preventative mastectomies.  There are many factors that oncologists, general surgeons, and plastic surgeons should consider before suggesting a prophylactic mastectomy for a patient including heredity, the breast cancer gene (BRCA1 and BRCA2), previous diagnoses, and more. It must also be explained to patients that advances in mammography techniques have made it easier to track potential cancers without removing the entire breast.

Choosing a preventative unilateral or bilateral mastectomy is a difficult choice for any woman. According to the chapter written by Dr. Elliott, the “plastic surgeon must limit his or her role to the very accurate description of the patient’s options after mastectomy and, equally important, a full and complete discussion of the recovery phase and the expected result.”

Oftentimes, prophylactic mastectomy patients are shown before and after pictures of women who have had breast cancer and undergone mastectomy and breast reconstruction surgery. It’s important that patients are given information specific to their particular procedure, regardless of the similarities between their procedures and another patient’s.

It’s rare that women with no risk factors are interested in prophylactic mastectomies with reconstructions. Some patients are motivated by fear. However a lack of risk factors in patients seeking prophylactic mastectomies probably means that they should not be considered for surgery.

Though controversial among some doctors and patients, there are benefits to preventative mastectomy and breast reconstruction. In the chapter, Dr. Elliott concludes, “With the variety of techniques available for breast reconstruction, intelligent management of the overlying skin, and gradual formation of the breast mass itself, patients can be increasingly assured of complete or near complete breast tissue removal and safe, predictable, uncomplicated breast reconstruction.”

To read the chapter, click here (link to PDF). Other articles written and used by Dr. Franklyn Elliott can be found on his articles page. You can also connect with him on Facebook and Twitter for the latest in plastic and reconstructive surgery news.