According to a recent article posted by the American Society of Plastic Surgeons, a survey, conducted by Harris Interactive, a research and polling company, found that less than a quarter (23%) of women know the wide range of breast reconstruction options available. Only 22% of women are familiar with the quality of outcomes that can be expected. Only 19% of women understand that the timing of their treatment for breast cancer and the timing of their decision to undergo reconstruction greatly impacts their options and results.
Breast reconstruction techniques are multiple and individual. No one technique is appropriate for all patients. The use of implants for reconstructions, have become more popular in the last few years with the advent of ADM (Autologous Dermal Matrix) materials. These will allow for larger submuscular pockets to be made and either immediate reconstruction with implants or secondary reconstructions after tissue expansion are now popular. In addition, nipple sparing mastectomy techniques are limiting scarring and allowing for more ease of reconstruction. The issue of post-radiation changes in skin and underlying muscle is important. Some patients suffer very significant changes to their skin and because of that are poor candidates for implant reconstructions. This skin and muscle does not expand well and scars easily and the chances of doing well with an implant for reconstruction are smaller. These chances have been improved with current techniques of fat transfer, which allow for “padding” around implants with the patient’s autologous fat. While that improvement has been significant it is in general not the case that if skin is significantly changed by radiation that those patients will be best served by implant reconstructions.
Autologous reconstructions take a couple of forms, by far the most popular is the use of the lower abdominal tissue as either a free flap or a pedicle flap called a TRAM flap. Also the latissimus muscle of the back along with overlying skin can be transferred to adjust to provide more cover for underlying implants and bring healthier vascularized tissue to the chest when radiation changes have taken place. Once again, techniques are varied and individualized for patients. We have had a longstanding interest in breast reconstruction in this community performing the first TRAM flaps ever done in Hampton Roads. We have seen a pendulum swing from the popularity of flap reconstructions back to the popularity of implant reconstructions and back again to the current state where both types of reconstructions are favored according to patients’ needs.
Breast reconstruction becomes a viable option for almost all patients, who have had to undergo either full or partial mastectomy. Because every breast reconstruction patient has their own unique experience, health concerns and needs, my partners and I at Associates in Plastic Surgery make every effort to inform patients of their options for reconstruction based on their individual circumstances.