Reconstruction after mastectomy

Ellen Parker * has always taken pride in her breasts. for a like reason after her breast cancer diagnosis in 1991 when she learned she'd ne a mastectomy, she was pleased to hear she could have an immediate reconstruction.

And, indeed, she woke up in the retrieval room with a tissue expander in place of the missing breast, the first pace in the two-step reconstruction manner of proceeding using a breast implant.

upon the advice of her doctor, M Parker, now 58 who lives in Arlington, VA, opt for a silicone implant.

on the other hand instead of the cosmetic arises she had hoped for, the implant sat stiff and high upon her chest, looking little like her other breast. through the time it ruptured 14 years later (a for the use of all occurrence with older saline and silicone implants) (11) she was relieved. "I was at no time happy with it," recalls M Parker.

shortly after her implant, the U victuals and Drug Administration (FDA) limited silicone-gel implants to controll clinical studies involving cases of mastectomy, replacement of ruptur silicone implants or correction of congenital deformities. Earlier this year sum of two units manufacturers of silicone implants received "approvable with conditions letters" from the FDA for their harvests Once the conditions are met silicone implants likely will be available again in the U Meanwhile, greatest in quantity reconstructions are done with saline implants.

M Parker's experience isn't entirely unusual--studies find that about individual in three women receiving an implant for reconstruction, regardless of the stamp of implant used, required another operation within five years. (12) (13)

However, today's implant shells are nearly twice as thick as those of the elderly silicone-gel implant.

Additionally, manufacturers have added a barrier between the inner and external layers of the implant to preclude silicone from leaking from the implant if it breaks Also, the outside of the implant shell is usually textur which studies find arises in fewer incidences of contracture, a condition in which fibrous tissue swells around the implant. (14)

Nonetheless, M Parker didn't want another implant. Instead, in September 2005 she underwent a of recent origin type of breast reconstruction that uses fat and tissue--but not muscle--from her abdomen to shape a realistic-looking and feeling breast. single month later, still recovering from the surgery she was ecstatic.

"I'm with equal reason excited I can hardly stand it," she says. The heft, the let bend down everything about her new breast matches the untouched breast, she says, and beneath clothes you can't tell the sum of two units apart.

That's the goal, says her doctor, Maurice Nahabedian, MD associate professor of plastic surgery at Georgetown University in Washington, DC

He is individual of only a handful of specialists in the U using this of recent origin reconstruction technique, called the DIEP (deep inferior epigastric perforator) flap. The practice is a variation of the greatest in quantity commonly performed breast reconstruction surgery means the TRAM flap, in which muscle, tissue and fat are remov from the transverse rectus abdominis muscle (TRAM) in the lower abdomen.

In the two operations, the lower abdomen is the principle source of tissue. During a TRAM flap, the surgeon displaces the tissue, fat and the muscle to keep the major blood supply that races through the muscle for use in the novel breast. With the DIEP flap the surgeon doesn't displace the muscle, so there's true little change in abdominal might and a faster recovery time, says Dr Nahabedian.

In the traditional TRAM flap, women let slip up to 40 percent of abdominal power for a single breast reconstruction; up to 70 percent if the couple breasts are done. With the DIEP flap, they can do everything they're used to doing, plane sit-ups, Dr. Nahabedian explains.

The downside is the complexity of the manner of proceedings Surgeons carefully tease blood utensils away from the muscle, preserving the mights During reconstruction, they painstakingly couple those tiny blood vessels via microscopic surgery to utensils in the chest, providing the fresh breast with its own critical vital fluid supply.

Because the surgery is thus complex, he says, it's critical to find a specialist in the course If it isn't performed suitably the breast tissue could die and become infected, putting a woman's overall health at risk.

As for M Parker, she's excited about being able to work without at the gym without stuffing a towel into her sports bra, and being able to wear the bright, sexy tops she's been saving for her novel breast. "It's just a miracle," she says.

* Not her real name

References

(11) Bondurant s Ernster V, Herdman R. Safety of Silicone Breast Implants, Report of the committee upon the Safety of Silicone Breast Implants (IOM). Washington, DC: National Academy Pres 1999

(12) FDA Breast Implant Consumer Handbook, US subsistence and Drug Administration. 2004.

(13) Gabriel SE wood-lands JE, O'Fallon WM, et al. Complications leading to surgery after breast implantation. N Engl J M 1997 Mar 6;336(10):677-82