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Current Options in Breast Reconstruction Following Mastectomy

Speaking at a recent national meeting of plastic surgeons, a physician recounted the story of a patient undergoing removal of her breast following the detection of breast cancer. Because of the disfiguring effect of mastectomy on her own mother, she had considered avoiding cancer detection altogether for fear she too would be left deformed. Now that there were so many options for reconstruction, she told him, she didn't fear the outcome so much. When given the news of her own breast cancer she immediately sought a consultation with a plastic surgeon to discuss her reconstructive options.

According to a recent press release by the American Society of Plastic Surgeons (ASPS), 82,975 women underwent breast reconstruction in 1999 as compared to 29,607 in 1992, reflecting a 180 percent increase. In this same period, breast reconstruction was the third most frequently performed reconstructive procedure by plastic surgeons. As suggested by the current ASPS president, two factors have contributed to this dramatic increase—insurance coverage and patient education.

If I Need Breast Reconstruction, Where Do I Begin?
Optimal results are best achieved through coordination between your general surgeon and your plastic surgeon. Only by establishing clear lines of communication between yourself and your physicians can you achieve an end-result with which you will be truly happy. During your initial consultation, your plastic surgeon will explain the most appropriate reconstructive options for you based on your overall health, anatomy, and your reconstructive goals, as well as any associated risks.

Breast Reconstruction Options

Women can choose from more than one option for reconstructive breast surgery.

Implant reconstruction
Excellent results can be obtained by placement of an implant beneath the chest wall muscle and skin. For small-breasted women, placement of a permanent implant after mastectomy in a single-stage reconstruction can also provide very good results. More commonly, however, a tissue expander will be placed at the time of surgery. A tissue expander will allow the skin to stretch to approximately the size of the opposite breast. In a separate procedure, a permanent implant will be placed to achieve more effective symmetry.

Tissue expansion involves placement of a balloon-like device beneath the skin and muscle of the breast. Over the next few weeks after surgery, the expander is gradually filled with salt water until the desired size is achieved. Expansion is unique in that it allows for tissue over the expander to grow and enlarge so that it can replace breast skin previously removed with the mastectomy. This is important because the new tissue will be similar in appearance and texture to the original tissue and can minimize the number of scars required for reconstruction of the breast.

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