Bolitho MD

9834 Genesee Ave Ste 311 La Jolla San Diego, California
Phone: (858) 458-5100


27Oct, 2016

New study reveals breast reconstruction psychosocial effects

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New study reveals breast reconstruction psychosocial effects

While the month of October marked Breast Cancer Awareness Month, this month’s issue of “Plastic and Reconstructive Surgery,” a medical journal published by the American Society of Plastic Surgeons, highlighted a study regarding women who underwent a mastectomy. The premise of the study was to see if there was a difference in psychosocial issues between those who had immediate breast reconstruction (IBR) to those who had delayed breast reconstruction (DBR).

It’s important to note that it’s a woman’s personal choice as to whether or not she wants to undergo breast reconstruction. While some may not want to pursue it, others do. With that said, it’s imperative for those diagnosed with breast cancer to know of the reconstruction options available to her when a single or bilateral mastectomy is surgically recommended.

According to Science Daily, the study was conducted at the University of Toronto. It was also cited that when compared to the USA, breast cancer medical centers based in Canada tend to perform more DBR than IBR procedures.

It was correctly noted that sometimes not all patients are candidates for immediate breast reconstruction due to a treatment protocol. It’s indeed individualized.

Participants from the study consisted of 106 patients who underwent an autologous breast reconstruction. From this group of patients, 30 patients had IBR following their mastectomy while 76 patients had their DBR roughly three years later.

Science Daily reported, “Before and at six, 12, and 18 months after mastectomy, the two groups completed questionnaires assessing a range of psychological factors. Scores were compared to assess differences in the psychosocial impact of and recovery from mastectomy with IBR versus DBR.” The news source added, “In both groups, anxiety decreased after breast reconstruction.”

In terms of “health-related quality of life,” women who underwent IBR were able to rebound back into this category earlier than those undergoing DBR. However, roughly six months following their reconstruction surgery, DBR patients had a restored sense of “health-related quality of life.”

Science Daily went on to note, “Lessening the psychosocial impact of breast cancer and its treatment is an important goal of breast reconstruction. While the study is not the first to show psychological benefits of IBR, it provides new information on the course of recovery, compared to DBR.” The article continued, “The results suggest that, when appropriate, IBR can avoid a period of psychosocial distress associated with mastectomy.”

While this study offers insight between the differences of IBR and DBR, it’s important to underscore the support a woman should have following her breast cancer diagnosis. In addition to her medical team, including a board certified plastic surgeon if she so chooses, other areas of support also include family and friends. And support such as this will help carry a patient to that finish line called hope.

14Nov, 2015

Antidepressants: Study Examines Meds Before Cosmetic Surgery

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Antidepressants: Study Examines Meds Before Cosmetic Surgery

A recent study published in Plastic and Reconstructive Surgery, a medical journal by the American Society of Plastic Surgeons, outlined a study indicating that there was no strong evidence suggesting that continuing antidepressants before cosmetic surgery would increase a patient’s risk intraoperatively or postoperatively. The study was conducted by Dr. Isabel Teo of Ninewells Hospital in Dundee along with Christopher Tam Song, a medical student at University of Edinburgh.

According to Science Daily which used Wolters Kluwer Health as its source, “Antidepressant use has increased in recent years, with one study reporting that 1 out of 10 U.S. adults and adolescents use these medications. Rates of antidepressant use may be even higher among patients undergoing cosmetic plastic surgery, or patients with breast cancer undergoing breast reconstruction.” It continued, “While plastic surgeons are alert for use of medications that might increase complications, such as blood thinners, they are typically not concerned about antidepressants.”

Antidepressants help adjust certain brain chemicals which alleviate a person’s mood disorder or specific behavior(s). This prescription drug can help with an array of conditions such as anxiety, depression, obsessive compulsive disorder, PTSD, ADHD, and more.

Additionally, antidepressants have been known to treat symptoms such as hot flashes, fibromyalgia, premenstrual symptoms, and neuropathy.

Antidepressants have benefited many individuals in a variety of ways, so a study such as this one is incredibly useful to both doctors and their patients.

The research article went on to say that Dr. Teo and Song crafted a comprehensive study which included various statistics and data regarding the relationship between cosmetic surgery risks and antidepressants. A total of 26 studies were part of the research. Different levels of study included:

  • Bleeding
  • Risk of breast cancer
  • Breast cancer outcome
  • Enlargement of the breasts

The study focused particularly on antidepressants categorized as SSRI, also known as selective serotonin reuptake inhibitors.

In reference to bleeding, Dr. Teo and Song assessed two groups of patients: over 34,000 breast reconstruction patients following breast cancer surgery and more than 2,500 cosmetic surgery patients. The results for bleeding were deemed inconsistent.

The report also indicated, “So while the evidence doesn’t rule out an increase in bleeding risk, stopping antidepressants before surgery–especially the widely used selective serotonin reuptake inhibitors (SSRIs)–might worsen depression symptoms…” They added, “Therefore, routine discontinuation of antidepressants before surgery in the absence of a careful evaluation should be avoided.”

In the breast cancer risk category, the results were again determined as conflicting for antidepressant users. While there was some moderate increase, others indicated no correlation.

For breast cancer outcomes, the study gleaned information about those taking tamoxifen to help reduce the recurrence of breast cancer. Researchers found no indication that antidepressants triggered a “drug combination” reaction.

Enlargement of the breasts was another area of the study. Any correlation of increased size was attributed to weight gain, a side effect of SSRI.

The report findings also cited, “While acknowledging the limitations of the available data, Dr. Teo and Mr. Song note their review finds no consistent evidence of increased complications related to antidepressants.” It added, “The risks of stopping prescribed antidepressant therapy in ‘psychologically vulnerable’ patients likely outweigh any increase in complications.

2Oct, 2015

Breast Reconstruction: Breaking the Silence

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Breast Cancer Cause Concept

When celebrities step forward and speak publicly regarding an issue, their words can make a profound impact. It brings not only awareness and dialog, but it can also raise funds toward a cause. While breast cancer awareness has been in the media spotlight, particularly during the month of October, celebrity Christina Applegate was one of the first to talk about her bilateral mastectomy and breast reconstruction surgery.

Not long after, in 2013 Angelina Jolie Pitt made her public announcement about her double mastectomy and reconstructive surgery because of her positive BRCA1 gene test results. Like other women who test positive for this test, Jolie Pitt wanted to eradicate the possibility of being diagnosed with breast cancer one day and was proactive in her decision to have the surgery.

It’s important to note that not all women who are diagnosed with BRCA1 decide to go to a plastic surgeon for this reconstructive procedure.  Others opt to have regular diagnostic screening, including MRIs.

With that said, Jolie Pitt’s announcement lit up media headlines around the world. It also fueled various studies.

For example, a research study from Austria recently emerged wanting to calculate how Jolie Pitt’s candid announcement trickled down to other women.

In Live Science, reporter Sara G. Miller revealed how the study showed that 92.6 percent of women were aware of a breast reconstruction procedure for those who lost one or both breasts due to cancer. Before Jolie Pitt’s public announcement the statistics were at 88.9 percent.

A total of 1,000 Austrian women took part in the study which was available online.

There was a poll taken one month prior to Jolie Pitt’s announcement and researchers wanted to see the effect immediately following the media coverage.

Head researcher of the study and assistant professor of plastic surgery at the Medical University of Graz in Austria, Dr. David Lumenta, said in a statement, “This is the first prospective report to prove the media’s effect on the healthcare-related issue of breast cancer among the general public.”

Because of the one-month retake of the poll, Lumenta described the study as a serendipitous design.

Other aspects comparing the two polls included awareness that one could have reconstruction using their own tissue versus breast implants. This increased from 57.6 to 68.9 percent; and approximately 1/5 of poll takers said Jolie Pitt’s announcement brought them a higher awareness toward breast cancer.

In a 2014 research study in the United Kingdom, numbers reflected a double increase in the demand for BRCA1 genetic testing. And those who wanted to learn more about prophylactic mastectomies and breast reconstruction were also noted to be on the rise.

Miller writes, “Another 2014 study found that although 75 percent of Americans were aware of Jolie Pitt’s announcement and surgery, less than 10 percent of the respondents fully understood how the BRCA gene affected her risk for the disease.” She went on to quote Lumenta in her article, “Since individual choice will become a driving force for patient-centered decision-making in the future, cancer specialists should be aware of public opinion when consulting patients with breast cancer.”

Frankly, anytime a celebrity opens up about their health struggles including breast cancer, infertility, or other diseases, it triggers knowledge and the desire to learn more. And knowledge is empowerment.

10Sep, 2015

New Strides In Breast Reconstruction

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“Pink Breast Cancer Ribbon” by scottchan

FreeDigitalPhotos by scottchan

Recently the medical journal published by the American Society of Plastic Surgeons (ASPS) released an article regarding a single-stage implant procedure for breast reconstruction patients. Generally women who undergo breast reconstruction have either lost one or both breasts due to breast cancer. Conversely, for women who are high risk for the disease may choose a prophylactic bilateral or single mastectomy.

More than ever, women are empowered to take care of their breast health and be educated on the availability of breast reconstruction.

Lead author, Dr. Mark Codner, an ASPS member surgeon of Emory University based in Atlanta, and co-author Dr. Jose Rodriguez-Feliz crafted an informative article. Since doing so, the “single-stage” implant reconstruction approach has lit up headlines and tells surgeons to “embrace the change.”

For patients who are candidates to this surgical approach, it is affording women with a shorter reconstruction process, swifter recovery, and a quicker way back to their new body image of a reconstructed breast(s).

In the article, Rodriguez-Feliz writes, “A selected group of patients will now benefit from a simplified reconstructive process with limited office visits for expansions, accelerated return to normal activities, and restoration of a natural breast with preservation of its most important landmark, the nipple areola complex.”

This advance is different than the two-stage reconstruction approach which utilized tissue expanders. After tissue expanders are inserted, saline fills are performed every few weeks at the plastic surgeon’s office.

Once the expansion is reached, another surgery is performed to replace the tissue expanders with implants.

A “single-stage” removes the need for tissue expanders which can last a few months or more.

The study which was discussed in the article followed 27 patients who underwent single-stage implantation (SSI).

The process of the surgery followed the following course.

Once the breast cancer surgeon removed the cancerous tissue, including the healthy tissue to complete the mastectomy, the goal was to then preserve as much breast skin as possible. This also included a technique called nipple sparing mastectomy which is also referred to preserving the nipple-areola complex (NAC). This is when a patient’s nipple and nearby tissue is retained.

Once the breast cancer surgeon is completed, a board certified plastic surgeon steps in for the reconstruction during the same surgery for an immediate implant based reconstruction.

The patient’s breast skin and NAC can be considered the natural shell for the procedure. Codner utilized a “teardrop” breast implant shape and acellular dermal matrix (ADM). The ADM provides the framework needed to sustain the reconstruction and promote the growth of new tissue.

Like tissue expander breast reconstruction, at the time when expanders are exchanged for implants during the second surgery, surgery, fat grafting is generally done to add fullness to the reconstructed breast. For Codner, he performed fat grafting during the SSI reconstruction procedure.

Rodriguez-Feliz added, “Preservation of the NAC and advances in technique have allowed us to achieve aesthetic results that resemble those of cosmetic breast enhancement patients. “As a result, we have limited the sense of mutilation that many patients would experience in the past with a two-stage breast reconstruction.”

The article also noted how the SSI reconstruction lowered patient discomfort and stress levels as opposed to the two-stage breast reconstruction.

However, like with tissue expander patients, it was noted that a low percentage of SSI patients did experience infection which triggered IV medication and/or surgery.

As mentioned earlier, patient candidates for SSI are determined based on their cancer, upcoming treatments, and comprehensive health.

SSI is another stride in breast reconstruction adding another level of empowerment when women need it the most.