Bolitho MD

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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.

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.