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, women who are at 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 for this surgical approach, it affords women 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 from 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.
