ASPS Report Examines Reconstruction Innovations for Breast Cancer Patients Including Partial and Full Mastectomies
For Immediate Release: April 2008
ARLINGTON HEIGHTS, Ill. – Lumpectomy or breast conservation surgery is the most common type of breast cancer surgery currently performed. A benefit of the surgery is that only part of the breast is removed, but a drawback can be the resulting physical appearance of the breast, which may be disfigured, dented or uneven. A report in April’s Plastic and Reconstructive Surgery® , the official medical journal of the American Society of Plastic Surgeons (ASPS), examines advances plastic surgeons have made in breast reconstruction to repair the damage left when cancer is removed.
“Although breast conversation therapies are a huge advance in the treatment of breast cancer, women are still concerned about how their breast will look after surgery,” said Sumner Slavin, MD, ASPS Member and report co-author. “Breast conservation surgery or lumpectomy can mean many things; a biopsy, partial mastectomy, wedge resection, or having a quarter of the breast taken. Women are often left with portions of their breasts removed and there are currently no implants that can address this unique cosmetic issue.”
After lumpectomy or breast conservation surgery, plastic surgeons are now approaching the challenge of misshapen breasts by immediately remodeling the breast with remaining breast tissue or tissue taken from another area of the body. The result is a more natural looking breast that is more symmetrical with the unaffected breast.
Three additional advances the report examines are nipple-sparing mastectomy, deep inferior epigastric perforator (DIEP) flaps and acellular dermis graft slings. These are options for women who require a full mastectomy and young women who opt for preventative mastectomy due to a strong family history of breast cancer.
In nipple-sparing surgery, cancerous tissue and the duct system of the breast are removed, but a pocket of skin, the nipple and areola are saved. Plastic surgeons insert either an implant or the patient’s own tissue into the pocket to recreate the breast. The result looks very similar to the patient’s original breast because the original nipple and areola are used. Nipple-sparing surgery is still somewhat controversial, but if the origin of the tumor is away from the nipple and areola, it is considered safe, according to the report.
DIEP flap surgery involves using skin and fat from the lower abdomen to recreate the breast. The muscle is left intact, eliminating potential muscle weakness in the donor area, according to the report.
For patients undergoing a mastectomy, the DIEP flap procedure may allow them to better resume normal activities since they have not loss muscle function in their abdomen.
Finally, the use of acellular dermis (connective tissue layer of the skin) derived from cadaver tissue (such as "Alloderm") allows plastic surgeons to create a new breast pocket, in patients undergoing a mastectomy, without using a tissue expander. A breast implant may then be inserted, creating an aesthetically pleasing breast. This one-stage method of breast reconstruction is often referred to as "Alloderm one-step breast reconstruction".
“Many women don’t know the full scope of their reconstructive options or are intimidated to ask,” said Dr. Slavin. “For breast cancer patients, even though they are living through the anguish of cancer, there are reconstructive procedures that will improve their quality of life and reduce the negative long-term impact of the disease and its treatment.”
In the United States today, there are nearly 2.5 million breast cancer survivors – the largest group of cancer survivors in the country, according to Susan G. Komen for the Cure. More than 56,000 breast reconstructions were performed in 2007, according to the ASPS.
Learn more about your breast reconstruction options here.
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Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including DIEP flap reconstruction. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.
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Showing posts with label breast reconstruction texas. Show all posts
Showing posts with label breast reconstruction texas. Show all posts
Sunday, April 27, 2008
Monday, April 14, 2008
DIEP Flap Reconstruction And Breast Cancer Recurrence
Can DIEP flap breast reconstruction prevent detection of breast cancer recurrence? This is a very important issue that is often not discussed.
A handful of studies have shown that breast reconstruction (with any reconstructive technique) does not impact local recurrence or long term survival in patients with early breast cancer (stage I and II). The rate of local recurrence and length of survival is the same in patients with stage I and II disease whether they undergo immediate breast reconstruction (ie reconstruction at the same time as mastectomy) or not. For this reason most institutions (including ours) offer breast cancer patients with early disease immediate breast reconstruction whenever possible.
Patients diagnosed with advanced disease are more likely to be candidates for delayed breast reconstruction once they have undergone mastectomy, completed their cancer treatment and remained disease free for several months.
Breast reconstruction (with a DIEP flap or any other method) does not encourage or enhance breast cancer recurrence or shorten long term survival in any way.
Dr C
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Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including DIEP flap reconstruction. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.
******
A handful of studies have shown that breast reconstruction (with any reconstructive technique) does not impact local recurrence or long term survival in patients with early breast cancer (stage I and II). The rate of local recurrence and length of survival is the same in patients with stage I and II disease whether they undergo immediate breast reconstruction (ie reconstruction at the same time as mastectomy) or not. For this reason most institutions (including ours) offer breast cancer patients with early disease immediate breast reconstruction whenever possible.
Patients diagnosed with advanced disease are more likely to be candidates for delayed breast reconstruction once they have undergone mastectomy, completed their cancer treatment and remained disease free for several months.
Breast reconstruction (with a DIEP flap or any other method) does not encourage or enhance breast cancer recurrence or shorten long term survival in any way.
Dr C
******
Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including DIEP flap reconstruction. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.
******
Thursday, March 20, 2008
Few Women Have Regrets When Choosing Preventive Mastectomy for Other Breast
by Ann M. Geiger and others
Is this for me? If you have been diagnosed with breast cancer in one breast and are considering having the other breast removed to reduce your risk of developing a new breast cancer or having the cancer coming back, you might want to read this article.
Background and importance of the study: If you have been diagnosed with breast cancer, your risk of developing a new cancer is higher than that of a woman who has never had the disease. The size of this risk varies from person to person, because each person has different risk factors. For the average woman who has had breast cancer, the risk of developing a new and different breast cancer in the other breast (not a recurrence of the first one) is about 1% per year. This means a risk of about 10% over 10 years. Put differently, out of 100 women who have a personal history of the disease, about 10 will get a new breast cancer on the other side within 10 years.
The risk of a new breast cancer is higher for women who have additional risk factors. If you've been diagnosed with breast cancer and also have a strong family history of the disease, your risk is likely to be higher than 1% a year. If you have a proven genetic abnormality, your risk is even higher. If you have both a strong family history of breast cancer AND a known breast cancer gene abnormality, on top of a personal history of breast cancer, the risk is higher still. The range of higher risk is about 2% to 5% per year, depending on all of these factors, plus other things that might affect how an abnormal gene behaves. Over 10 years, this translates to a risk that ranges from 20% to 50%.
If you have a personal history of breast cancer plus other risk factors for a new breast cancer, it's important for you to help reduce your risk. You may want to seriously consider extra preventive measures, including lifestyle changes, medications, and surgery.
Preventive surgery to remove the other breast is a serious option with real benefits and side effects. While removing the breast can substantially reduce your risk of breast cancer, it involves permanent changes that can change your quality of life. The higher your risk of breast cancer, the more likely you are to benefit from preventive surgery. Removal of the breast can decrease the risk of a new breast cancer by about 90%. That's a big reduction. If your risk is estimated to be 80%, it could be lowered to about 8% by preventive breast removal. If your risk is 10%, it could be lowered to 1%.
The surgical option of breast removal is called "prophylactic," which means "preventive." If you take this step, you are doing something that will significantly reduce your risk for cancer in the future (although there is no guarantee). This option is permanent and irreversible.
Earlier studies have shown that for women with a personal history of breast cancer and other strong risk factors, preventive removal of the other breast (called contralateral mastectomy) reduces their risk of developing a new cancer and is associated with improved survival. Up to this point, however, no one had looked at how happy or satisfied women were with their choice.
In this study, the researchers asked women how content they were with their choice to have or not have preventive mastectomy.
Study design: In this study, the researchers asked 772 women who had preventive mastectomy and 105 who didn't have preventive mastectomy how content they were with their choice.
All the women had been diagnosed with breast cancer in one breast between 1979 and 1999 at one of six Cancer Research Network health care system centers in the United States. The women were aged 18 to 80.
To determine how content women were with their preventive mastectomy choice, the researchers mailed them a survey that asked questions about:
1) quality of life,
2) satisfaction with the surgery,
3) body image,
4) sexual satisfaction,
5) depression,
6) breast cancer thoughts, and
7) health perception.
About 73% of the surveys were returned, from 519 women who had preventive mastectomy and 61 women who didn't. Of those 61 women, 30 had single mastectomy and 31 had lumpectomy.
The research was funded by the National Cancer Institute.
Results: Of the 519 women who had preventive mastectomy, 86.5% were satisfied with the procedure and had no second thoughts about it, and 76% were very content with their quality of life.
Similarly, of the 61 women who did not have preventive surgery, 75% were very content with their quality of life.
There was no association between women reporting having a lower quality of life and having had preventive mastectomy or breast reconstruction, or with the women's age, race, education, or body mass index. But a lower quality of life WAS linked to:
1) poor perception of one's own general health,
2) possible depression,
3) unhappiness or self-consciousness about appearance,
4) unhappiness with sex life, and
5) feeling the need to avoid thoughts of breast cancer.
The results also showed that almost 75% of the women who didn't have preventive mastectomy were concerned about breast cancer, compared to 50% of the women who had the preventive surgery.
Conclusions: The researchers concluded that most women who have preventive mastectomy are satisfied with their choice and report having a good quality of life. The women who had preventive mastectomy were less likely than the other women to be concerned about breast cancer.
Women who reported having a lower quality of life were more likely to have poor body image, be unhappy with their sex life, possibly be depressed, feel the need to avoid thoughts of breast cancer, and have a poor general health perception.
Take-home message: If you have been diagnosed with breast cancer in one breast and are considering a preventive mastectomy, this study offers strong support that no matter which decision you make, you are likely to be content with that decision later.
More than 75% of women in each group were very content with their quality of life. The adage "whatever decision you make will be right for you" seems to carry truth for women grappling with this decision.
Of course, you need to balance the potential benefits of preventive surgery against the side effects. Every woman is unique. How you balance the benefits and side effects in your own situation is very personal.
In general, factors that might make you more likely to choose preventive mastectomy are:
1) a strong family history of breast cancer,
2) a serious diagnosis of breast cancer in the other breast,
3) being very fearful of another cancer,
4) lacking confidence in the power of early detection, and
5) feeling determined to never go through cancer therapy again.
This wasn't a randomized study, in which women are assigned to different groups. Every woman made her own decisions, and the women who chose preventive surgery are probably different in many ways from the women who chose not to have this procedure. As a result, comparing the two groups has limited value.
You probably know that we all need to believe in the big decisions we make—particularly important decisions about our health. But even when we get used to a big decision, it's normal to have mixed feelings. Although mastectomy can give women more peace of mind, it's also normal for women to have concerns about their body image and to miss their breast.
Also remember that no procedure—even surgery—totally eliminates the risk of cancer. Even when a breast has been removed, cancer can still develop in the area where the breast used to be. Close follow-up is necessary for all women, even after preventive surgery.
You have time to decide. The decision to have preventive surgery is not an emergency. Of course, the decision to have preventive surgery at any age requires much thought, and must be made in consultation with your health care team.
Learn about surgical options for breast reconstruction here.
SOURCE: Journal of Clinical Oncology; breastcancer.org
******
Is this for me? If you have been diagnosed with breast cancer in one breast and are considering having the other breast removed to reduce your risk of developing a new breast cancer or having the cancer coming back, you might want to read this article.
Background and importance of the study: If you have been diagnosed with breast cancer, your risk of developing a new cancer is higher than that of a woman who has never had the disease. The size of this risk varies from person to person, because each person has different risk factors. For the average woman who has had breast cancer, the risk of developing a new and different breast cancer in the other breast (not a recurrence of the first one) is about 1% per year. This means a risk of about 10% over 10 years. Put differently, out of 100 women who have a personal history of the disease, about 10 will get a new breast cancer on the other side within 10 years.
The risk of a new breast cancer is higher for women who have additional risk factors. If you've been diagnosed with breast cancer and also have a strong family history of the disease, your risk is likely to be higher than 1% a year. If you have a proven genetic abnormality, your risk is even higher. If you have both a strong family history of breast cancer AND a known breast cancer gene abnormality, on top of a personal history of breast cancer, the risk is higher still. The range of higher risk is about 2% to 5% per year, depending on all of these factors, plus other things that might affect how an abnormal gene behaves. Over 10 years, this translates to a risk that ranges from 20% to 50%.
If you have a personal history of breast cancer plus other risk factors for a new breast cancer, it's important for you to help reduce your risk. You may want to seriously consider extra preventive measures, including lifestyle changes, medications, and surgery.
Preventive surgery to remove the other breast is a serious option with real benefits and side effects. While removing the breast can substantially reduce your risk of breast cancer, it involves permanent changes that can change your quality of life. The higher your risk of breast cancer, the more likely you are to benefit from preventive surgery. Removal of the breast can decrease the risk of a new breast cancer by about 90%. That's a big reduction. If your risk is estimated to be 80%, it could be lowered to about 8% by preventive breast removal. If your risk is 10%, it could be lowered to 1%.
The surgical option of breast removal is called "prophylactic," which means "preventive." If you take this step, you are doing something that will significantly reduce your risk for cancer in the future (although there is no guarantee). This option is permanent and irreversible.
Earlier studies have shown that for women with a personal history of breast cancer and other strong risk factors, preventive removal of the other breast (called contralateral mastectomy) reduces their risk of developing a new cancer and is associated with improved survival. Up to this point, however, no one had looked at how happy or satisfied women were with their choice.
In this study, the researchers asked women how content they were with their choice to have or not have preventive mastectomy.
Study design: In this study, the researchers asked 772 women who had preventive mastectomy and 105 who didn't have preventive mastectomy how content they were with their choice.
All the women had been diagnosed with breast cancer in one breast between 1979 and 1999 at one of six Cancer Research Network health care system centers in the United States. The women were aged 18 to 80.
To determine how content women were with their preventive mastectomy choice, the researchers mailed them a survey that asked questions about:
1) quality of life,
2) satisfaction with the surgery,
3) body image,
4) sexual satisfaction,
5) depression,
6) breast cancer thoughts, and
7) health perception.
About 73% of the surveys were returned, from 519 women who had preventive mastectomy and 61 women who didn't. Of those 61 women, 30 had single mastectomy and 31 had lumpectomy.
The research was funded by the National Cancer Institute.
Results: Of the 519 women who had preventive mastectomy, 86.5% were satisfied with the procedure and had no second thoughts about it, and 76% were very content with their quality of life.
Similarly, of the 61 women who did not have preventive surgery, 75% were very content with their quality of life.
There was no association between women reporting having a lower quality of life and having had preventive mastectomy or breast reconstruction, or with the women's age, race, education, or body mass index. But a lower quality of life WAS linked to:
1) poor perception of one's own general health,
2) possible depression,
3) unhappiness or self-consciousness about appearance,
4) unhappiness with sex life, and
5) feeling the need to avoid thoughts of breast cancer.
The results also showed that almost 75% of the women who didn't have preventive mastectomy were concerned about breast cancer, compared to 50% of the women who had the preventive surgery.
Conclusions: The researchers concluded that most women who have preventive mastectomy are satisfied with their choice and report having a good quality of life. The women who had preventive mastectomy were less likely than the other women to be concerned about breast cancer.
Women who reported having a lower quality of life were more likely to have poor body image, be unhappy with their sex life, possibly be depressed, feel the need to avoid thoughts of breast cancer, and have a poor general health perception.
Take-home message: If you have been diagnosed with breast cancer in one breast and are considering a preventive mastectomy, this study offers strong support that no matter which decision you make, you are likely to be content with that decision later.
More than 75% of women in each group were very content with their quality of life. The adage "whatever decision you make will be right for you" seems to carry truth for women grappling with this decision.
Of course, you need to balance the potential benefits of preventive surgery against the side effects. Every woman is unique. How you balance the benefits and side effects in your own situation is very personal.
In general, factors that might make you more likely to choose preventive mastectomy are:
1) a strong family history of breast cancer,
2) a serious diagnosis of breast cancer in the other breast,
3) being very fearful of another cancer,
4) lacking confidence in the power of early detection, and
5) feeling determined to never go through cancer therapy again.
This wasn't a randomized study, in which women are assigned to different groups. Every woman made her own decisions, and the women who chose preventive surgery are probably different in many ways from the women who chose not to have this procedure. As a result, comparing the two groups has limited value.
You probably know that we all need to believe in the big decisions we make—particularly important decisions about our health. But even when we get used to a big decision, it's normal to have mixed feelings. Although mastectomy can give women more peace of mind, it's also normal for women to have concerns about their body image and to miss their breast.
Also remember that no procedure—even surgery—totally eliminates the risk of cancer. Even when a breast has been removed, cancer can still develop in the area where the breast used to be. Close follow-up is necessary for all women, even after preventive surgery.
You have time to decide. The decision to have preventive surgery is not an emergency. Of course, the decision to have preventive surgery at any age requires much thought, and must be made in consultation with your health care team.
Learn about surgical options for breast reconstruction here.
SOURCE: Journal of Clinical Oncology; breastcancer.org
******
Friday, February 15, 2008
Breast Cancer patients may benefit from picking own breast surgeon
Women with breast cancer who are involved in the process of selecting their surgeon are more likely to be treated by more experienced surgeons and in hospitals with established cancer programs, according to a study published in the Journal of Clinical Oncology.
Surgeon and hospital characteristics can influence the outcomes of cancer treatments, the authors explain, but little is known about the factors that influence how referrals are made.
Dr. Steven J. Katz from the University of Michigan, Ann Arbor, and colleagues used survey data from women recently diagnosed with breast cancer and their attending surgeons to determine how surgeons are selected, and if there is any association between the referral process and characteristics of the surgeon and hospital.
Most women were referred to their surgeon by another doctor or by their health plan. They chose their surgeon for a number of reasons -- the surgeon's reputation, the institution's reputation, the recommendation of family or friends, or convenience of the location.
The investigators found that 54.3 percent of women were referred and did not select their surgeon; 21.9 percent were referred, but were also involved in selecting their surgeon; 20.3 percent selected their surgeon and were not referred by a provider or plan; and the rest of the patients had a prior relationship with their surgeon.
Women who selected their surgeon by reputation were twice as likely to have a surgeon who performed many procedures (high-volume surgeon) and to be treated at a cancer center designated by the National Cancer Institute or a program approved by the American College of Surgeons, the team reports.
Patients referred by another doctor or health plan were less likely to be treated by a high-volume surgeon or in hospitals with approved cancer programs, the researchers note.
Previous studies have shown that surgical patients often have better outcomes if they are treated by highly experienced surgeons and at hospitals that perform many similar procedures each year.
More research is needed to investigate the implications of the different referral patterns in this study, Katz and colleagues point out. "In the meantime, women with breast cancer should be aware that provider-based referral might not connect them with the most experienced surgeons or the most comprehensive practice setting in their community."
"Patients might consider a second opinion," the researchers suggest, "especially if they are advised to undergo a particular procedure without a full discussion of treatment options or a clear medical rationale for the recommendation."
SOURCE: Journal of Clinical Oncology; breastcancer.org
******
Surgeon and hospital characteristics can influence the outcomes of cancer treatments, the authors explain, but little is known about the factors that influence how referrals are made.
Dr. Steven J. Katz from the University of Michigan, Ann Arbor, and colleagues used survey data from women recently diagnosed with breast cancer and their attending surgeons to determine how surgeons are selected, and if there is any association between the referral process and characteristics of the surgeon and hospital.
Most women were referred to their surgeon by another doctor or by their health plan. They chose their surgeon for a number of reasons -- the surgeon's reputation, the institution's reputation, the recommendation of family or friends, or convenience of the location.
The investigators found that 54.3 percent of women were referred and did not select their surgeon; 21.9 percent were referred, but were also involved in selecting their surgeon; 20.3 percent selected their surgeon and were not referred by a provider or plan; and the rest of the patients had a prior relationship with their surgeon.
Women who selected their surgeon by reputation were twice as likely to have a surgeon who performed many procedures (high-volume surgeon) and to be treated at a cancer center designated by the National Cancer Institute or a program approved by the American College of Surgeons, the team reports.
Patients referred by another doctor or health plan were less likely to be treated by a high-volume surgeon or in hospitals with approved cancer programs, the researchers note.
Previous studies have shown that surgical patients often have better outcomes if they are treated by highly experienced surgeons and at hospitals that perform many similar procedures each year.
More research is needed to investigate the implications of the different referral patterns in this study, Katz and colleagues point out. "In the meantime, women with breast cancer should be aware that provider-based referral might not connect them with the most experienced surgeons or the most comprehensive practice setting in their community."
"Patients might consider a second opinion," the researchers suggest, "especially if they are advised to undergo a particular procedure without a full discussion of treatment options or a clear medical rationale for the recommendation."
SOURCE: Journal of Clinical Oncology; breastcancer.org
******
Wednesday, January 9, 2008
Breast Reconstruction Often Not Discussed
By Megan Rauscher
NEW YORK (Reuters Health) - Women with breast cancer faced with treatment decisions are often not told by their surgeons about the possibility of breast reconstruction after a mastectomy, a study confirms. When these conversations do occur, many more women choose mastectomy, researchers found.
In a survey of 1,178 women who had breast cancer surgery, only 33 percent reported that their surgeon had discussed breast reconstruction with them during the surgical decision-making process.
"We found it surprising that very few patients were informed about their options for breast reconstruction, and that information regarding reconstruction was more likely to be given to younger women who were more educated," Dr. Amy K. Alderman of the University of Michigan Medical Center, Ann Arbor, told Reuters Health.
The survey, posted online Friday by the medical journal Cancer, also indicates that women who had these discussions with their surgeon were four times more likely to have a mastectomy compared to women who did not discuss reconstruction.
"Women need to be fully informed about all of their surgical options for breast cancer: lumpectomy, mastectomy and mastectomy with reconstruction," Alderman said. "All are great options with the same long-term survival."
Breast reconstruction, continued Alderman, "is a personal decision for each woman that is influenced by her body image, sexuality, fear of recurrence, etc. Women should be educated consumers of their healthcare."
She concluded: "We, as physicians, need to make sure that all women, regardless of the patients' education and socioeconomic status, are fully informed of their surgical choices for breast cancer care."
SOURCE: Cancer, February 1, 2008
******
NEW YORK (Reuters Health) - Women with breast cancer faced with treatment decisions are often not told by their surgeons about the possibility of breast reconstruction after a mastectomy, a study confirms. When these conversations do occur, many more women choose mastectomy, researchers found.
In a survey of 1,178 women who had breast cancer surgery, only 33 percent reported that their surgeon had discussed breast reconstruction with them during the surgical decision-making process.
"We found it surprising that very few patients were informed about their options for breast reconstruction, and that information regarding reconstruction was more likely to be given to younger women who were more educated," Dr. Amy K. Alderman of the University of Michigan Medical Center, Ann Arbor, told Reuters Health.
The survey, posted online Friday by the medical journal Cancer, also indicates that women who had these discussions with their surgeon were four times more likely to have a mastectomy compared to women who did not discuss reconstruction.
"Women need to be fully informed about all of their surgical options for breast cancer: lumpectomy, mastectomy and mastectomy with reconstruction," Alderman said. "All are great options with the same long-term survival."
Breast reconstruction, continued Alderman, "is a personal decision for each woman that is influenced by her body image, sexuality, fear of recurrence, etc. Women should be educated consumers of their healthcare."
She concluded: "We, as physicians, need to make sure that all women, regardless of the patients' education and socioeconomic status, are fully informed of their surgical choices for breast cancer care."
SOURCE: Cancer, February 1, 2008
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Wednesday, December 19, 2007
Microsurgical Breast Reconstruction With Perforator Flaps
So what are "perforator flaps"?
Pioneered in the early 1990's, perforator flap breast reconstruction represents the state of the art in breast reconstruction surgery after mastectomy. The tissue removed at the time of mastectomy may be replaced with the patient's own warm, soft, living tissue to recreate a "natural" breast.
Skin, fatty tissue, and the tiny blood vessels that supply nutrients to the tissue ("perforators") can be taken from the patient's abdomen (SIEA flap and DIEP flap procedures) or buttocks (GAP flap procedure).
Unlike conventional tissue reconstruction techniques (like the TRAM flap), these microsurgical perforator flap techniques carefully preserve the patient's underlying musculature. The tissue is then transplanted to the patient's chest and reconnected using microsurgery.
Preserving underlying muscles lessens postoperative discomfort making the recovery easier and shorter, and also enables the patient to maintain muscle strength long-term. This is particularly important for active women.
While microsurgical breast reconstruction offers many advantages to the patient, the surgeries are very complex and time-consuming and specialized training is required. Our surgeons perform over 300 microsurgical breast procedures per year making PRMA Plastic Surgery one of the busiest breast reconstruction centers in and beyond the USA.
To learn more about each of the perforator flap techniques offered at PRMA please click on the following links:
DIEP flap
SIEA flap
GAP flap
******
Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.
******
Pioneered in the early 1990's, perforator flap breast reconstruction represents the state of the art in breast reconstruction surgery after mastectomy. The tissue removed at the time of mastectomy may be replaced with the patient's own warm, soft, living tissue to recreate a "natural" breast.
Skin, fatty tissue, and the tiny blood vessels that supply nutrients to the tissue ("perforators") can be taken from the patient's abdomen (SIEA flap and DIEP flap procedures) or buttocks (GAP flap procedure).
Unlike conventional tissue reconstruction techniques (like the TRAM flap), these microsurgical perforator flap techniques carefully preserve the patient's underlying musculature. The tissue is then transplanted to the patient's chest and reconnected using microsurgery.
Preserving underlying muscles lessens postoperative discomfort making the recovery easier and shorter, and also enables the patient to maintain muscle strength long-term. This is particularly important for active women.
While microsurgical breast reconstruction offers many advantages to the patient, the surgeries are very complex and time-consuming and specialized training is required. Our surgeons perform over 300 microsurgical breast procedures per year making PRMA Plastic Surgery one of the busiest breast reconstruction centers in and beyond the USA.
To learn more about each of the perforator flap techniques offered at PRMA please click on the following links:
DIEP flap
SIEA flap
GAP flap
******
Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.
******
Wednesday, August 29, 2007
The Hype Around DIEP Flap Breast Reconstruction And How To Find A DIEP Flap Surgeon
If you are a woman facing mastectomy you have a decision to make: do I want breast reconstruction? If the answer is “yes”, plastic surgery holds the key. Although reconstruction cannot replace the breast(s) you were born with or allow you to breastfeed, it can restore your natural silhouette and make you feel “whole” again following mastectomy.
Depending on your health, breast reconstruction can be performed immediately after your mastectomy surgery so you can wake up with new breasts already in place. While the cosmetic results with immediate reconstruction are generally superior, breast reconstruction can also be performed at a later time once the cancer treatment has been completed.
The DIEP flap breast procedure is today’s gold standard in breast reconstruction. Advances in breast reconstruction have made it possible to use excess skin and fat from the abdomen (rather like the tissue removed during a tummy tuck) to construct a new breast without the need for implants or the sacrifice of abdominal muscle. This procedure, known as the Deep Inferior Epigastric Perforator (DIEP) flap, is a sophisticated modification of an existing procedure known as the TRAM (Transverse Rectus Abdominus Myocutaneous) flap.
TRAM flap surgery is a common breast reconstruction technique that requires the rectus abdominus (sit-up) muscle to be sacrificed and relocated to the upper abdomen. Unfortunately, this technique can be associated with significant post-operative pain, prolonged recovery, loss of abdominal muscle strength (up to 20%), abdominal bulging (or “pooching”), and even abdominal hernia.
DIEP flap breast reconstruction is similar to TRAM flap surgery but spares the rectus abdominus muscle. SKIN AND FAT ONLY are removed from the abdomen, transplanted to the chest and connected using microsurgery to create the new breast. NO MUSCLE is sacrificed. As the sit-up muscle is left behind in its natural place many of the above complications are avoided and the patient essentially receives a tummy tuck at the same time as the breast reconstruction. There also tends to be far less pain following the DIEP procedure, and a quicker recovery time.
Knowing the significant advantages of the DIEP flap it is easy to understand the reason for all the hype, especially for active individuals who don’t want to sacrifice the strength of their abdomen. A breast that has been reconstructed with fat and skin will also look and feel more natural than an implant reconstruction and will last longer. Unlike an implant, the reconstructed breast also ages like a natural breast.
As with all types of breast reconstruction however, 2 or 3 procedures performed a few months apart are often required to complete the reconstruction process and to obtain the best cosmetic result. Unfortunately, due to the complexity of the DIEP procedure very few centers in the US perform DIEP flap surgery so many patients will have to travel for the procedure. The good news is that many of these DIEP flap centers will accommodate out-of-state and even international patients.
To learn if a breast center or plastic surgeon near you offers DIEP flap breast reconstruction, please check the following websites:
www.breastrecon.com and www.diepsisters.com
The lists on these websites seem fairly thorough but there are plastic surgeons out there who perform DIEP breast reconstruction that have not made the lists (for whatever reason). Having said that, currently there are only about 40 plastic surgeons in the US that routinely perform the DIEP flap procedure. Before choosing a plastic surgeon ensure that he/she is certified by the American Board of Plastic Surgery and has extensive experience with the DIEP flap procedure. Ask about the success rate of the procedure in their hands (most DIEP flap specialists boast a flap survival rate of at least 97%) and how many DIEP flaps they have performed.
Insurance companies are federally mandated to pay for the cost of breast reconstruction. Unfortunately, some patients will still face difficulties in gaining access to a DIEP flap surgeon and the procedure. Here again it pays to seek out plastic surgeons who specialize in the DIEP procedure as typically insurance specialists are available to help patients with insurance issues.
Learn more about the DIEP flap procedure and other breast reconstruction options here.
******
Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.
*****
Depending on your health, breast reconstruction can be performed immediately after your mastectomy surgery so you can wake up with new breasts already in place. While the cosmetic results with immediate reconstruction are generally superior, breast reconstruction can also be performed at a later time once the cancer treatment has been completed.
The DIEP flap breast procedure is today’s gold standard in breast reconstruction. Advances in breast reconstruction have made it possible to use excess skin and fat from the abdomen (rather like the tissue removed during a tummy tuck) to construct a new breast without the need for implants or the sacrifice of abdominal muscle. This procedure, known as the Deep Inferior Epigastric Perforator (DIEP) flap, is a sophisticated modification of an existing procedure known as the TRAM (Transverse Rectus Abdominus Myocutaneous) flap.
TRAM flap surgery is a common breast reconstruction technique that requires the rectus abdominus (sit-up) muscle to be sacrificed and relocated to the upper abdomen. Unfortunately, this technique can be associated with significant post-operative pain, prolonged recovery, loss of abdominal muscle strength (up to 20%), abdominal bulging (or “pooching”), and even abdominal hernia.
DIEP flap breast reconstruction is similar to TRAM flap surgery but spares the rectus abdominus muscle. SKIN AND FAT ONLY are removed from the abdomen, transplanted to the chest and connected using microsurgery to create the new breast. NO MUSCLE is sacrificed. As the sit-up muscle is left behind in its natural place many of the above complications are avoided and the patient essentially receives a tummy tuck at the same time as the breast reconstruction. There also tends to be far less pain following the DIEP procedure, and a quicker recovery time.
Knowing the significant advantages of the DIEP flap it is easy to understand the reason for all the hype, especially for active individuals who don’t want to sacrifice the strength of their abdomen. A breast that has been reconstructed with fat and skin will also look and feel more natural than an implant reconstruction and will last longer. Unlike an implant, the reconstructed breast also ages like a natural breast.
As with all types of breast reconstruction however, 2 or 3 procedures performed a few months apart are often required to complete the reconstruction process and to obtain the best cosmetic result. Unfortunately, due to the complexity of the DIEP procedure very few centers in the US perform DIEP flap surgery so many patients will have to travel for the procedure. The good news is that many of these DIEP flap centers will accommodate out-of-state and even international patients.
To learn if a breast center or plastic surgeon near you offers DIEP flap breast reconstruction, please check the following websites:
www.breastrecon.com and www.diepsisters.com
The lists on these websites seem fairly thorough but there are plastic surgeons out there who perform DIEP breast reconstruction that have not made the lists (for whatever reason). Having said that, currently there are only about 40 plastic surgeons in the US that routinely perform the DIEP flap procedure. Before choosing a plastic surgeon ensure that he/she is certified by the American Board of Plastic Surgery and has extensive experience with the DIEP flap procedure. Ask about the success rate of the procedure in their hands (most DIEP flap specialists boast a flap survival rate of at least 97%) and how many DIEP flaps they have performed.
Insurance companies are federally mandated to pay for the cost of breast reconstruction. Unfortunately, some patients will still face difficulties in gaining access to a DIEP flap surgeon and the procedure. Here again it pays to seek out plastic surgeons who specialize in the DIEP procedure as typically insurance specialists are available to help patients with insurance issues.
Learn more about the DIEP flap procedure and other breast reconstruction options here.
******
Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.
*****
Sunday, January 14, 2007
Will Insurance Pay For My DIEP Flap Breast Reconstruction?
"Will insurance pay for my DIEP breast reconstruction?"
This is a question I am repeatedly asked. The easy answer is "they should". However, some women have experienced difficulties with their insurance companies in terms of getting their DIEP breast reconstruction covered. Women must also be aware of "balance billing".
The good news is that there are a handful of plastic surgeons across the country that do routinely offer these advanced procedures and many of them accept insurance. Unfortunately most women will have to travel to gain access to them. We have posted an article on our website about finding a DIEP flap surgeon near you and which questions to ask.
Our group, Plastic, Reconstructive & Microsurgical Associates (PRMA) is located in San Antonio, Texas. We perform over 350 DIEP breast reconstructions per year, the vast majority of which are covered by insurance. We are in-network for most major US insurance plans and do not balance bill. We have insurance specialists on staff so our patients typically do not need to worry about the insurance side of things themselves.
Answers to more DIEP insurance FAQs can be found here.
Answers to more general DIEP flap FAQ's can be found here.
Dr C
*********
Dr Chrysopoulo, board certified plastic surgeon, PRMA Plastic Surgery, San Antonio, TX. Specializing in breast reconstruction surgery after mastectomy for breast cancer. Over 350 DIEP flaps performed yearly. In-network for most US insurance plans. Toll Free (800) 692-5565. www.prma-Enhance.com. Latest breast reconstruction news available at The Breast Cancer Reconstruction Blog.
*********
This is a question I am repeatedly asked. The easy answer is "they should". However, some women have experienced difficulties with their insurance companies in terms of getting their DIEP breast reconstruction covered. Women must also be aware of "balance billing".
The good news is that there are a handful of plastic surgeons across the country that do routinely offer these advanced procedures and many of them accept insurance. Unfortunately most women will have to travel to gain access to them. We have posted an article on our website about finding a DIEP flap surgeon near you and which questions to ask.
Our group, Plastic, Reconstructive & Microsurgical Associates (PRMA) is located in San Antonio, Texas. We perform over 350 DIEP breast reconstructions per year, the vast majority of which are covered by insurance. We are in-network for most major US insurance plans and do not balance bill. We have insurance specialists on staff so our patients typically do not need to worry about the insurance side of things themselves.
Answers to more DIEP insurance FAQs can be found here.
Answers to more general DIEP flap FAQ's can be found here.
Dr C
*********
Dr Chrysopoulo, board certified plastic surgeon, PRMA Plastic Surgery, San Antonio, TX. Specializing in breast reconstruction surgery after mastectomy for breast cancer. Over 350 DIEP flaps performed yearly. In-network for most US insurance plans. Toll Free (800) 692-5565. www.prma-Enhance.com. Latest breast reconstruction news available at The Breast Cancer Reconstruction Blog.
*********
Sunday, November 19, 2006
Age Not An Exclusion Criterion for Breast Reconstruction
Breast Reconstruction in Older Women: Should Age Be an Exclusion Criterion?
Plastic & Reconstructive Surgery. 118(1):16-22, July 2006.
Bowman, Cameron C. M.D.; Lennox, Peter A. M.D.; Clugston, Patricia A. M.D. +; Courtemanche, Douglas J. M.D., M.S.
Abstract:
Background: At present, breast reconstruction is undertaken by fewer than 10 percent of breast cancer patients undergoing mastectomy. Even though the benefits are numerous, this finding is even more notable among older women. Traditionally, women older than the age of 60 have been offered implant reconstruction or no reconstruction at all in hopes of minimizing potential morbidity. This practice may be due to a number of factors including a lack of patient education and information, as well as physician/surgeon bias regarding the safety or relevance of breast reconstruction in older women.
Methods: The authors undertook a retrospective study in which they surveyed 75 women (age range, 60 to 77 years) from two surgeons' practices who underwent various forms of breast reconstruction over the past 8 years. Type of reconstruction, recovery time, and complication rate were correlated with patient satisfaction, general health, and quality of life.
Results: An 81 percent response rate was obtained, yielding an average age of 66.6 years over a 3.8-year period. The overall rate of complications requiring operative intervention was 20.5 percent. When asked whether age should be a determining factor for breast reconstruction, more than 90 percent felt that it should not be. Only 16.1 percent of patients who had a delayed reconstruction stated that the option of breast reconstruction was presented to them at the time of their diagnosis, although 100 percent felt that it should have been. A significantly poorer physical health score was found among patients who experienced a complication, and lower mental health scores correlated with women who were less satisfied with their outcome.
Conclusions: The authors believe that all types of reconstruction should be an option for women older than 60 years of age and that age as an isolated factor should not deter physicians from offering these women the option of breast reconstruction.
******
Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including the DIEP flap procedure. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.
******
Plastic & Reconstructive Surgery. 118(1):16-22, July 2006.
Bowman, Cameron C. M.D.; Lennox, Peter A. M.D.; Clugston, Patricia A. M.D. +; Courtemanche, Douglas J. M.D., M.S.
Abstract:
Background: At present, breast reconstruction is undertaken by fewer than 10 percent of breast cancer patients undergoing mastectomy. Even though the benefits are numerous, this finding is even more notable among older women. Traditionally, women older than the age of 60 have been offered implant reconstruction or no reconstruction at all in hopes of minimizing potential morbidity. This practice may be due to a number of factors including a lack of patient education and information, as well as physician/surgeon bias regarding the safety or relevance of breast reconstruction in older women.
Methods: The authors undertook a retrospective study in which they surveyed 75 women (age range, 60 to 77 years) from two surgeons' practices who underwent various forms of breast reconstruction over the past 8 years. Type of reconstruction, recovery time, and complication rate were correlated with patient satisfaction, general health, and quality of life.
Results: An 81 percent response rate was obtained, yielding an average age of 66.6 years over a 3.8-year period. The overall rate of complications requiring operative intervention was 20.5 percent. When asked whether age should be a determining factor for breast reconstruction, more than 90 percent felt that it should not be. Only 16.1 percent of patients who had a delayed reconstruction stated that the option of breast reconstruction was presented to them at the time of their diagnosis, although 100 percent felt that it should have been. A significantly poorer physical health score was found among patients who experienced a complication, and lower mental health scores correlated with women who were less satisfied with their outcome.
Conclusions: The authors believe that all types of reconstruction should be an option for women older than 60 years of age and that age as an isolated factor should not deter physicians from offering these women the option of breast reconstruction.
******
Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including the DIEP flap procedure. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.
******
Saturday, November 18, 2006
Breast Reconstruction Not as Safe For Obese Patients
Significantly obese women may wish to consider delaying breast reconstruction following mastectomy until they achieve a healthier body weight. According to findings presented today at the American Society of Plastic Surgeons (ASPS) Plastic Surgery 2006 conference in San Francisco, women who are significantly obese are at higher risk for complications and have a lower satisfaction rate than do normal and overweight patients.
“Just because someone is overweight doesn’t mean they should not be entitled to undergo breast reconstruction after mastectomy,” said Elisabeth Beahm, MD, ASPS Member Surgeon, author of the study, and associate professor at M. D. Anderson Cancer Center. “Feeling ‘whole’ can be an integral part of recovery from cancer, yet significant concerns have been
raised about the wisdom of doing breast reconstruction in very obese patients due to a high complication rate.”
The current retrospective study found that patients with a BMI greater than 35 demonstrated significantly increased complication rates for all types of breast reconstruction, from implants to flaps. The complication rate approached 100 percent for morbidly obese patients with a BMI over 40.
“We investigated whether plastic surgeons can safely perform breast reconstruction for these patients or if we would be depriving them reconstruction simply because of empiric concerns for their weight,” said Dr. Beahm. “We found that significantly obese patients, those having a BMI of 35 or higher, had a higher risk for complications. Our experience suggests that in many cases it may be more prudent to delay breast reconstruction until the patient has lost weight.”
The most frequent complications for obese patients were fluid collections and infection at both the reconstructive site and the flap donor site. When the flap was harvested from the abdominal area, weakness and deformity of the abdominal wall such as hernia and bulge was much more common than in normal weight patients.
“While it’s very difficult to tell a patient she needs to wait for breast reconstruction, patient safety is our primary concern,” said Dr. Beahm. “We must not compromise the oncologic imperative in breast cancer. Each case must be individualized. Morbidly obese patients need to work with their plastic surgeons and carefully assess risk factors. Patients may be best served by deferring breast reconstruction until they have achieved and maintained a lower BMI through exercise and nutrition.”
For referrals to ASPS Member Surgeons certified by the American Board of Plastic Surgery, call 888-4-PLASTIC (475-2784) or visit www.plasticsurgery.org where you can also learn more about cosmetic and reconstructive plastic surgery.
The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. With more than 6,000 members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.
******
Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including the DIEP flap procedure. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.
******
“Just because someone is overweight doesn’t mean they should not be entitled to undergo breast reconstruction after mastectomy,” said Elisabeth Beahm, MD, ASPS Member Surgeon, author of the study, and associate professor at M. D. Anderson Cancer Center. “Feeling ‘whole’ can be an integral part of recovery from cancer, yet significant concerns have been
raised about the wisdom of doing breast reconstruction in very obese patients due to a high complication rate.”
The current retrospective study found that patients with a BMI greater than 35 demonstrated significantly increased complication rates for all types of breast reconstruction, from implants to flaps. The complication rate approached 100 percent for morbidly obese patients with a BMI over 40.
“We investigated whether plastic surgeons can safely perform breast reconstruction for these patients or if we would be depriving them reconstruction simply because of empiric concerns for their weight,” said Dr. Beahm. “We found that significantly obese patients, those having a BMI of 35 or higher, had a higher risk for complications. Our experience suggests that in many cases it may be more prudent to delay breast reconstruction until the patient has lost weight.”
The most frequent complications for obese patients were fluid collections and infection at both the reconstructive site and the flap donor site. When the flap was harvested from the abdominal area, weakness and deformity of the abdominal wall such as hernia and bulge was much more common than in normal weight patients.
“While it’s very difficult to tell a patient she needs to wait for breast reconstruction, patient safety is our primary concern,” said Dr. Beahm. “We must not compromise the oncologic imperative in breast cancer. Each case must be individualized. Morbidly obese patients need to work with their plastic surgeons and carefully assess risk factors. Patients may be best served by deferring breast reconstruction until they have achieved and maintained a lower BMI through exercise and nutrition.”
For referrals to ASPS Member Surgeons certified by the American Board of Plastic Surgery, call 888-4-PLASTIC (475-2784) or visit www.plasticsurgery.org where you can also learn more about cosmetic and reconstructive plastic surgery.
The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. With more than 6,000 members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.
******
Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including the DIEP flap procedure. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.
******
Breast Reconstruction Helps Cancer Patients Return to Normalcy, According to the American Society of Plastic Surgeons
"It's only a part of my body, not my life," said Lola Sawyers when she was diagnosed with breast cancer in October 1997. The diagnosis was not a shock to Sawyers as her mother had breast cancer.
Lynette Dilbert, whose sister died from breast cancer, was determined not to let the disease take over her life when she was diagnosed in August 2000. "I'm in charge of what I decide," explained Dilbert about her treatment.
Just eight months after Judy Tanner's husband died from a brain tumor in June 1998, she found a lump on her right breast while dressing. Devastated by her husband's death, the diagnosis of breast cancer was hard to bear, but like Sawyers and Dilbert, Tanner would not let the disease take her life.
Through research and discussions with physicians and breast cancer survivors, these women made a firm decision - after mastectomy they would undergo breast reconstruction.
This year, more than 175,000 women in the U.S. will be diagnosed with breast cancer. However, if diagnosed and treated the survival rate is greater than 90 percent. For those women, whose treatment includes either partial or full mastectomy, advances in breast reconstruction and breakthrough legislation helps make this devastating news easier to bear.
"Strength and determination are simple words, yet they are strong terms that truly describe Lola, Lynette and Judy," said American Society of Plastic Surgeons President Walter Erhardt, MD, Albany, Ga., about his patients. "Choosing breast reconstruction is a big decision when facing this life-altering disease, but as any plastic surgeon can tell you, after breast reconstruction, survivors have a renewed sense of self-esteem and confidence.
"After breast reconstruction, no one can tell I had cancer," explained Dilbert. Tanner noted that she felt like a whole woman again. "I'm looking better than I did before," she said. "Even my co-workers have noticed a positive change in me."
Nearly 79,000 breast reconstruction procedures were performed last year, a 166 percent increase since 1992. The passage of the Women's Health and Cancer Rights Act of 1998 has aided this increase. The law mandates insurance coverage for breast reconstruction and the alteration of the opposite breast for symmetry for women who have undergone mastectomy. The law applies to women with group health insurance or a health insurance plan purchased through a health insurance company.
Discussion about breast reconstruction can start immediately after diagnosis. Typically, plastic surgeons make recommendations based upon the patient's age, health, anatomy, tissues and goals. The most common procedures include skin expansion followed by the use of implants, or flap reconstruction.
"Breast reconstruction gives patients the ability to feel whole again," said Dr. Erhardt. "As a plastic surgeon it's rewarding to see my patients develop a renewed confidence and love of life."
When confronted with breast cancer, Sawyers, who is known as the lemonade lady in her community because she's taken life's lemons and made lemonade, reminds woman to look at all the options. "Make reconstruction a personal choice based on what you believe and what you know," she says. "Let the final decision be yours."
"Loosing a breast is not the end of the world," said Dilbert who is active in her community's breast cancer advocacy programs. "I constantly remind women to schedule their mammograms."
Tanner strongly advises women to ask questions when choosing reconstruction. "Find out all you can about the surgeon's credentials, talk to other patients and do your homework," she reminds.
ASPS, founded in 1931, is the largest plastic surgery organization in the world and the foremost authority on cosmetic and reconstructive plastic surgery. ASPS represents physicians certified by The American Board of Plastic Surgery (ABPS) or The Royal College of Physicians and Surgeons of Canada. For referrals to ABPS-certified plastic surgeons in your area and to learn more about cosmetic and reconstructive plastic surgery, call the ASPS at (888) 4-PLASTIC (1-888-475-2784) or visit www.plasticsurgery.org.
******
Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including the DIEP flap procedure. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.
******
Lynette Dilbert, whose sister died from breast cancer, was determined not to let the disease take over her life when she was diagnosed in August 2000. "I'm in charge of what I decide," explained Dilbert about her treatment.
Just eight months after Judy Tanner's husband died from a brain tumor in June 1998, she found a lump on her right breast while dressing. Devastated by her husband's death, the diagnosis of breast cancer was hard to bear, but like Sawyers and Dilbert, Tanner would not let the disease take her life.
Through research and discussions with physicians and breast cancer survivors, these women made a firm decision - after mastectomy they would undergo breast reconstruction.
This year, more than 175,000 women in the U.S. will be diagnosed with breast cancer. However, if diagnosed and treated the survival rate is greater than 90 percent. For those women, whose treatment includes either partial or full mastectomy, advances in breast reconstruction and breakthrough legislation helps make this devastating news easier to bear.
"Strength and determination are simple words, yet they are strong terms that truly describe Lola, Lynette and Judy," said American Society of Plastic Surgeons President Walter Erhardt, MD, Albany, Ga., about his patients. "Choosing breast reconstruction is a big decision when facing this life-altering disease, but as any plastic surgeon can tell you, after breast reconstruction, survivors have a renewed sense of self-esteem and confidence.
"After breast reconstruction, no one can tell I had cancer," explained Dilbert. Tanner noted that she felt like a whole woman again. "I'm looking better than I did before," she said. "Even my co-workers have noticed a positive change in me."
Nearly 79,000 breast reconstruction procedures were performed last year, a 166 percent increase since 1992. The passage of the Women's Health and Cancer Rights Act of 1998 has aided this increase. The law mandates insurance coverage for breast reconstruction and the alteration of the opposite breast for symmetry for women who have undergone mastectomy. The law applies to women with group health insurance or a health insurance plan purchased through a health insurance company.
Discussion about breast reconstruction can start immediately after diagnosis. Typically, plastic surgeons make recommendations based upon the patient's age, health, anatomy, tissues and goals. The most common procedures include skin expansion followed by the use of implants, or flap reconstruction.
"Breast reconstruction gives patients the ability to feel whole again," said Dr. Erhardt. "As a plastic surgeon it's rewarding to see my patients develop a renewed confidence and love of life."
When confronted with breast cancer, Sawyers, who is known as the lemonade lady in her community because she's taken life's lemons and made lemonade, reminds woman to look at all the options. "Make reconstruction a personal choice based on what you believe and what you know," she says. "Let the final decision be yours."
"Loosing a breast is not the end of the world," said Dilbert who is active in her community's breast cancer advocacy programs. "I constantly remind women to schedule their mammograms."
Tanner strongly advises women to ask questions when choosing reconstruction. "Find out all you can about the surgeon's credentials, talk to other patients and do your homework," she reminds.
ASPS, founded in 1931, is the largest plastic surgery organization in the world and the foremost authority on cosmetic and reconstructive plastic surgery. ASPS represents physicians certified by The American Board of Plastic Surgery (ABPS) or The Royal College of Physicians and Surgeons of Canada. For referrals to ABPS-certified plastic surgeons in your area and to learn more about cosmetic and reconstructive plastic surgery, call the ASPS at (888) 4-PLASTIC (1-888-475-2784) or visit www.plasticsurgery.org.
******
Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including the DIEP flap procedure. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.
******
Breast Cancer and Reconstruction: Exploring the Options, Procedures and Perceptions
By Lisa Barclay
Breast cancer. It is the leading cancer diagnosed in women in America. This year, it will affect the lives of more than 180,000 women for the first time – and end the lives of 40,000 more. Thanks to proactive efforts like National Breast Cancer Awareness Month celebrated in October, the disease doesn't automatically mean a death sentence. However, the impact breast cancer has on the lives of its victims is arguably life altering – and not easily erased.
In this article, we will share the experiences of five women who have survived the disease, as well as the expertise of several American Society of Plastic Surgeons (ASPS) members who specialize in breast reconstruction after breast cancer. It is our hope that the information presented in this article will serve as a valuable resource in your journey through breast cancer treatment and recovery.
A Diagnosis of Cancer
Fear. Shock. Denial. These are just a few of the emotions women experience upon learning they have breast cancer. Jayne Siebold, of Hinsdale, Ill., was 49 when she was diagnosed with the disease and explains her initial reaction to the news. "When the doctor confirmed it was cancer, I remember thinking, 'They can't be talking about me, this must be a mistake.' Then the fear kicked in."
Barbara Taylor of Dallas went into physical shock. "Everyone I had ever known or heard of who had the disease died from it. So the fear I experienced initially was completely overwhelming, virtually crippling."
When Sue Kocsis of Omaha, Neb., was diagnosed she was 34 years old and the mother of three little girls. "The entire process was extremely overwhelming. It took visits to five different physicians before the cancer was actually diagnosed, so in the beginning I was relieved to know just what I was dealing with – but felt a tremendous amount of anger toward the doctors who kept telling me it was just fibrocystic disease and nothing to worry about."
The treatment of breast cancer involves a physical change to the body. As a result, it can have a profound psychological impact. "A woman's breasts are deeply rooted in her sense of femininity...her role as mother and nurturer, " says Jack Bruner, M.D., of Sacramento, Calif. "Therefore, facing the loss of one or both breasts can be very traumatic." Dr. Bruner recommends that every women diagnosed with breast cancer request information about reconstructive options from their general surgeon and seek the opinions of several plastic surgeons prior to surgery.
Reconstructive Solutions
Almost any woman who loses her breast to cancer can have it rebuilt through reconstructive surgery. And discussion about reconstruction can start immediately after diagnosis. Ideally, you'll want your breast surgeon and your plastic surgeon to work together to develop a strategy that will put you in the best possible condition for reconstruction.
There are several reconstructive options available after mastectomy. Typically, your plastic surgeon will make a recommendation based upon your age, health, anatomy, tissues and goals. The most common procedures include skin expansion followed by the use of implants or flap reconstruction.
Flap reconstruction is a more complex procedure than skin expansion. Scars will be left at both the tissue donor site and at the reconstructed site, and recovery time is longer than with an implant. However, when the breast is reconstructed with one's own tissue, the results are generally more natural and concerns related to implants are non-existent. Recovery times for both procedures range from six months to one year, or longer, depending on individual circumstances.
Skin Expansion
This common technique combines skin expansion and subsequent insertion of an implant. Following mastectomy, your plastic surgeon will insert a balloon expander beneath the skin and chest muscle. Through a tiny valve mechanism buried beneath the skin, he or she will periodically inject a salt-water solution to gradually fill the expander over several weeks or months. After the skin over the breast area has been sufficiently stretched, the expander is removed in a second operation and a more permanent implant – either saline or silicone – will be inserted. Some expanders are designed to be left in place as the final implant. The nipple and dark skin surrounding it – called the areola – are reconstructed in a subsequent procedure.
Flap Reconstruction
An alternative approach to implant reconstruction involves creation of a skin flap using tissue taken from other parts of the body, such as the abdomen, back or buttocks. In one type of flap surgery, the tissue remains attached to its original site, retaining its blood supply. The flap, consisting of skin, fat and muscle with its blood supply, are tunneled beneath the skin to the chest, creating a pocket for an implant or, in some cases, creating the breast mound itself without need for an implant. Another flap technique uses tissue that is surgically removed from the abdomen, thighs or buttocks and then transplanted to the chest by reconnecting the blood vessels to new ones in that region.
Making the Choice
Breast cancer affects women differently depending on their age, marital status and self-image, as does their attitudes about reconstruction. No matter how they feel about it, Glenn Davis, M.D., of Raleigh, N.C., stresses that "every woman should be afforded the choice of undergoing reconstruction as part of her breast cancer treatment, and provided adequate facts to make an informed decision.
Unfortunately, many women are not given the option or the information they need to make an informed decision about reconstruction. According to Christine Horner-Taylor, M.D., of Edgewook, Ky., the women who don't undergo reconstruction procedures after losing a breast to mastectomy have many reasons for doing so. "Many women have told me the reason they didn't have breast reconstruction was because their general surgeon didn't recommend it or didn't mention that it could be done at the same time as the mastectomy. If the women are older, their surgeon may have decided they don't really need to go through it," she says.
Other reasons women pass on reconstruction include their unwillingness to have any more surgery than is absolutely necessary and an inability to weigh all the options available while they're struggling to cope with a diagnosis of cancer.
When Reconstruction May Not Be an Option
Not all women are good candidates for breast reconstruction. According to Dr. Horner-Taylor, "Women who have had a mastectomy or Lumpectomy with radiation are typically not strong candidates for skin expansion reconstruction. Radiation changes the characteristics of skin tissue, causing a variety of complications ranging from excessive scar tissue development, to blood supply and overall healing problems."
Dr. Davis feels that while radiation does present some difficult challenges, it doesn't automatically rule out the possibility of reconstruction. "While each circumstance is different, I strongly believe that if there is enough good tissue to work with, reconstruction remains a viable option for most women," he says.
Dr. Bruner notes that patients that are emotionally unstable should probably postpone reconstruction. "Coping with the reality of breast cancer is an extremely overwhelming process. If a woman cannot understand the risks and limitations of reconstruction prior to her mastectomy surgery, I would recommend she wait."
Managing Misconceptions
Misconceptions abound regarding breast cancer reconstruction. "Most misconceptions are fueled by a lack of information," says Dr. Bruner.
Common misconceptions include having to wait up to one year to safely undergo reconstruction, reconstruction makes it difficult to identify cancer if it recurs, and reconstruction interferes with cancer treatments, such as chemotherapy.
"Wrong on all counts," says Dr. Horner-Taylor. "Reconstruction can take place immediately following mastectomy with little complication. In the case of implants, reconstruction may take longer if the patient has to undergo chemotherapy, but otherwise doesn't interfere with the process."
Managing Expectations
Managing patient expectations is one of the most important aspects of breast cancer reconstruction. It is important for women to remember that the goal of reconstruction is improvement, not perfection. "Be sure to discuss your expectations candidly with your plastic surgeon, and expect nothing less than total honesty from him or her in return," says Dr. Horner-Taylor. "It's always smart to get the opinions of several plastic surgeons before moving ahead."
To ensure reconstructive surgery has the desired outcome, breast symmetry procedures – surgery to the other breast – is usually also part of the reconstructive process. "Symmetry procedures either reduce, lift or reshape the remaining breast to ensure a better match to the reconstructed breast," says Dr. Bruner. He goes on to note that symmetry procedures can be an ongoing process, with periodic adjustments necessary to correct the affects of the aging process. ASPS is currently pushing for legislation to ensure women have access to symmetry procedures as part of their reconstruction treatment after breast cancer.
Dolores Glover, Siebold and Kocsis all decided to undergo reconstruction procedures – Siebold at the same time as her mastectomy, Glover 10 years later and Kocsis one year later. Glover and Siebold opted for skin expansion with implants. Kocsis decided to go with flap reconstruction.
"Breast reconstruction was the number one motivation that got me through the most difficult times of my treatment," says Siebold. "The breast reconstruction, although excellent, will never look or feel the same as a natural breast. However, not having to stuff my bra with fillers is a great relief, and I truly feel like a complete woman again."
Glover was never given the option of reconstruction at the time her cancer was diagnosed and her mastectomy performed. She was 38. "I was so busy being a mom to my two children and a wife that I didn't think about reconstruction initially. I also didn't want to endure any more pain or surgery, although my oncologist strongly recommended it," she says. However, every time she caught a glimpse of herself in the mirror, she was reminded of her disfigurement. "I felt deformed, and that feeling never went away until I had reconstruction. I eventually did use a prosthesis, but still wasn't happy with the results." Ten years after her mastectomy, Glover finally decided to have breast reconstruction. "I'm glad I had it done. It helped me to find closure and feel normal again."
For Kocsis, breast reconstruction was a completely mind restorative process. "The day I had my reconstructive surgery was the day I took my life back," she says. She first learned about flap reconstruction through a local support group and decided to undergo the procedure one year after her diagnosis. "I liked the idea of using natural tissue for the reconstruction, and once I made the decision to have surgery, I actually looked forward to having it done." The reconstruction was a success and Kocsis is thrilled with her results. "I really feel great about my decision and the end result. In fact, my family and I celebrate the date of my surgery every year as my re-birthday." Kocsis is now active in public education efforts for breast cancer and reconstruction, writing articles, conducting interviews and giving presentations.
Davis decided not to undergo reconstruction, although she was prepared to go through with it until the day before her mastectomy. "I just decided that I didn't want to be under anesthesia or on the operating table that long," she says. And five years later, she's confident she made the right decision. "It was more important to me to focus on treating the cancer. My breasts are not that important to me, they don't define who I am as a person."
Making An Informed Decision
The decision to undergo breast reconstruction is an intensely personal one. All of the ASPS members interviewed for this article agree that the decision should be made by the patient, not by treating physicians. "It really is a quality of life issue," says Dr. Davis. "And it doesn't matter how old the patient is or if they're married or single. All women should have the option, if they want it."
The most important tool available to women coping with breast cancer is information. "Women need to get as much information as they can, from doctors, cancer organizations, support groups and other women," says Dr. Bruner. "And they shouldn't be afraid to ask the tough questions, as many as necessary to increase their comfort level with their treatment and aid in their recovery process."
To learn more about your breast reconstruction options CLICK HERE.
For more information about breast cancer, call any of the following toll-free numbers:
American Cancer Society
1-800-ACS-2345
Cancer Care, Inc.
1-800-813-HOPE
Cancer Research Foundation of America
1-800-227-2732
National Alliance of Breast Cancer Organizations (NABCO)
1-800-719-9154
National Cancer Institute's Cancer Information Service
1-800-4-CANCER
Y-ME National Breast Cancer Organization
1-800-221-2141
******
Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including the DIEP flap procedure. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.
******
Breast cancer. It is the leading cancer diagnosed in women in America. This year, it will affect the lives of more than 180,000 women for the first time – and end the lives of 40,000 more. Thanks to proactive efforts like National Breast Cancer Awareness Month celebrated in October, the disease doesn't automatically mean a death sentence. However, the impact breast cancer has on the lives of its victims is arguably life altering – and not easily erased.
In this article, we will share the experiences of five women who have survived the disease, as well as the expertise of several American Society of Plastic Surgeons (ASPS) members who specialize in breast reconstruction after breast cancer. It is our hope that the information presented in this article will serve as a valuable resource in your journey through breast cancer treatment and recovery.
A Diagnosis of Cancer
Fear. Shock. Denial. These are just a few of the emotions women experience upon learning they have breast cancer. Jayne Siebold, of Hinsdale, Ill., was 49 when she was diagnosed with the disease and explains her initial reaction to the news. "When the doctor confirmed it was cancer, I remember thinking, 'They can't be talking about me, this must be a mistake.' Then the fear kicked in."
Barbara Taylor of Dallas went into physical shock. "Everyone I had ever known or heard of who had the disease died from it. So the fear I experienced initially was completely overwhelming, virtually crippling."
When Sue Kocsis of Omaha, Neb., was diagnosed she was 34 years old and the mother of three little girls. "The entire process was extremely overwhelming. It took visits to five different physicians before the cancer was actually diagnosed, so in the beginning I was relieved to know just what I was dealing with – but felt a tremendous amount of anger toward the doctors who kept telling me it was just fibrocystic disease and nothing to worry about."
The treatment of breast cancer involves a physical change to the body. As a result, it can have a profound psychological impact. "A woman's breasts are deeply rooted in her sense of femininity...her role as mother and nurturer, " says Jack Bruner, M.D., of Sacramento, Calif. "Therefore, facing the loss of one or both breasts can be very traumatic." Dr. Bruner recommends that every women diagnosed with breast cancer request information about reconstructive options from their general surgeon and seek the opinions of several plastic surgeons prior to surgery.
Reconstructive Solutions
Almost any woman who loses her breast to cancer can have it rebuilt through reconstructive surgery. And discussion about reconstruction can start immediately after diagnosis. Ideally, you'll want your breast surgeon and your plastic surgeon to work together to develop a strategy that will put you in the best possible condition for reconstruction.
There are several reconstructive options available after mastectomy. Typically, your plastic surgeon will make a recommendation based upon your age, health, anatomy, tissues and goals. The most common procedures include skin expansion followed by the use of implants or flap reconstruction.
Flap reconstruction is a more complex procedure than skin expansion. Scars will be left at both the tissue donor site and at the reconstructed site, and recovery time is longer than with an implant. However, when the breast is reconstructed with one's own tissue, the results are generally more natural and concerns related to implants are non-existent. Recovery times for both procedures range from six months to one year, or longer, depending on individual circumstances.
Skin Expansion
This common technique combines skin expansion and subsequent insertion of an implant. Following mastectomy, your plastic surgeon will insert a balloon expander beneath the skin and chest muscle. Through a tiny valve mechanism buried beneath the skin, he or she will periodically inject a salt-water solution to gradually fill the expander over several weeks or months. After the skin over the breast area has been sufficiently stretched, the expander is removed in a second operation and a more permanent implant – either saline or silicone – will be inserted. Some expanders are designed to be left in place as the final implant. The nipple and dark skin surrounding it – called the areola – are reconstructed in a subsequent procedure.
Flap Reconstruction
An alternative approach to implant reconstruction involves creation of a skin flap using tissue taken from other parts of the body, such as the abdomen, back or buttocks. In one type of flap surgery, the tissue remains attached to its original site, retaining its blood supply. The flap, consisting of skin, fat and muscle with its blood supply, are tunneled beneath the skin to the chest, creating a pocket for an implant or, in some cases, creating the breast mound itself without need for an implant. Another flap technique uses tissue that is surgically removed from the abdomen, thighs or buttocks and then transplanted to the chest by reconnecting the blood vessels to new ones in that region.
Making the Choice
Breast cancer affects women differently depending on their age, marital status and self-image, as does their attitudes about reconstruction. No matter how they feel about it, Glenn Davis, M.D., of Raleigh, N.C., stresses that "every woman should be afforded the choice of undergoing reconstruction as part of her breast cancer treatment, and provided adequate facts to make an informed decision.
Unfortunately, many women are not given the option or the information they need to make an informed decision about reconstruction. According to Christine Horner-Taylor, M.D., of Edgewook, Ky., the women who don't undergo reconstruction procedures after losing a breast to mastectomy have many reasons for doing so. "Many women have told me the reason they didn't have breast reconstruction was because their general surgeon didn't recommend it or didn't mention that it could be done at the same time as the mastectomy. If the women are older, their surgeon may have decided they don't really need to go through it," she says.
Other reasons women pass on reconstruction include their unwillingness to have any more surgery than is absolutely necessary and an inability to weigh all the options available while they're struggling to cope with a diagnosis of cancer.
When Reconstruction May Not Be an Option
Not all women are good candidates for breast reconstruction. According to Dr. Horner-Taylor, "Women who have had a mastectomy or Lumpectomy with radiation are typically not strong candidates for skin expansion reconstruction. Radiation changes the characteristics of skin tissue, causing a variety of complications ranging from excessive scar tissue development, to blood supply and overall healing problems."
Dr. Davis feels that while radiation does present some difficult challenges, it doesn't automatically rule out the possibility of reconstruction. "While each circumstance is different, I strongly believe that if there is enough good tissue to work with, reconstruction remains a viable option for most women," he says.
Dr. Bruner notes that patients that are emotionally unstable should probably postpone reconstruction. "Coping with the reality of breast cancer is an extremely overwhelming process. If a woman cannot understand the risks and limitations of reconstruction prior to her mastectomy surgery, I would recommend she wait."
Managing Misconceptions
Misconceptions abound regarding breast cancer reconstruction. "Most misconceptions are fueled by a lack of information," says Dr. Bruner.
Common misconceptions include having to wait up to one year to safely undergo reconstruction, reconstruction makes it difficult to identify cancer if it recurs, and reconstruction interferes with cancer treatments, such as chemotherapy.
"Wrong on all counts," says Dr. Horner-Taylor. "Reconstruction can take place immediately following mastectomy with little complication. In the case of implants, reconstruction may take longer if the patient has to undergo chemotherapy, but otherwise doesn't interfere with the process."
Managing Expectations
Managing patient expectations is one of the most important aspects of breast cancer reconstruction. It is important for women to remember that the goal of reconstruction is improvement, not perfection. "Be sure to discuss your expectations candidly with your plastic surgeon, and expect nothing less than total honesty from him or her in return," says Dr. Horner-Taylor. "It's always smart to get the opinions of several plastic surgeons before moving ahead."
To ensure reconstructive surgery has the desired outcome, breast symmetry procedures – surgery to the other breast – is usually also part of the reconstructive process. "Symmetry procedures either reduce, lift or reshape the remaining breast to ensure a better match to the reconstructed breast," says Dr. Bruner. He goes on to note that symmetry procedures can be an ongoing process, with periodic adjustments necessary to correct the affects of the aging process. ASPS is currently pushing for legislation to ensure women have access to symmetry procedures as part of their reconstruction treatment after breast cancer.
Dolores Glover, Siebold and Kocsis all decided to undergo reconstruction procedures – Siebold at the same time as her mastectomy, Glover 10 years later and Kocsis one year later. Glover and Siebold opted for skin expansion with implants. Kocsis decided to go with flap reconstruction.
"Breast reconstruction was the number one motivation that got me through the most difficult times of my treatment," says Siebold. "The breast reconstruction, although excellent, will never look or feel the same as a natural breast. However, not having to stuff my bra with fillers is a great relief, and I truly feel like a complete woman again."
Glover was never given the option of reconstruction at the time her cancer was diagnosed and her mastectomy performed. She was 38. "I was so busy being a mom to my two children and a wife that I didn't think about reconstruction initially. I also didn't want to endure any more pain or surgery, although my oncologist strongly recommended it," she says. However, every time she caught a glimpse of herself in the mirror, she was reminded of her disfigurement. "I felt deformed, and that feeling never went away until I had reconstruction. I eventually did use a prosthesis, but still wasn't happy with the results." Ten years after her mastectomy, Glover finally decided to have breast reconstruction. "I'm glad I had it done. It helped me to find closure and feel normal again."
For Kocsis, breast reconstruction was a completely mind restorative process. "The day I had my reconstructive surgery was the day I took my life back," she says. She first learned about flap reconstruction through a local support group and decided to undergo the procedure one year after her diagnosis. "I liked the idea of using natural tissue for the reconstruction, and once I made the decision to have surgery, I actually looked forward to having it done." The reconstruction was a success and Kocsis is thrilled with her results. "I really feel great about my decision and the end result. In fact, my family and I celebrate the date of my surgery every year as my re-birthday." Kocsis is now active in public education efforts for breast cancer and reconstruction, writing articles, conducting interviews and giving presentations.
Davis decided not to undergo reconstruction, although she was prepared to go through with it until the day before her mastectomy. "I just decided that I didn't want to be under anesthesia or on the operating table that long," she says. And five years later, she's confident she made the right decision. "It was more important to me to focus on treating the cancer. My breasts are not that important to me, they don't define who I am as a person."
Making An Informed Decision
The decision to undergo breast reconstruction is an intensely personal one. All of the ASPS members interviewed for this article agree that the decision should be made by the patient, not by treating physicians. "It really is a quality of life issue," says Dr. Davis. "And it doesn't matter how old the patient is or if they're married or single. All women should have the option, if they want it."
The most important tool available to women coping with breast cancer is information. "Women need to get as much information as they can, from doctors, cancer organizations, support groups and other women," says Dr. Bruner. "And they shouldn't be afraid to ask the tough questions, as many as necessary to increase their comfort level with their treatment and aid in their recovery process."
To learn more about your breast reconstruction options CLICK HERE.
For more information about breast cancer, call any of the following toll-free numbers:
American Cancer Society
1-800-ACS-2345
Cancer Care, Inc.
1-800-813-HOPE
Cancer Research Foundation of America
1-800-227-2732
National Alliance of Breast Cancer Organizations (NABCO)
1-800-719-9154
National Cancer Institute's Cancer Information Service
1-800-4-CANCER
Y-ME National Breast Cancer Organization
1-800-221-2141
******
Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including the DIEP flap procedure. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.
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