Breast reconstruction can help restore the look and feel of the breast after a mastectomy. Performed by a plastic surgeon, breast reconstruction can be done at the same time as the mastectomy (“immediate”) or at a later date (“delayed”).
Breast reconstruction is an option available to most women confronted with the physical changes following mastectomy. While breast reconstruction is considered elective surgery, undergoing breast reconstruction can have profound emotional and practical benefits. It is also important to keep in mind that breast reconstruction does not interfere with the treatment of breast cancer or surveillance for recurrence. It can, however, help to enhance a woman’s confidence and self-image after mastectomy.
In PART 1 of this article, Dr Matthew Peters explained the psychological benefits that a breast reconstruction after a mastectomy may provide. In this article he details the many exciting developments in breast reconstruction. Just a few worth noting are:
Allografts: An allograft is a term used to describe an organ or tissue donated from one individual to another.
“The allograft I prefer is a suppler, elastic allograft specifically for use in restorative breast surgery and is used to supplement remaining breast tissue,” Explains Dr Peters. “It can provide support for the soft tissue and help prevent the implant from extruding through the skin. This allograft is not only a strong tissue substitute, it also supports the natural, full regrowth of the patient’s own tissue, a process called tissue regeneration.
“In the long term, allografts can lead to less surgical revisions caused by obvious protrusions, rippling, muscle animation or contractions.”
More choice than ever in surface, shape, size, base and projection of implants:
Traditionally, breast implant surfaces have been either smooth or textured. Textured surfaces have been manufactured by projecting salt, sugar or other particles on the implant shell. Lately, several studies have shown that aggressive textures, which are typically obtained with such materials, can have secondary effects for women.
“Several types of implants are now available that create unique surfaces obtained without the use of foreign materials like salt or sugar, but instead are created with a controlled process designed for a better biocompatibility,” says Dr Peters. “Additionally, these nano-surfaces promote a more natural interaction between the implant and the surrounding tissue, allowing the implant to better adapt to the normal movement of the breast.”
The implant’s shape has also evolved dramatically over the last few years and in addition to implant shape, plastic surgeons can now guide their patients to consider size, base and projection in order to achieve the desired breast aesthetic outcome. The base of the implant will define the resulting cleavage, the fullness is determined by the implant projection and the cup by the implant volume.
Self-managed tissue expanders:
These devices are game-changing and allow the patient greater control over their own body. For patients in remote locations or who find it difficult to attend frequent clinical appointments, the self-management devices are certainly less onerous, with less disruptions to daily routine and less painful than receiving injections for larger expansion doses.
“The self-managed tissue expander system I prefer to use with my patients is comprised of two primary components: the tissue expander itself and the dosage controller,” explains Dr Peters. “With one press of the single-touch button, the controller syncs with the expander and a dose of 10cc of carbon dioxide is released, allowing the expander to gradually expand.”
“Fat grafting techniques are getting better and better with the new equipment available,” Says Dr Peters.
Autologous fat grafting increasingly plays a role in breast reconstruction and flexibility comes into play because the contours of a reconstructed breast mound may lead to step-offs in the reconstruction. The flexibility of fat gives surgeons the ability to sculpt and reconstruct the breast so that there is a more gradual contour from chest wall to breast mound.
“I think the range of possibilities in breast reconstruction is widely unknown and under-estimated – certainly by the general public and to a large extend amongst surgeons – and it can become a barrier to women seeking reconstruction,” Says Dr Peters. “Many women have an outdated notion of what a breast reconstruction will look and feel like and decide it’s not worth the perceived hassle to go down that path and that’s a shame because the psychological benefits a reconstruction can bring are tremendous.