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Archive for May, 2009

Breast Reconstruction Information

Saturday, May 2nd, 2009

Breast cancer remains a significant disease, effecting 1 in 8 American women. More than 57,000 breast reconstruction procedures were performed in 2007. Seventy-five percent of women who have mastectomies have surgical reconstruction of one or both breasts.

Immediate vs. Delayed Reconstruction:

Reconstruction can be immediate, (at time of the mastectomy), or delayed until after the mastectomy wound has healed. Advantages of immediate reconstruction are that the patient wakes up with a breast mound. Delayed reconstruction occurs frequently, as women complete adjuvant treatments, (i.e.; radiation, chemotherapy), or women who have had mastectomies years ago find out about new options they may not have had when they were going through the process.

Expander/Implant vs. Autogolus, (One’s own tissue).

One way to make a new breast is placing an expander in the breast pocket at the time of the mastectomy. This allows the Plastic Surgeon to fill the expander until the skin and soft tissue size is right. Typically one takes out the expander and places an implant.
Using one’s own tissue is another option. This is where tissue can be rotated from one area of the body to another to make a breast mound. There is now an expanding interest in free tissue transfer. This is where the tissue to be used is dissected from one area of the body and then “plugged in” to another area, (artery to artery, vein to vein, etc).

Nipple Reconstruction:

This is usually one of the last stages. A popular way is to make a little flap from surrounding tissue to make a nipple. The new nipple and areola can later be colored in professionally to match the other side.

How to find a Reconstructive Surgeon:

Your breast surgeon may have a plastic surgeon that he often works with. You can ask him for a recommendation. Also, it may be a good idea to get more than one opinion.
Look to see if your reconstructive surgeon is Board Certified by the American Board of Plastic Surgery. All of the members of The American Society of Plastic Surgeons are Board Certified and have been trained in breast reconstruction. They have a convenient surgeon finder feature. www.plasticsurgery.org

Top 10 Questions About Breast Augmentation

Friday, May 1st, 2009

1. Why do women get breast augmentation, and who is a candidate?

To enhance the body contour of a woman who feels her breast size is too small. In addition to positive aesthetic results, data has shown women often receive a substantial psychological boost.(1)

To correct a reduction in breast volume.

To balance a difference in breast size.

For reconstruction after breast surgery.(2)

Candidates are women who are looking for improvement, (not perfection).  One should be physically healthy, and have realistic expectations.  Sometimes just the augmentation will address the issue, other times a lift is needed.  Goals should be discussed with your Plastic Surgeon, as each individual is different. (2)

2. How many breast augmentations are done in the United States?

There were 355,671 done in the United States in 2008.

It is the most popular cosmetic surgery overall, (replacing liposuction this year).(1)

There is a very high satisfaction rate (93%), (average follow-up 13 years). (3)

3. Where will the scar be?

Options include: axillae, (armpit), inframammary fold, (under the breast), or peri-areolar, (around the nipple/areola complex).  Incision placement will depend on multiple factors including your particular anatomy, tissues, and goals.

4. How long does the procedure take, what is the recovery time, and pain involved?

Operating time is usually 1 to 1-1/2 hours, depending on multiple factors; surgical approach, amount of dissection, etc.  You’ll wake up in the recovery room and typically go home after that.

Recovery time depends on your specific operation, and the work that you do.  Stitches are usually removed a week after surgery.  Most are back to work in around 10 days or so.

The discomfort is usually well tolerated. We also offer the option of placing a “pain pump” during the procedure.  The pump, (which comes in a fanny pack), will drizzle out medicine into the pocket.  It is simply removed in 2-3 days.  Patients with the pump typically take less pain medicine and are more active earlier.

5. Can breast implants leak?

Implant failures are rare, (reported to be 1-3% over many years).  Implants are filled with saline, (basically sterile salt water), which will be absorbed and then excreted in the urine. The implant is then replaced.  The current silicone implants are made of a more cohesive gel, (Think gummi-bear).  If there is a tear in the implant, the gel is designed not to leak out of the implant.  The implant should still be replaced.

6. Do implants pose a problem for mammography?

Implants do not cause inaccurate mammography.  The person doing the mammogram needs to know that you have breast implants, and then they can take the extra, (displacement), views.

7. Do breast implants affect pregnancy or breast feeding?

As of this writing, there is no evidence that breast implants affect pregnancy or ability to breast-feed.  Pregnancy can alter breast size in an unpredictable way and could affect the long-term results of breast augmentation.(1)

8. Can fat be taken from one area of the body and placed into the breasts?

No.  Fat placed into breast tissue will sometimes calcify.  These small calcifications may be seen on a mammogram and taken as a sign of cancer.  Women may then go through a breast biopsy that they did not need.

9. How old do I have to be to have breast augmentation?

As of May 2000, Federal regulation prohibits breast augmentation for purely aesthetic surgery in women less than 18 years of age.(1)

10. Are there systemic effects of breast implants?

As of this writing, there is no scientific evidence that breast augmentation increases the risk of breast cancer, autoimmune disease, or any systemic illness.(1)  Studies have shown that the incidence of breast cancer in women with breast augmentation is actually lower than average. This may be due to multiple factors.

Remember, this is elective surgery.  That means that you’re the boss.  It is important to like the Plastic Surgeon, and the office staff, that you choose.

If you have any questions about breast augmentation, or Plastic Surgery in general, please give me a call.

Jeffrey J. Roth, M.D., F.A.C.S.
Las Vegas Plastic Surgery
Board Certified:
American Board of Surgery
American Board of Plastic Surgery

www.jjrothmd.com
702-450-0777
9280 W. Sunset Rd.  Suite 236
Las Vegas, NV 89148

Sources:
(1) American Society for Aesthetic Plastic Surgery (ASAPS).
(2) American Society of Plastic Surgeons (ASPS).
(3) Cunningham BL, Lokeh A, Gutowski KA.  Saline-filled breast implant safety and efficacy:  a multicenter retrospective review.  Plas Reconstr Surg.  2000. May 105(6):2143-9.