Los Angeles Breast Reconstruction
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by: jelewis8
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Restoration or reconstruction of a breast has greatly advanced since the days of the radical mastectomy.
If a woman is a good candidate for reconstruction, she can usually
expect a breast mound that will fill a bra cup to her desired volume,
along with a nipple and areola, if desired. The opposite breast can be
made to match by augmentation, reduction or lifting. These procedures
are covered by insurance, as mandated by law. In addition, significant
breast symmetry as a result of lumpectomy/radiation or multiple
biopsies can be corrected with reconstructive surgery.
The word "can" is used because breast reconstruction is a matter of
choice. Some women choose to wear a breast prosthesis with their bra.
Others may choose reconstruction, which is not limited to one's age.
The overall health condition and status of the cancer are the issues
that determine feasibility.
Consultation with a plastic surgeon prior to mastectomy is part of a
comprehensive breast care center program. The patient should be fully
informed of her options for immediate versus delayed breast
reconstruction. The technique(s) recommended are based upon her
anatomy, medical background and anticipated future cancer treatments.
Decision-making in breast reconstruction begins with the
simple question of whether breast reconstruction will be part of the
woman's recovery process.
Some women know the answer immediately; others need days or
weeks to decide. Once the decision is made to go ahead with the
procedure, the next question is which technique to select. In each
case, the decision is based upon surgical preference and which
technique will be better in the face of any anticipated treatments of
chemotherapy and/or radiation therapy.
The two most common types of breast reconstruction are the
tissue expander/implant technique and the transverse abdominus
musculoctaneous (TRAM) flap. A third technique is the latissimus dorsi
musculocutaneous flap with a breast implant. The table shown here
summarizes and compares these techniques.
With the plastic surgeon's guidance, the most appropriate technique can
be selected for breast reconstruction, taking into account the desires,
health status and unique anatomy of the individual woman.
The expander/implant technique requires two stages. The first
stage of this breast reconstruction is placement of the tissue expander
below the pectoralis chest muscle. This procedure adds less than one
hour to the mastectomy time with the same overnight hospital stay.
The second stage is the exchange of the tissue expander for
the permanent saline or silicone gel filled breast implant. This stage
requires general anesthesia, but is usually less than one hour in
duration unless a procedure on the opposite breast is added.
Breast implants are confirmed safe by multiple medical
studies. Both saline and gel filled breast implants were released years
ago by the Food and Drug Administration (FDA) to be used for breast
reconstruction and for replacement of older or present gel implants.
The TRAM flap technique uses autogenous, or one's own tissue
to create a breast mound. This surgery takes an average of five hours
in addition to mastectomy completion with the average hospital stay of
five days and an average recovery time of five weeks. The abdominal
skin above the belly button is lifted off the abdominal fascia and
sutured down to the pubic area skin with replantation of the belly
button. The four to five week recovery period is necessary to
straighten and strengthen the abdominal walls and muscles. Activity
levels usually return to the normal, pre-operative status.
The latissimus dorsi flap with implant is usually used as a salvage
technique in the face of previous radiation or surgery. The flap
consists of the latissimus muscle with an overlying skin paddle from
the back. It usually requires a breast implant to obtain the desired
breast shape and volume. The implant is placed below the latissimus
muscle after the muscle is passed onto the chest wall through a tunnel
at the base of the axilla (underarm). It is a useful reconstructive
technique in the face of irradiated breast skin with deformity after
lumpectomy and a lack of an adequate volume of abdominal fat.
Nipple areolar reconstruction can be performed at the time of
the second stage reconstruction. Or, it can be done as a separate
procedure as an outpatient under local anesthesia. The skin on the
breast mound is the source of the nipple reconstruction with a full
thickness skin graft, usually from the inner, upper thigh skin used for
the areolar reconstruction. This skin is usually textured and pigmented
resulting in a realistic appearing areola.
An extensive and detailed consultation with the plastic
surgeon is mandatory for a patient to be truly informed and guided to
make the best decision about breast reconstruction in conjunction with
the treatment recommendations from the breast surgeon and oncologist.
About the Author
Los Angeles, CA Breast Implants Surgeon Dr. Mary A. Powers, brings surgical expertise and personal care to Beverly Hills and the Orange County areas in Breast Implants, Breast Augmentation, and Breast Enhancement surgery!
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