The latest innovations in breast cancer reconstruction

When a woman is first diagnosed with breast cancer and is facing treatment, the prospect of breast reconstruction may be daunting. It is, after all, another procedure to prepare for at a time when she may be overwhelmed by the impact of the diagnosis. But with recent innovations in breast reconstruction techniques, the process is becoming less invasive and producing improved, more natural results.

Says Dr. Christine H. Rohde, Chief of Plastic Surgery at NewYork-Presbyterian Lawrence Hospital in Bronxville and Associate Professor of Surgery at Columbia University Medical Center, “The removal of a breast, usually for treatment of breast cancer, can have both physical and emotional consequences for women. Restoring breast appearance through breast reconstruction can provide significant improvements in quality of life. While usually performed at the time of the mastectomy or lumpectomy, breast reconstruction may also be performed afterwards using implants or the patient’s own tissue. It is typically during the consultation stage that a plastic surgeon will discuss various options with the patient.”

Implants

Over the years, there have been significant improvements to the silicone gels used in breast implants. Says Dr. Rohde, “The latest generation of gel is improved in substance, giving implants increased longevity and reduced risk of damage and failure, such as rupture. There are also many more choices in implant size, shape, projection, and feel.”

Implant reconstruction is typically done in stages, although some patients may be candidates for a single-stage implant reconstruction. The first stage is performed at the time of the mastectomy, when a temporary inflatable implant (tissue expander) is placed beneath or above the chest muscles after the mastectomy is completed. The purpose is to stretch the overlying tissue in order to be able to later place an implant. The tissue expander is filled with saline injections, a procedure typically performed every one or two weeks in the office after the mastectomy. Alternatively, a newer “air expander” can be filled remotely with air, so that needle injections are not required and patients control the filling process.  About three months later, a second surgery is performed, in which the tissue expander is removed and the permanent implant is placed. A procedure on the other breast or additional fat grafting might also be performed to improve symmetry and contour.

Using your own tissue

Breast reconstruction that uses a woman’s own tissue, rather than implants, is known as “autologous” reconstruction, or “flap” reconstruction, and can be performed at the time of the mastectomy or at a future operation. “During flap reconstruction, a plastic surgeon removes tissue (a flap) from somewhere on the body (the donor site), such as the lower abdomen, thighs, back or buttocks, and uses the tissue to reconstruct the breast,” explains Dr. Rohde. “The advantage of this procedure is that the breast can be reconstructed to appear and feel quite natural, and it requires only a single surgery to create the breast.”

Flap reconstruction has improved with advances in microsurgery, which uses a microscope and extremely small instruments that allow the surgeon to work on small structures in the body, such as blood vessels. “We can take tissue much more precisely and carefully and avoid having to take muscles that might cause more damage to the donor site,” says Dr. Rohde. “This translates into an easier recovery, lower rates of complications and the potential for better aesthetic outcomes.”

Additional Techniques

The advances in mastectomy techniques allow for options in reconstruction. Breast cancer surgeons are now able to spare more of the breast than was previously possible and, in some instances, the nipple and the areola. “The ability to preserve more breast skin has dramatic effects on the reconstructive outcomes,” says Dr. Rohde.

Oncoplastic surgeries can also improve breast appearance after lumpectomies. For some patients, a breast reduction or lift can be performed at the time of the lumpectomy to minimize the deformity and improve the aesthetic result.

Weighing the options

Although there has been great progress in breast reconstruction techniques, the most important thing to remember is that each case is unique. A treatment protocol that may work well for one woman may not work for another. Notes Dr. Rohde, “Not all women are candidates for every reconstruction technique or mastectomy type. The timing of reconstruction (immediate versus delayed) will also vary for each patient.” In all instances, a woman will need to have comprehensive evaluation by the reconstructive surgeon, working in tandem with the surgical oncologist and any other members of her multidisciplinary treatment team, to decide what is appropriate and what is possible in her particular case. Says Dr. Rohde, “Asking questions and learning about your options will help you and your surgeon make the best possible choices.”

To make an appointment with Dr. Rohde in Westchester, please call 212-342-3707.

Visit nyp.org/lawrence for more information on our cancer center services.

This story is provided and presented by our sponsor: NewYork-Presbyterian Hospital.