The following is an article Dr. LaTrenta wrote for the Breast Cancer Alliance, published in the annual report.
Building a Better Breast
Any woman facing mastectomy also faces another difficult decision: reconstructive surgery. The most basic decision is for whether to reconstruct the breast at all. If that is your choice, as it is for may women, you need to determine whether to reconstruct the breast at the same time as the mastectomy( simultaneous reconstruction ) or wait until the initial operation heals.
Simultaneous breast reconstruction offers several distinct emotional advantages: avoidance of unnatural and uncomfortable prosthetics, a diminished period of postoperative depression, and an improved sense of long term well being and sexual sensibility. Having the procedure immediately also offers several surgical advantages: preservation of native breast skin on the reconstructed breast, most symmetry in shape and volume, and the avoidance of another major general anesthetic procedure.
The two basic reconstruction methods are implants and flaps. Implants are either saline or gel silicone filled prostheses which mimic the substance of the breast. Flaps are developed from the body’s naturally excessive soft tissue (generally taken from the abdomen- a “tummy tuck” bonus.)
Implants are generally best for patients considering bilateral breast reconstruction, for women who don’t have much lower abdominal tissue, and for menopausal and post-menopausal patients who wish to keep reconstruction as simple as possible. Implant reconstruction is also preferable for young women who have never been pregnant and who have an inheritable form of bilateral breast cancer.
Implants are not without drawbacks, however. First, implants need to be replaced over time- the recommendation is every 10 to 15 years to avoid rupture. Second, implants have a hardening, or capsular contracture, rate of 2 to 3 %, although that is usually correctable with a minor surgical procedure. Third, implants have a rare incidence of infection, like all implantable devices. Because of this, implant patients should take prophylactic antibiotics prior to “dirty” procedures, such as colonoscopy and dental cleanings.
It may be somewhat misleading to call implant reconstruction simultaneous or immediate. In fact, implants require several different procedures and temporary prostheses to achieve a high quality, durable, long term result. As I tell all my implant reconstruction patients, if it takes God nine months to make a breast, it’s going to take Dr. LaTrenta a year.
The lower abdominal flap procedure, known as a TRAM, is often advisable for women with ample lower abdominal wall tissue who desire a natural tissue reconstruction. The TRAM procedure also works for patients with breast cancer recurrence who have undergone previous breast lumpectomy and radiotherapy and for women with a considerable amount of lower abdominal excess who are contemplating bilateral mastectomy.
TRAMS often result in a temporarily weakened abdominal wall, but one year after surgery most [patients are doing sit-ups again. If the TRAM procedure is performed for bilateral breast reconstruction, however, the lower abdominal wall is permanently weakened and bulging sometimes ensues. Overall, the TRAM flap is an extremely reliable breast reconstructive technique which produces natural post-mastectomy long-term results with minimal risk.
Post-op bilateral breast reconstruction with implants following removal of tissue expanders
More women who undergo implant surgery today are choosing to reconstruct their breasts with gel silicone implants rather than saline because the gel implants have a softer texture and lower incidence of rippling. Another trend we’re seeing is the increase in prophylactic mastectomies. Many at risk young women are now seeking genetic testing and some choose bilateral prophylactic mastectomies with simultaneous implant reconstruction.
These technical advances provide patients with far superior bilateral breast reconstruction results and far greater satisfaction than reconstructive surgeon could produce even a few years ago. As diagnostic and surgical procedures continue to improve, we anticipate that we will also make strides in reconstruction techniques, resulting in smaller wounds, faster healing, and the most natural looking results possible.