A team of AAMC Breast Center surgeons and plastic surgeons offer many options to women
With earlier detection and better treatment for breast cancers, more women are undergoing lumpectomies and mastectomies than ever before. And after surgery to remove malignant breast tissue, many of these women also will have a surgical reconstruction of one or both breasts. At the AAMC Breast Center, the team emphasizes returning patients to good health both physically and emotionally, said Lorraine Tafra, M.D., medical director of the AAMC Breast Center.
“If a woman needs or elects to have her breast removed, there are many options available to create a new breast,” said Dr. Tafra.
AAMC’s plastic surgeons work to ensure the best outcomes for patients choosing to have reconstructive procedures. To ensure the safest options, these specialists are designing protocols to decrease complications and investigate new areas that could improve reconstructive procedures, said Dr. Tafra.
And general surgeons who perform mastectomies and lumpectomies collaborate with the plastic surgeons and experts from other disciplines to provide the best results, said Vincent Sayan, M.D., an AAMC surgeon. “Our physicians are unique professionals who will take extra measures to do what works best in each situation. I think patients feel very well taken care of here.”
There are two major types of breast reconstructions, explains Christopher Spittler, M.D., an AAMC plastic surgeon who completed a year-long fellowship in a surgical practice specializing in reconstruction procedures.
“Options include autologous tissue reconstruction, in which the surgeon builds a breast from the patient’s own tissue; and implant procedures, in which a silicone or saline implant is used to reconstruct the breast,” he said.
Autologous procedures use skin, fat and muscle from other areas of the body, most commonly the abdomen and back. Sometimes the surgeon detaches these completely and moves them to the chest area. But most often the tissue is partially detached and shifted to the chest area so some original blood vessels remain intact. Keeping a flap of tissue attached increases the chances that it will transplant and adjust well when the surgeon sews it into place.
When tissue is shifted from the abdomen, the procedure is called a TRAM (transverse rectus abdominus muscle) flap. The TRAM procedure includes a “tummy tuck” as skin, fat and muscle are moved upward under the skin.
Another autologous procedure, the latissimus dorsi flap, uses the area of back muscle beneath the shoulder blade and armpit. In a procedure similar to a TRAM flap, the attached tissue is shifted around the body to the breast area. Because women tend to have less flesh in the back area, the latissimus dorsi procedure may sometimes be done in conjunction with an implant.
Implants may be filled with silicon gel or saline (salt water). When an implant procedure is performed, the surgeon often will insert a temporary tissue expander to stretch the skin over a period of time, making more room for the permanent implant. Within a few weeks to a few months the implant can be filled gradually through the skin. The permanent implant is placed when the tissue has stretched to match the other breast.
“All of these reconstructive procedures obtain good results—there is no ‘best’ method,” explained Dr. Spittler. “We take many factors into account when developing a plan for the individual patient.”
It is important for women to know all of their options so they can make informed decisions, said AAMC plastic surgeon Kelly M. Sullivan, M.D. She completed her plastic surgery fellowship at Emory University, where many breast reconstruction techniques were developed. Approximately half of her practice is dedicated to reconstruction.
“Decisions about reconstruction involve considerations about body type, size and shape of breasts, level of physical activity and the various recovery processes,” said Dr. Sullivan. “Since many younger women now are getting reconstructions, their lifestyles really come into play.”
The timing of reconstruction and how the process goes depends on the individual as well, said Dr. Sullivan.
“Some reconstructions are done at the time of the original mastectomy or lumpectomy, and some later. There are different options, depending on factors like follow-up radiation treatments and what a woman’s needs are,” she said.“There are always a few steps in the reconstruction process, and each one gets easier and less invasive.”
AAMC plastic surgeon James Chappell, M.D., said some women who already are dealing with a cancer diagnosis and imminent breast surgery may want to take some time to make a decision about when to have reconstruction. For others, immediate reconstruction, done just after the mastectomy is completed, is a good option. “The woman goes to sleep with both breasts and wakes up with both breasts, or at least the beginning of the process,” he said.
Dr. Chappell also suggests that women make sure they get all of their questions answered. “It may be helpful to have a supportive person there, perhaps a partner or a close friend, to listen to the information presented,” he said. “Women should always feel free to follow up for further consultation if they need clarification about something. It’s important that patients not rush a decision.”
Adds Dr. Tafra, “The goal of any team taking care of patients should always be to return them to as healthy a state as possible following treatment. We are fortunate to have a talented team for whom this goal is the priority.”