Many of my referring physicians have recently diagnosed a patient with breast cancer and have asked about the latest techniques in breast reconstruction. This article details the most recent updates in implant reconstruction, tissue reconstruction, nipple reconstruction and stem cells.
With implant reconstruction, surgeons use artificial implants to make breasts look and feel natural. In the past, gel-like implants dominated, but now "form-stable" implants are coming to the forefront. As their name implies, they are more stable, and they retain their shape longer.
In a one-stage reconstruction, the implant is inserted during the same general procedure as the mastectomy; one surgeon takes away the breast tissue, then a plastic surgeon performs the implant insertion. These surgeons use a graft of sorts to keep the implant stable. A two-stage reconstruction allows for treatment such as radiation therapy after breast tissue is removed; a surgeon places an expandable sac either after therapy or during the mastectomy. A salt-water mixture is then injected into the implant during the next two to three months so that the sac expands. After expansion is complete, there is usually a second surgery to remove the expander and to insert a long-term implant. Two-stage surgeries are common when the body is not healthy enough yet to sustain a permanent implant.
The downsides of implant reconstruction include a likelihood of up to 50 percent that patients will need further surgery in the 10 years that follow so that the implant can be either adjusted or fully replaced. Silicone gel implants are also somewhat prone to breakage. However, the emergence of form-stable implants minimizes many of these problems. Other techniques, such as pre-pectoral placement of a tissue expander, also hold a lot of promise.
Tissue reconstructions are also called autologous or flap reconstructions. They use tissue from elsewhere on a patient's body, most commonly the back, thigh, buttocks or abdomen, to build her new breast. This approach has an extended recovery time and more potential for complications (for example, with blood vessels) but when it is successful, the breasts look and feel more natural than implants. There are also fewer long-term complications. For example, patients don't need to worry about an implant needing to be replaced.
For many women, nipple reconstruction is a vital element of any breast reconstruction. Silicone implants are one option, as is using tissue from elsewhere on the patient's body. Whatever avenue is used, the "nipple" and "areola" are colored to look natural. The disadvantages, however, are that all too often, they do not last long. Sometimes they don't even last one year.
3D printing offers a solution. While this approach has not been used yet, clinical trials could get started by 2017. The aim is to enable a woman to pick the precise color she wants for her new nipple. The procedure would also cost less than the other two approaches and be safer, as it would not require as invasive a surgery.
Breast transplants are not a viable option due to the potential for breast cancer to develop again, plus patients would have to take immunosuppressants, which carry a host of potential problems. Instead, stem cells could be the future of breast reconstruction. However, much more work and study in this field is needed, and the possibility for cancer to re-emerge is there, too.
It is critical for women to be informed of all of their options when it comes to breast reconstruction. Implants and tissue reconstruction come with their fair share of pros and cons, and often the decision comes down to the expertise of the surgeon and the patient's comfort level.
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