NEW YORK, Feb. 21, 2018 /PRNewswire-PRWeb/ -- The ancient Egyptians described breast cancer in papyrus writings as far
Modern approaches to breast reconstruction began with the introduction of silicone implants in the 1960s, first with delayed insertion after mastectomy and then in a single surgery immediately following mastectomy. Tissue expansion enabled a staged reconstruction process for women who did not have enough skin to cover an implant. A tissue expander is a temporary device that is placed on the chest wall and gradually filled with saline solution until the skin has stretched enough to hold the permanent implant. Today there are two general types of implants: saline-filled and implants filled with silicone gel that have different degrees of cohesiveness.
"Implants have continued to improve," says Dr. Chen, "but many women suffer complications, such as pain, infection, and hardening that often require removal of the implants. And many women are unhappy with their implants. They may find that they feel rock hard and look unnatural, or that they've lost all feeling in the breast, or that their breasts are distorted and asymmetrical. As a result, the gold standard today is autologous tissue breast reconstruction – surgery that creates a breast from a woman's own tissue, resulting in a breast that feels better, looks better, and lasts a lifetime."
Surgery that uses a woman's own tissue to form a breast mound became popular at the end of the 1970s with the refinement of techniques that initially used skin, fat, and muscle from the back and then, in the early 1980s, with the introduction of the "TRAM flap," skin and fat from the lower abdomen to form the breast. "The TRAM flap was the gold standard for many years," says Dr. Chen. "It created a soft, natural-looking breast but its disadvantage was the subsequent destruction of the muscle in the abdominal wall. New techniques have made it unnecessary to sacrifice muscle from the donor site to create the new breast." This new type of reconstruction, known as "perforator flap breast reconstruction," carefully dissects out the blood vessels perforating through the muscles to keep the tissue alive, so that only the fat and skin are used to reconstruct the breast while the muscle is completely preserved. Usually, microvascular techniques are used to sew together the blood vessels from the donor site to blood vessels in the chest wall so that the transferred soft tissue stays alive and healthy in its new position on the chest wall. Preserving the muscle also reduces the postoperative recovery time. The resulting breast reconstruction is soft, warm, and living, and replaces the fat and skin that was lost to mastectomy.
Changes in mastectomy itself have also facilitated improved restoration results. Surgery that spares skin and the nipple-areola complex enhances the surgeon's ability to create a breast that is difficult to distinguish from the original breast. "And we are now crossing the next frontier in breast restoration," says Dr. Chen, "by microsurgically reconnecting nerves that are cut during mastectomy and restoring sensation to the breast. We can not only create a soft, warm breast that looks and feels natural to others but one that feels like her own breast to the woman herself. Over the last several decades, there have been significant advances in restorative surgical techniques. There are many options for breast reconstruction, and every woman should make an educated decision about what is best for her to bring back her health, confidence, and quality of life."
Constance M. Chen, MD, is a board-certified plastic surgeon with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine. http://www.constancechenmd.com
SOURCE Dr. Constance M Chen
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