I am excited to announce my participation in an IRB approved  study using Seriscaffold for breast reconstruction.  Seriscaffold is a FDA approved silk based product which is used to provide soft tissue support and repair during the reconstruction after a mastectomy.  For patients who are undergoing breast reconstruction with a tissue expander  Seriscaffold is used to support the lower pole of the breast and to help maintain the position of the pectoralis muscle.

The American Society of Plastic Surgeons released their statistics for 2010 yesterday.  The overall number of cosmetic procedures increased 5 % in 2010.  This may represent some pent-up demand as patients return who had put off cosmetic work when the economy was so unstable.  Reconstructive procedures also increased 2% in 2010 with breast reconstruction up 8% !  This puts breast reconstruction into the top five reconstructive procedures for the first time .  The other top reconstructive procedures were (1) tumor removal (2)laceration repair (3)scar revision and (4) hand surgery.  Good news !  Hopefully this means that our work to get the word out to patients  undergoing mastectomies about their reconstructive options is working!

A very interesting study was presented recently at Plastic Surgery 2010 : Joint Annual Scientific Meeting of the  American Society of Plastic Surgery (ASPS)  and the Canadian Society of Aesthetic Plastic Surgery (CSAPS)meeting in Toronto Canada.  The  study looked at cases of breast cancer between 1998 and 2003 and analyzed  data in the US National Cancer Institute  Surveillance, Epidemiology, and End Results (SEER) registry database.  The SEER analysis looked at more than 46,000 women who had undergone mastectomy alone and 8500 who had undergone a first stage of reconstruction at the time of their mastectomy. The analysis showed an amazing result that immediate breast reconstruction was associated with a 26% reduction in breast-cancer- specific mortality!  No one thinks that breast reconstruction is saving lives but the hypothesis is that patients who undergo immediate breast reconstruction  are usually in higher income brackets and are better educated.  This has been widely supported in the literature.  In addition patients with better access to good cancer centers are more likely to be referred to a reconstructive plastic surgeon by their breast surgeons than patients being treated outside a cancer center and they might be getting better overall care. This study certainly is interesting and more research needs to be done to sort out the reasons behind this increased survivial .  It certainly is interesting though!

A recent survey  of  women with breast cancer found that 43% of the patients who were eligible for reconstruction did not receive information about their reconstructive options when making decisions at diagnosis.    This is an alarmingly low number!  Many patients are not aware that  a federal law signed into effect by President Bill Clinton mandates that breast reconstruction be covered by insurance companies.  this means that even if a women does not opt for reconstruction at the time of her mastectomy she has the option at any time later-  even years later.  This law also covers the opposite breast -  this means that the breast not involved with cancer can be reduced, lifted and even augmented to achieve symmetry between the two breasts.  God built women with two breasts and we need to get the word out that even if a woman suffers through cancer treatment she can again have the opportunity to have two breasts !

Recently I went to Sweden to observe the practice of Dr Charles Randquist.  Dr Randquist has extensive experience with form stable breast  implants -  Mentor’s CPG implants and Allergans 410 implants -  which are not currently available in the USA except under study conditions.  These implants are shaped -  with a sloping upper pole .  We used to have shaped implants in the United States but the FDA did not include them in the approval process along with round implants so they were taken off the market in the States five years ago.    I am hopeful that soon we will have shaped implants as I think especially for the reconstruction patient they are a valuable tool.

When a woman is diagnosed with breast cancer she is faced with a multitude of decisions -  lumpectomy or mastectomy, decisions about chemotherapy and radiation therapy - it can sometimes seem like too much to have to decide about breast reconstruction (implant reconstruction, flap reconstruction, silicone vs saline implants) at the same time.  Our goal as plastic surgeons is to try and make sure each patient has all the information she needs to make the best choice for her.  For some patients this might be to undergo the breast cancer treatment and not even worry about the reconstruction until later.  For others it might be to undergo breast  reconstruction at the same time as the mastectomy.  Recent data suggests that 70% of breast cancer patients are not informed of the various reconstructive options available to them.  This is not acceptable.  We need to work harder to make sure that women are given all the information they need at the time of their cancer diagnosis so they can make the best , informed decsions for themselves.

Plastic surgery as a specialty encompasses both cosmetic as well as reconstructive surgery.  The definition of cosmetic surgery is surgery  ”to improve on the normal”  whereas reconstructive surgery is surgery  ” to restore to normal form and function”.  In some cases it is clear -   repair of a cleft lip is clearly reconstructive surgery and liposuction of small amounts of fat that one just does not like is cosmetic surgery.  In other situations it is more difficult.  An upper eyelid lift to improve one’s appearance is cosmetic while an upper eye lift to remove excessive skin which is blocking one’s vision is reconstructive.   Breast reconstruction after cancer treatment is unusual in that there is a Federal Law signed into effect by Bill Clinton mandating that breast reconstruction and surgical treatment of the opposite breast (if needed) is covered by insurance.  Thank you Mr. Clinton!

A few years ago I surveyed a group of female plastic surgeons as to what they would choose for reconstruction if they were faced with the diagnosis of breast cancer.,  My thinking was that this group of doctors had an unique perspective on breast reconstruction options -  they were very well informed as to  not only the options available but also to the risks and outcomes of each reconstructive option .  The results were interesting.,  A total of 54 female plastic surgeons were surveyed.  Ninety one percent stated that they would opt for mastectomy over breast conservation .  Most   (87%) choosing a mastectomy would opt for reconstruction.  For their reconstructive procedure 54% would choose tissue expansion with implant reconstruction and, 28% would choose a Tram flap and only 5% would choose a latissimus flap.  For the women choosing implant reconstruction 79% would choose a silicone implant , 24% would choose a saline implant and one respondent felt that either choice would be acceptable.  The most frequently chosen reconstruction then was tissue expansion followed by a silicone implant (43%).  Interesting  and food for thought!

  There has been a major advance in breast reconstruction with the use of acellular dermis.  Tissue expansion and implant reconstruction have  produced good results for many patients but there have been problems for some.  Now there is a new advance which can help patients with certain problems and even for some women allow them to have a single stage reconstruction .  This advance is the use of acellular dermis .  This is a product which is derived from human skin -  the cellular elements are removed and left behind is strong matrix which can be used to provide an internal sling.  This acellular dermis is used as an extension of the pectoralismajor muscle allowing  coverage and support of the breast implant.  It can be used with tissue expansion  but it is really exciting that we now have for some women the choice of a single stage reconstruction.  This product has also been helpful in correcting implant position problems as well as it has been used to add an additonal layer of coverage in areas of thin coverage over an implant.