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.