Posted March 23, 2021 in Dr. Aldona Spiegel, News, Reconstruction
More Options and Better Results
Breast reconstruction procedures have advanced over the past decade, allowing patients more than ever the freedom of choice. From a surgeon’s perspective, the more choices we have the better we can tailor the operation to the patient. I would like to share some of the trends in breast reconstruction and how these advances in the field can benefit you as a patient.
I would first like to touch on an advancement in breast general surgery. Nipple-sparing mastectomy has become increasingly popular in select patients. A nipple-sparing mastectomy removes only the underlying breast tissue, leaving the skin, areola, and nipple intact. Not every patient is a candidate for this procedure, as the type of cancer, tumor size, and location all influence what surgical plan is appropriate. However, for the patients that are a candidate for this surgery, the reconstruction results can be excellent, even achieving the look of an unoperated breast. The scar for this type of mastectomy is hidden in the fold under the breast. The option for a nipple-sparing mastectomy is particularly promising for patients considering a preventive mastectomy due to family history or genetic predisposition to breast cancer. This surgical technique reduces cancer risk and allows the best possible aesthetic outcome.
Another exciting trend in breast reconstruction is prepectoral implant reconstruction and direct to implant reconstruction. Prepectoral implant reconstruction allows the breast implant to be placed above the pectoralis, or chest, muscle. Previously in breast reconstruction, implants were placed below the chest muscle. This was uncomfortable for patients, required a two-stage surgical approach, and unfortunately did not result in a natural look or feel to the breast. The reason implants were placed below the muscle in a staged fashion, with a tissue expander followed by an implant, was to provide tissue coverage over the implant, support the implant, and to prevent capsular contracture. Advance in technology, specifically the use of an acellular dermal matrix, have allowed us to address these problems and reduce patient discomfort, surgery time, and achieve a natural and soft breast. Prepectoral implant reconstruction not only results in a better aesthetic outcome for patients, it has also opened the door for one stage breast reconstruction or direct to implant placement. If you are a candidate for direct to implant placement you will not require a tissue expander and an implant can be placed directly to the breast at the time of the mastectomy. We are proud to perform direct to implant reconstruction regularly as an outpatient procedure at Houston Methodist.
Another trend in the field is called composite reconstruction. Composite reconstruction combines implant reconstruction with fat grafting. Fat grafting is a great tool to improve breast symmetry, address irregularities to the breast, such as indentations that may result after a mastectomy, and improves skin quality after radiation therapy through the stem cells contained within the fat. Liposuction is performed during this procedure and this suctioned fat is processed and precisely injected to the breast. This technique allows symmetry to be tailored more than ever to you as a patient, targeting specific problem areas of your breast.
Fat grafting can also be performed as a supplemental procedure in patients that elect to use their own tissue for reconstruction. Fat grafting can be used in a similar way as we do with implants, to camouflage irregularities, but also can be performed in stages to gradually build volume to the reconstructed breast. Another option to increase breast size or projection is combination surgery, which uses both your own tissue and implant reconstruction. This is a good option for patients who would like to use their own tissue for reconstruction but do not have a lot of excess abdominal tissue. DIEP flap surgery can still be performed, and an implant is placed after you have healed from your DIEP surgery to improve breast volume and projection. Alternatively, some patients may prefer the look of implant reconstruction or have minimal excess fatty tissue present but require a skin or nipple excision during their mastectomy. In these select cases, implant reconstruction is typically performed at the time of the mastectomy and during a secondary procedure a mini-DIEP flap can be performed to transfer a small amount of tissue to replace the skin that was removed during the breast surgery. This option allows for the aesthetic of implant reconstruction with the benefit of replacing the tissue that was removed during the mastectomy.
These are just a few options that may be available to you. I encourage you to contact our office to make a consultation so we can discuss all of your options in detail, making a surgical plan that takes advantage of the innovations in our field to offer you the best care available.
