|
|||||||||||
 |
Healthy You Archives Healthy You Archives |
Just for Women
Rebuilding the BreastAfter a mastectomy, women have many options today
Is Silicone Safe?Silicone-gel breast implants are widely used overseas, but the FDA bans them in the United States except for women with breast cancer and a few other conditions. “There’s been a lot of controversy over leaks and other risks,” plastic surgeon Walter Okunski, M.D., says, “but nothing has been scientifically proven.” Depending in part on the patient’s preference, he uses both saline and silicone-gel implants—and predicts that gel implants may well come back on the market in the future. “They feel and look somewhat more natural than saline,” he says. Fortunately, for most women reconstruction is a non-issue, because mastectomy (loss of the breast) isn’t a given anymore. “We do everything we can to treat breast cancer with lumpectomy and radiation,” says Okunski’s colleague, breast surgeon Gerald Sherwin, M.D. When the surgeon removes just the lump, reconstruction is almost never necessary. If you have a very large tumor or multiple tumors in the same breast, you probably will need a mastectomy. And you’ll have several choices for reconstruction. “The basic challenge in rebuilding a breast is replacing the skin lost in surgery,” Okunski says. The simplest solution is a soft tissue expander—a deflated balloon-like device that’s gradually enlarged with saline injections. Over several weeks, it stretches the skin enough to cover a permanent implant. The result is more dome-shaped than a natural breast, Okunski says, but the technique is a good option for women who aren’t candidates for other types of reconstruction, or who don’t want more extensive procedures. A newer option involves bringing skin and tissue to the breast from elsewhere in the body. In the earliest technique, surgeons lifted a flap of skin and muscle from the patient’s back and tunneled it through the armpit to the chest. Today, Okunski says, they prefer a newer abdominal technique. “The skin and fat from the belly create a softer, better-matching breast,” he says, “and no implant is needed. Any patient who isn’t extremely heavy or thin and doesn’t have much previous abdominal scarring is a good candidate.” One issue with breast reconstruction is matching the new breast to the opposite one. Pennsylvania law requires insurers to cover not only reconstruction, but also cosmetic surgery to the other breast (if the patient wants it) to create symmetry. Even the appearance of a nipple can be recreated with a skin graft or tattoo. In years past, reconstruction didn’t happen until months after cancer surgery. “For women who needed radiation, there was concern that the implant might interfere, and conversely, that the radiation could cause scarring or shrinkage of the reconstructed breast,” Sherwin says. Today’s techniques allow for immed-iate reconstruction—“and it’s appealing to the patient to have it all done at once,” Okunski says. But as they study the radiation issue more closely, researchers are questioning the wisdom of immediate reconstruction. For now, the decision on timing is each patient’s own. Given all these complexities, it’s not surprising that some women decide against reconstruction altogether. “It’s about 50-50,” Okunski says. “Typically, older women do fine with an external prosthesis (breast-shaped pad). A prosthesis can cause problems like skin irritation for younger, more physically active women.” If you say no to reconstruction, it’s not forever — Okunski has done the procedure as late as 10 years after a mastectomy. But Sherwin finds that a woman who opts for delay often decides never to go ahead with reconstruction. “Her treatment is over, she gets a prosthesis, settles back into normal life and is comfortable with her self-image,” he says. “When the time comes to talk about reconstruction, she’ll say, ‘I don’t want any more surgery —I’m fine the way I am.’ ”
Want to Know More about breast prostheses, mastectomy, or lumpectomy? Click here. This page last updated 2/12/08 04:08 PM
ARTICLE TOOLS:
|
 September October 2005 Eating Healthy
Staying Fit
Caring for Mind and Body
Just for Women
Just for Men
Raising a Family
Heart of Healthy You
Protecting Your Health
Coping with Illness
Aging Well
Keeping Up to Date
Weight Control
|
|
||||
|
|
|
||||||
