Reconstructive Breast Surgery: New Options
by Joseph D. Alkon, M.D.
Chief, Division of Plastic & Reconstructive Surgery
Trinitas Regional Medical Center, Elizabeth, NJ
A woman diagnosed with breast cancer may have an immediate flood of
decisions to make regarding her medical care. One of those choices is the
option of breast reconstruction if she chooses to undergo a mastectomy, or
breast removal. Breast reconstruction, if chosen, may be performed at the
time of mastectomy â€" termed an immediate reconstruction, or alternatively at
a later date â€" termed a delayed reconstruction. From an oncologic, or cancer
standpoint, both options are safe and effective, yet this, too, is something
that should be discussed between a patient, her breast cancer physicians,
and her plastic surgeon.
Data from the American Society of Plastic Surgeons reveals a 113% increase
in the frequency of breast reconstruction from 1992-2004. In 2004, nearly
63,000 women chose to undergo breast reconstruction. Mirroring this increase
in reconstructive frequency are the refinements and advances in techniques
to perform these operations. Currently, breast reconstruction may be
performed by using a patient's own tissues, taken from her abdomen in what
is called a 'TRAM Flap,' or by using an implanted prosthetic device.
If a patient chooses to undergo a TRAM flap operation, skin and underlying
tissue is removed from her lower abdomen. This is the same place tissue
would be removed from in a tummy-tuck procedure. The tissue is relocated to
underneath her chest to reconstruct her removed breast. This may not be
feasible in someone who is very thin, or perhaps someone who has had
multiple prior abdominal operations (or even a prior tummy-tuck). In this
setting, a patient who desires a reconstructed breast using her own tissues
would consider alternate body regions to serve as the donor-site.
Other women may opt for a reconstructed breast to be created with an implant
device. If, however, a mastectomy has been previously performed (such as in
the delayed reconstruction) or if the cancer surgeon needs to remove a
significant amount of overlying skin, the area may be too tight a space to
have an implant immediately placed within. In this scenario, a 'tissue
expander', which looks like a deflated or unfilled implant, may be used.
This device may then be sequentially inflated in the office with saline or
salt water. Between short weekly or biweekly filling sessions lasting only a
few minutes, the overlying tissues have a chance to gradually stretch and
grow. Ultimately, when the desired volume has been added and the desired
breast size achieved, the expander device may be replaced for a permanent
implant. Each of these options has their advantages and disadvantages, which
must be discussed during the plastic surgical consultation.
The Division of Plastic & Reconstructive Surgery at Trinitas
The Division of Plastic and Reconstructive Surgery at Trinitas Regional Medical Center is
generating a lot of excitement, particularly as a complement to its recently
developed Comprehensive Cancer Center. The division will offer breast
reconstruction as another jewel in its crown of patient care. For those
considering cosmetic or post-oncological breast surgery, the division offers
an opportunity for quality care and topnotch surgical expertise right here
About Joseph D. Alkon, MD:
Joseph D. Alkon, MD, is the Chief of the newly created Division of Plastic
and Reconstructive Surgery at Trinitas. A graduate of Brandeis University
and the Boston University School of Medicine, Dr. Alkon is a member of Alpha
Omega Alpha, the National Medical Honor Society. While completing his
training in plastic surgery at Strong Memorial Hospital/The University of
Rochester Medical Center, Dr. Alkon served as Chief Resident in Plastic and
Reconstructive Surgery. He has been published in several peer-reviewed
publications, including Plastic and Reconstructive Surgery, Annals of
Vascular Surgery, Journal of Cardiac Surgery and Annals of Thoracic Surgery.
He has been invited to lecture nationally on Plastic and Reconstructive
Surgery. As part of his practice, Dr. Alkon offers a full range of surgical
procedures for women including reconstructive surgery, body contouring,
breast surgery and facial aesthetics.
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