TIME: Almanac 1993/TIME Almanac 1993.iso/time/011491/0114352.000

Text File | 1992-08-28 | 3.7 KB | 80 lines

                                                                                MEDICINE, Page 54

COVER STORIES

Restoring Lost Curves and Confidence



    Last November, at the age of 43, Carol Beebe lost her left
breast to cancer. But when she awoke from mastectomy surgery
at New York City's Columbia-Presbyterian Medical Center and
gazed down at her chest, nothing appeared to be missing. Beebe,
an IBM employee from Point Pleasant, N.J., had chosen to have
a reconstruction of her breast immediately following the
mastectomy. In a single operation, plastic surgeons shaped a
new breast from Beebe's own abdominal tissue, moving it into
place minutes after the general surgeons had removed the
diseased breast. The technique spares the patient the anguish
of amputation. "Our basic philosophy is that you don't leave
the hospital without a breast," explains Plastic and
Reconstructive Surgery chairman Norman Hugo, who performed the
operation.

    Rebuilding the breast after mastectomy has become
increasingly popular in recent years: more than 34,000 U.S.
women chose some form of reconstruction in 1988, up 71% from
1981, according to the American Society of Plastic and
Reconstructive Surgeons. Younger patients are particularly drawn
to the procedure, though Hugo has reconstructed breasts for
women of all ages and types, including a nun.

    The majority of reconstructions are done with implants,
small bags that are inserted under the muscle of the chest wall
and filled with either silicone gel or saline solution. The
inflation must be done gradually over a period of weeks to
allow time for the muscle and skin to stretch, a process that
can cause discomfort and sometimes lead to infections.

    Linda Lehman, 43, a mother of two from Newville, Pa.,
received two silicone implants last February, three months
after undergoing double mastectomies. That summer she went out
and bought a new two-piece swimsuit. "Losing your breasts is
a terrible experience," she says. "You mourn the loss. You have
the same phantom feelings as when you lose a limb." The
implants, she says, have restored her spirit along with her
figure. "I wear more revealing clothing than before, and I've
never looked better."

    Silicone implants are not without drawbacks. Because they
sit high on the chest and are compactly curved, the implants
most closely reproduce the look of a young woman's breast and
can be a poor match for an older patient. They can also make
the breast feel hard, interfere with mammography and, on
occasion, rupture, causing inflammation if silicone has been
used. This spring, as a result of pressure from
patient-advocacy groups and members of Congress, the FDA will
require implant manufacturers to provide proof of the safety
of their products. Still, many surgeons say the risks have been
exaggerated.

    Reconstruction using a flap of abdominal tissue, as Beebe
had, avoids most of the implant problems but is a far more
complex operation, lasting upwards of six hours and requiring
a longer recovery period. The plastic surgeon must carve a
large, almond-shape swath from the belly, about 16 cm by 30 cm
(6 in. by 12 in.), carefully lifting  up the skin, fat and an
underlying muscle, without severing the artery that supplies
the tissue. The flap is then fashioned into a new breast. A new
nipple can be created later by twisting the tissue and tattooing
on an areola. For Beebe, there was abdominal pain at first and
cramping of the relocated muscle that continued for several
weeks following her surgery. But she has no doubt that she made
the right choice. "It feels natural and moves naturally," she
says. "I don't even feel like I've lost a breast. It's just a
little different now."