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[ PRINT ]
Abramson Family Cancer Research Institute
"Confronting Cancer Through Art" is an exhibition by people whose lives have been touched by cancer.
This week's artwork was donated by a pediatric cancer patient who received treatment for cancer at The Children's Hospital of Philadelphia. |
Breast Reconstructive Surgery Options Author: Don LaRossa MD, Professor of Surgery
Affiliations: University of Pennsylvania Medical Center
Posted Date: October 20, 1997
.iso/Web/Breast/nisc8a.upenn.edu/images/oncolink/bar2.gif){kind=small}
Last Revision Date: Sunday, 14-Feb-1999 13:54:27 EST
Copyright © 1994-1999, The Trustees of the University of Pennsylvania
OncoLink Advisory: Photographs linked to from this page graphically illustrate the results of breast reconstruction therapy. Since they depict actual patients, some OncoLink readers may choose not to view them. Reconstruction of the breast following mastectomy has become an integral part of the holistic treatment of breast cancer. Many patients are candidates for reconstruction simultaneous with mastectomy, though it can be done at a later date as a separate operation depending on various factors. These factors would include the type of tumor, need for radiation or chemotherapy, or the patient's wishes. These decisions will be made by the patient in consultation with her surgeon, oncologist, and plastic surgeon. Breast reconstruction can be viewed as occurring in stages, the first of which is reconstruction of a breast mound. This can be accomplished in one of several ways depending on the patient's general medical condition, body, and breast shape, and the patient's desires. The methods fall into two general categories: implant type restorations and those using the patient's own tissues. Implant type restorations: In this method, an implant of silicone filled with silicone gel or saline (IV solution) or a combination of both is placed beneath the skin and the pectoral muscle. Some surgeons prefer to first use a tissue expander (a silicone balloon) to stretch the skin over a period of weeks or months followed by the replacement with a breast prosthesis (gel, saline, or a combination) at a second operation. It should be noted here that all implants made of silicone polymers are currently being evaluated by the FDA. Although both saline filled and gel implants are permitted for breast reconstruction by the FDA. All patients are required to read and sign a manufacturer's consent for implant use. The form reviews the potential risks of silicone implants. Tissue Reconstruction: A breast mound can be recreated from the patient's own tissues. the most common donor site is the abdomen, the so called TRAM (transverse rectus abdominus skin-muscle) flap. In this operation, an area of skin around and below the umbilicus (belly button) is transferred to the site from which the breast has been removed. Most commonly, the skin and fat remains attached to one or both of the rectus abdominus muscles which provide it's blood supply, much like an electrical cord supplies power for an appliance. On some occasions, the muscle and skin can be detached entirely and reconnected to the blood vessels in the armpit using microsurgery. This is usually done when the more commonly used method is not possible as when someone has had a scar from previous abdominal surgery as from removal of a gallbladder. However, some surgeons use this as their preferred method. The transferred skin and fat is shaped to resemble the opposite breast or into two breasts if both breasts have been removed. The abdomen is closed and leaves a scar that extends from hip to hip, much like that seen in a "tummy-tuck" operation. The missing muscle is often replaced with a surgical mesh material to reduce the risk of a hernia or bulging of the abdomen. Another approach is the use of a large, flat, broad muscle from the back, the latissimus dorsi muscle, and overlying skin. Although the skin and muscle may provide sufficient bulk to reproduce a small breast, an implant is usually needed to restore a larger breast. A scar remains on the back but can sometimes be designed to be hidden under a brassier strap. Some flattening of the back remains from removal of the muscle, but use of the arm remains essentially unimpaired. Finally, soft tissue can be transferred from the buttock or thigh using microsurgery. These represent the most sophisticated and complex methods of breast reconstruction and are generally reserved for specific indications. The second phase of breast reconstruction is the creation of symmetry. Many patients wish to have a nipple or areolar complex reconstruction which is done several months after the breast mound reconstruction. This can be done with the patient's own tissues or by tattooing color into the skin at the nipple areolar site simulating the nipple areolar complex. Tattooing is done in the doctor's office while the nipple reconstruction is done using the patient's own tissues is done as an outpatient procedure in the hospital operating room. The creation of symmetry may involve lifting of the opposite breast or making it smaller or larger to match the reconstructed breast. These methods vary in their complexity, risk, complications, length of surgery, and length of time for recovery. The following table outlines these parameters: Table I The following are illustrations of results using these various methods in patients who have consented to their use for medical education. Each patient is unique in their body and breast reconfiguration, scar formation, etc. The results, therefore, such as those illustrated cannot be guaranteed. Many patients who have had reconstruction volunteered to discuss their experience with patients facing reconstruction. This can be discussed with your reconstructive surgeon.
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GENERAL DISCLAIMER OncoLink is designed for educational purposes only and is not engaged in rendering medical advice or professional services. The information provided through OncoLink should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you have or suspect you may have a health problem, you should consult your health care provider. |
| For further information, consult the Editors at: editors@oncolink.upenn.edu |
|
[ PRINT ]
Abramson Family Cancer Research Institute
"Confronting Cancer Through Art" is an exhibition by people whose lives have been touched by cancer.
This week's artwork was donated by a pediatric cancer patient who received treatment for cancer at The Children's Hospital of Philadelphia. |
Breast Reconstructive Surgery Options Author: Don LaRossa MD, Professor of Surgery
Affiliations: University of Pennsylvania Medical Center
Posted Date: October 20, 1997
Last Revision Date: Sunday, 14-Feb-1999 13:54:27 EST
Copyright © 1994-1999, The Trustees of the University of Pennsylvania
OncoLink Advisory: Photographs linked to from this page graphically illustrate the results of breast reconstruction therapy. Since they depict actual patients, some OncoLink readers may choose not to view them. Reconstruction of the breast following mastectomy has become an integral part of the holistic treatment of breast cancer. Many patients are candidates for reconstruction simultaneous with mastectomy, though it can be done at a later date as a separate operation depending on various factors. These factors would include the type of tumor, need for radiation or chemotherapy, or the patient's wishes. These decisions will be made by the patient in consultation with her surgeon, oncologist, and plastic surgeon. Breast reconstruction can be viewed as occurring in stages, the first of which is reconstruction of a breast mound. This can be accomplished in one of several ways depending on the patient's general medical condition, body, and breast shape, and the patient's desires. The methods fall into two general categories: implant type restorations and those using the patient's own tissues. Implant type restorations: In this method, an implant of silicone filled with silicone gel or saline (IV solution) or a combination of both is placed beneath the skin and the pectoral muscle. Some surgeons prefer to first use a tissue expander (a silicone balloon) to stretch the skin over a period of weeks or months followed by the replacement with a breast prosthesis (gel, saline, or a combination) at a second operation. It should be noted here that all implants made of silicone polymers are currently being evaluated by the FDA. Although both saline filled and gel implants are permitted for breast reconstruction by the FDA. All patients are required to read and sign a manufacturer's consent for implant use. The form reviews the potential risks of silicone implants. Tissue Reconstruction: A breast mound can be recreated from the patient's own tissues. the most common donor site is the abdomen, the so called TRAM (transverse rectus abdominus skin-muscle) flap. In this operation, an area of skin around and below the umbilicus (belly button) is transferred to the site from which the breast has been removed. Most commonly, the skin and fat remains attached to one or both of the rectus abdominus muscles which provide it's blood supply, much like an electrical cord supplies power for an appliance. On some occasions, the muscle and skin can be detached entirely and reconnected to the blood vessels in the armpit using microsurgery. This is usually done when the more commonly used method is not possible as when someone has had a scar from previous abdominal surgery as from removal of a gallbladder. However, some surgeons use this as their preferred method. The transferred skin and fat is shaped to resemble the opposite breast or into two breasts if both breasts have been removed. The abdomen is closed and leaves a scar that extends from hip to hip, much like that seen in a "tummy-tuck" operation. The missing muscle is often replaced with a surgical mesh material to reduce the risk of a hernia or bulging of the abdomen. Another approach is the use of a large, flat, broad muscle from the back, the latissimus dorsi muscle, and overlying skin. Although the skin and muscle may provide sufficient bulk to reproduce a small breast, an implant is usually needed to restore a larger breast. A scar remains on the back but can sometimes be designed to be hidden under a brassier strap. Some flattening of the back remains from removal of the muscle, but use of the arm remains essentially unimpaired. Finally, soft tissue can be transferred from the buttock or thigh using microsurgery. These represent the most sophisticated and complex methods of breast reconstruction and are generally reserved for specific indications. The second phase of breast reconstruction is the creation of symmetry. Many patients wish to have a nipple or areolar complex reconstruction which is done several months after the breast mound reconstruction. This can be done with the patient's own tissues or by tattooing color into the skin at the nipple areolar site simulating the nipple areolar complex. Tattooing is done in the doctor's office while the nipple reconstruction is done using the patient's own tissues is done as an outpatient procedure in the hospital operating room. The creation of symmetry may involve lifting of the opposite breast or making it smaller or larger to match the reconstructed breast. These methods vary in their complexity, risk, complications, length of surgery, and length of time for recovery. The following table outlines these parameters: Table I The following are illustrations of results using these various methods in patients who have consented to their use for medical education. Each patient is unique in their body and breast reconfiguration, scar formation, etc. The results, therefore, such as those illustrated cannot be guaranteed. Many patients who have had reconstruction volunteered to discuss their experience with patients facing reconstruction. This can be discussed with your reconstructive surgeon.
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GENERAL DISCLAIMER OncoLink is designed for educational purposes only and is not engaged in rendering medical advice or professional services. The information provided through OncoLink should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you have or suspect you may have a health problem, you should consult your health care provider. |
| For further information, consult the Editors at: editors@oncolink.upenn.edu |
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