Atlanta reconstructive surgery

April 23, 2012

Frequently Asked Breast Reconstruction Questions

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Breast reconstruction surgery is an emotionally charged process filled with a number of “what-ifs.” From basic questions regarding what to bring to the hospital to more complicated inquiries like what happens in surgery, we know that educating our patients is the first step to helping them feel comfortable with their decision to undergo breast reconstruction. Below are just a few of the common question we answer for our breast reconstruction patients.

What kind of clothes should I wear after surgery?

Many patients find that button-up and zip-up shirts are more comfortable the first week or more after surgery. Lifting your arms overhead may be difficult due to the nature of the surgery, so shirts with openings in the front will allow you to move more comfortably. Patients recommend soft, warm fabrics as many find hospitals on the chilly side. Some women say large camisoles that allow them to step into the shirt and pull it up or “bird-wing” their arms into the sleeves without raising them are also nice after surgery. Some companies make custom post-surgical shirts that are loose and even have pockets for drains.

What kind of scarring can I expect after breast reconstruction surgery?

Depending on the breast reconstruction technique used during your surgery, there are different incision placements. Some patients’ cases are less complicated and surgeons can try to hide scars. The flap procedures in which spare tissue is taken from the tummy can result in a tummy tuck like scar across the lower abdomen. Scars can be vertical, horizontal, straight, or curved. Each patient’s scars will be different because each woman’s medical needs are different. See Dr. Elliott’s breast reconstruction photo gallery to see the types of scars associated with specific surgical techniques.

Is breast reconstruction hard on the body? What is recovery like?

Each woman’s breast reconstruction situation is different. Some women undergo bilateral mastectomies of both breasts while others only have one removed. As such, each person’s recovery is different. Some breast reconstruction surgery techniques are less invasive than others. The TRAM procedures, for example, use tissue from another area of the body to replace the breast tissue lost during breast cancer removal surgery. Recovery from these surgeries generally takes longer. Dr. Franklyn Elliott provides all his breast reconstruction patients with specific aftercare instructions to ensure each patient’s recovery is as quick as possible.

Breast reconstruction surgery is never an easy choice. Some patients decide to have their surgery immediately after breast cancer removal, while some decide to wait or have to wait because of the need for radiation or other factors. We recommend you seek a consultation from a board certified plastic and reconstructive surgeon like Dr. Franklyn Elliott along with your oncologist and general surgeon. There, you and your doctors can formulate a plan that best suits your needs, and you can ask any questions you may have.

To stay up to date on the latest breast cancer and reconstruction news, make sure to follow Dr. Elliott on Facebook, Twitter, and Google+. You can also sign up for his monthly newsletter.

April 16, 2012

Can I Have Radiation Therapy for Breast Cancer after Breast Implant Reconstruction?

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dr elliott Radiation is meant to kill any remaining cancer cells in the body in order to prevent a recurrence of breast cancer. While it destroys cancer cells, radiation also affects blood supply to skin and deep tissues and even causes scar tissue. A breast implant would be subject to these changes since it would be directly within the radiation treatment area. Implants placed under the pectoral (chest) muscle would be subject to scarring that occurs in the muscle.

As the skin and muscle scars after radiation therapy, so does the scar capsule surrounding the implant. This puts patients at a greater risk for capsular contracture which occurs when a patient’s body reacts to a foreign object, forming a capsule around the implant. The extra scarring causes the capsule to tighten around the implant, creating a painful condition in which the breast looks hard and abnormal. While the implant itself remains normal, the tissue around it is affected.

Patients can have radiation therapy after TRAM flap reconstruction procedures with tissue expanders. However, it’s important to remember that the tissue will still be affected (i.e., scarring, changes in blood flow). This means the skin used in reconstruction will not be as soft as it would be if it were not part of radiation therapy. Most surgeons will delay breast reconstruction if their patients need radiation so that they may use healthy tissue that hasn’t been affected by the treatment. Although each patient’s situation is unique, in general I prefer the TRAM flap procedure in any situation where radiation therapy is involved.

Stay up to date on the latest breast cancer and breast reconstruction news by following Dr. Elliott on Facebook, Twitter, and Google+.

March 23, 2012

Prophylactic Nipple-Sparing Mastectomy and Methods of Reconstruction

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Though once popular in the 70s and 80s, the prophylactic mastectomy fell out of favor with doctors and patients in the 90s. However, the advances of mammography in the 90s and beyond have lessened the number of women who are choosing to have one or both of their breasts removed to prevent the advent or spread of breast cancer.

Fewer people are as supportive of preventative mastectomies nowadays because of the potential complications and reports of low patient satisfaction. Thinner skin used over implants can cause capsular contracture or hardening of the tissue lining surrounding the implant.

In a chapter written for the textbook Surgery of the Breast, Dr. Franklyn Elliott writes regarding patient satisfaction:

Patients did not believe they were properly prepared for some of the results of these major surgical procedures, and because they did not have frank breast cancer, were not in the mind-set to deal properly with major surgical extirpation and reconstruction.

However, in a recent study only 5% of patients regretted undergoing prophylactic mastectomy and reconstruction surgery. Many felt that were inadequately prepared for the pain and incapacitation of the recovery period.

For this reason, it’s important that a plastic surgeon is one of the many consulting surgeons who advise a potential mastectomy and breast reconstruction patient.

Many women who are at a high risk for potential breast cancer and those who’ve had one breast removed because of cancer seek preventative mastectomies. There are many factors that oncologists, general surgeons, and plastic surgeons should consider before suggesting a prophylactic mastectomy for a patient including heredity, the breast cancer gene (BRCA1 and BRCA2), previous diagnoses, and more. It must also be explained to patients that advances in mammography techniques have made it easier to track potential cancers without removing the entire breast.

Choosing a preventative unilateral or bilateral mastectomy is a difficult choice for any woman. According to the chapter written by Dr. Elliott, the “plastic surgeon must limit his or her role to the very accurate description of the patient’s options after mastectomy and, equally important, a full and complete discussion of the recovery phase and the expected result.”

Oftentimes, prophylactic mastectomy patients are shown before and after pictures of women who have had breast cancer and undergone mastectomy and breast reconstruction surgery. It’s important that patients are given information specific to their particular procedure, regardless of the similarities between their procedures and another patient’s.

It’s rare that women with no risk factors are interested in prophylactic mastectomies with reconstructions. Some patients are motivated by fear. However a lack of risk factors in patients seeking prophylactic mastectomies probably means that they should not be considered for surgery.

Though controversial among some doctors and patients, there are benefits to preventative mastectomy and breast reconstruction. In the chapter, Dr. Elliott concludes, “With the variety of techniques available for breast reconstruction, intelligent management of the overlying skin, and gradual formation of the breast mass itself, patients can be increasingly assured of complete or near complete breast tissue removal and safe, predictable, uncomplicated breast reconstruction.”

To read the chapter, click here (link to PDF). Other articles written and used by Dr. Franklyn Elliott can be found on his articles page. You can also connect with him on Facebook and Twitter for the latest in plastic and reconstructive surgery news.

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