Sept. 17, 2008 -- About 78,000 U.S. women undergo a mastectomy each year, but just 57,100 had breast
reconstruction in 2007, according to experts speaking at a web seminar hosted
by the American Society of Plastic Surgeons.
For a minority of women, reconstruction of the breast after a cancer diagnosis is simply not
important, says Roberta Gartside, MD, a Virginia plastic surgeon and breast cancer survivor who
But other women, says Gartside, are not fully informed of their options,
face financial barriers, or both.
These obstacles exist, Gartside and other speakers say, even though
insurance coverage for post-mastectomy breast reconstruction is mandated by the
1998 Women's Health and Cancer Rights Act.
At the seminar, speakers talked about new or improved reconstruction options
and what is being done to reduce barriers to the procedure.
Breast Reconstruction Options
By far, the most popular breast reconstruction option is the implant and
tissue expander, says Gartside. Other options include using tissue flaps or an
In the flap technique, the surgeon repositions a woman's own muscle, fat,
creating or covering the breast mound.
A tissue expander stretches the skin to provide the coverage for the breast
implant. Final steps can include recreating the nipple and areola.
Silicone implants are back "and better than ever before," says
Andrea Pusic, MD, a plastic surgeon at Memorial Sloan-Kettering Cancer Center
in New York.
Once banned, the silicone implants were approved by the FDA for breast
reconstruction in women of all ages and for breast
augmentation in those 22 and older in 2006.
A study released earlier this year at the annual meeting of the American
Society of Plastic Surgeons showed that women who got silicone implants were
more satisfied than those who got saline, Pusic says. Women who received
silicone implants say they are softer and have less rippling, she says.
Newer generation silicone implants -- the so-called "gummy bear''
implants -- may prove even better, according to Pusic.
Fat injections are being used to fill in deformities left by lumpectomies
and mastectomies, she says.
And other research has studied the use of stem cells derived from fat to
correct deformities after breast-sparing surgery.
Transplanting donor tissue from a patient's identical twin to
reconstruct the breast with a flap technique is another new option, and three
such cases are reported in the October issue of Plastic and Reconstructive
None of the patients could supply her own tissue for the transplant, for
various reasons. One, for instance, was too lean and had no excess abdominal or
buttocks tissue to transfer, according to Robert J. Allen, Jr., MD, a surgeon
in Charleston, S.C., the lead author of the report. He reports that all three
transplants were successful and believes the report is the first documentation
of flap transplants for breast reconstruction.
In the future, he writes, such transplants for breast reconstruction might
be possible between nonidentical twins.