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New Options for Breast Reconstruction

Experts Say Many Breast Cancer Survivors Are Uninformed About the Choices
By
WebMD Health News
Reviewed by Louise Chang, MD

Advances Breast Reconstruction

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 spoke.

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 implant alone.

In the flap technique, the surgeon repositions a woman's own muscle, fat, and skin, 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 Surgery. 

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.

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