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    New Options for Breast Reconstruction

    Experts Say Many Breast Cancer Survivors Are Uninformed About the Choices

    Breast Reconstruction Options continued...

    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.

    Breast Reconstruction and Quality of Life

    Research is under way to evaluate the personal impact of having breast reconstruction.

    A new questionnaire, developed by Pusic, aims to quantify how breast reconstruction affects the patient's quality of life.

    Called the Memorial Sloan-Kettering Cancer Center Breast-Q, it measures satisfaction and quality of life by examining body image as well as psychological, social, sexual, and physical functioning.

    It is hoped that the results will educate patients and doctors about the value of breast reconstruction for some women, she says.

    Breast Reconstruction: The Access Problem

    Despite legislation mandating coverage and new techniques for reconstruction, racial and regional gaps exist, says Amy Alderman, MD, assistant professor of surgery at the University of Michigan Medical Center, Ann Arbor.

    African-American women are half as likely to have breast reconstruction as whites, for instance, she says.

    In one study, 35% of women in Atlanta opted for immediate reconstruction but just 8% of those in Connecticut did.

    To find out why more women weren't opting for reconstruction, Alderman searched patient data bases in Los Angeles and Detroit that included more than 2,000 women and found that providers did a "poor job in informing women about their options."

    One barrier, she says, is that many of the women didn't have access to a plastic surgeon before their mastectomy. The Society advocates a team approach, with the general surgeon working with the plastic surgeon.

    If a woman isn't offered a team approach, the speakers say, she can first find a plastic surgeon and ask him or her to help assemble a team.

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