Breast reconstruction in irradiated patients

Many women following mastectomy will receive adjuvant radiation therapy. 

A recent study by Dr. Steve Kronowitz from MD Anderson in Houston appeared in the October issue of “Plastic and Reconstructive Surgery”.  

Generally, it was found using a patient's own tissue (autologous) for reconstruction gave better results. 

Implants, however, may be the only choice available.  In one study, they found a complication rate of 45% for women receiving implants WITH radiation compared to 24% in women with NO radiation.  Complications were more common when the patient received radiation BEFORE rather than after reconstruction.  

Basically, radiation therapy affects the skin, which ultimately compromises the reconstruction.  It is also important for me to remember, as a cosmetic surgeon, disease control / eradication is ALWAYS my primary goal.

LUMPECTOMY FOR BREAST CANCER

Today, many women will bypass a mastectomy for a lumpectomy followed by chemotherapy and/or radiation.

A recent article in the Journal of the American Medical Association revealed that one in four (25%) of patients undergoing this therapy will undergo a second operation.

This creates a significant degree of anxiety along with many questions about the patients future – how deformed will it be? Did it spread?

There is a sincere sense of anxiety and stress associated with this. I also think a patients personality and sense of body image may come into play when making a decision on what therapy is best for her.

PROPHYLACTIC MASTECTOMY

Many surgeons are concerned with the increasing trend among women to request removal of their other “normal” breast after undergoing a mastectomy.

Many women voice concerns about developing cancer in the “other” normal breast. Why is this?

There are several reasons. One – fear of recurrence. Two – new technology such as MRI can pick up miniscule lesions not seen on normal mammograms. Third – many women are getting genetic testing to see if they carry BRCA-1 and BRCA-2, genes associated with an increased cancer risk.

Even after a “double mastectomy” the risk of breast cancer is reduced by 90% - NOT 100%. Tumors can still grow back in scar tissue or under the arm where extra breast tissue may be located.

Careful planning with your surgeon trumps decision making out of fear. Dr. Brueck offers general guidance on his Fort Myers Plastic surgeon web site. You are invited to visit.

Sparing the nipple is okay.

This is another message from blogger Dr. Robert Brueck MD, who practices plastic surgery in Fort Myers.

Plastic surgeons were always concerned that sparing the nipple during mastectomy may cause a greater recurrence following breast cancer surgery.

A recent article in Plastic and Reconstructive Surgery reports that 20 years of research shows there is NO greater incidence of breast cancer in nipple sparing mastectomies.

This technique however is not right for all women. Women with more advanced cancer or large pendulous breasts may require a standard mastectomy.

Another testimonial for Fort Myers Plastic Surgeon, Dr. Robert Brueck MD

Practicing plastic surgery in Fort Myers, FL brings me many satisfactions. From time to time, a patient heightens that satisfaction by writing me a thank you note. This one struck me as particularly heartfelt because of the patient's background. I hope you agree. (The original printed letter has been transcribed here as written.)

~~~~~~~

"Dear Dr. Brueck and Staff:

Thank you, thank you, thank you. I had a mastectomy in 2009 and was very adamant about not getting reconstructed and using a prosthetic. I did that for a year and a half and was getting tired of not having myself back. I did some soul searching and decided to interview a few Plastic Surgeons. I went on line and did a search and found Dr. Brueck. My husband and I had a consultation with him and immediately knew he was the one. From the minute we walked in his office from his staff to Dr. Brueck couldn't have made my decision any easier. I had reconstruction and a nipple done on my left side and an augmentation done on my right side do to a lumpectomy I had eleven years ago. I feel WONDERFUL and the reconstruction/augmentation looks BEAUTIFUL. Dr. Brueck is blessed with magic hands and a great personality.

Dr. Brueck and his staff made a very difficult sensitive situation easier tio handle. THANK-YOU!" - TC