Breast Cancer Awareness

Serving Chattanooga, Tennessee

October is National Breast Cancer Awareness Month.  Around our community and country, activities have been planned to promote awareness regarding the early detection and management of breast cancer.   As a plastic surgeon, it has been my great privilege to have become involved in breast reconstruction in our community.  It is now one of my principle interests.  There are many aspects of breast reconstruction that I enjoy.  The technical challenge is stimulating, and the results are predictably good. But, far and away, what I have found that always brings me back to breast reconstruction as my favorite surgery are the patients.  The women I have had the pleasure to work with are some of the most gracious, tolerant, patient and thankful people I have ever contacted.  And particularly this month, I want to say “Thank-you” for inviting me into your lives.

Breast reconstruction can be a confusing choice for patients, especially when one is already confronted with the management of a dangerous disease. There are a myriad of options, and patients really need a reliable guide to help navigate through these personally uncharted waters.  To bring the issues to basics, one can have an immediate or a delayed reconstruction.  At times, the tumor type dictates that reconstruction should be delayed.  Anticipated radiation therapy typically precludes immediate reconstruction.  I have also learned that in some patients, immediate reconstruction is just too great a psychological burden.  Delayed reconstructions can be performed when the patient is ready, and the cosmetic results are equal to that of an immediate procedure. 

There are three types of reconstruction.  One type uses all “off-the-shelf” implants.  One type employs entirely pieces moved from other areas of the body.  A third type uses a combination approach.  The best breast reconstruction is patient dependent.  I always tell patients that I believe my job is to achieve the best cosmetic result with the least impact on their body. To that end, I have been a great fan of the “off-the-shelf” reconstruction with tissue expansion technique.  Here, a flat implant is placed into the mastectomy site and slowly filled postoperatively until the patient is happy with the size.  It is then removed, some positional adjustments are made, and a definitive modern silicone implant is placed into the site of the expander.  This effort is particularly well received in bilateral cases, where symmetry can be quite close.  With one sided mastectomy, often the opposite breast is altered to provide improved aesthetics and symmetry with a breast lift, reduction, or later implant augmentation.

Patients who have had radiation therapy are usually reconstructed about a year after their treatment.  I have grown particularly fond of the cosmetic results achieved with a latissimus dorsi and tissue expander technique.  Here, a back muscle is swung around to the front through the axilla to provide a healthy environment for the expander.  The course then proceeds similar to the "off-the-shelf" expander technique.

There are, of course, several other options with specific applications in my practice.  Though no technique is perfect, I have found that the results are very gratifying and serve the patient population well.

           

Remember Breast Cancer Awareness month, and join the fight to prevent, treat and control breast cancer.