Breast Reconstruction Can Be Performed Any Time

Did you know breast reconstruction can be performed at any time, even years after a mastectomy?

"Immediate breast reconstruction" is performed at the same time as the mastectomy and typically provides the most natural results with the least amount of scarring. Unfortunately, for many women this simply isn't an option....

For starters, 70% of women facing mastectomy aren't even told that reconstruction may be an option for them. They undergo surgery only to find out some time later that they could have woken up from their mastectomy with new breasts instead of having to experience a flat chest.

Of the women that are informed, some may not have access to a reconstructive plastic surgeon where they live and have to travel for reconstruction.

Other women are not candidates for immediate reconstruction because unfortunately the disease is too advanced at the time of diagnosis.

Sometimes radiation therapy is recommended as part of the breast cancer treatment. Most plastic surgeons prefer to hold off on reconstruction until the patient is several months out from her last radiation therapy. This allows the tissues to recover and soften up as much as possible to improve the results of the subsequent reconstruction.

As you can see, there are several reasons why a women wanting breast reconstruction may not be able to have it straight away, ideally at the same time as the mastectomy.

Whatever the reason for delay may be, it is important to remember there is no time limit when it comes to breast reconstruction - it can be performed at any time, even years after mastectomy.

Like immediate reconstruction, delayed breast reconstruction is also covered by insurance regardless of how many years have passed since the breast cancer diagnosis.

Dr C

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PRMA Plastic Surgery specializes in advanced breast reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap and Alloderm One-Step. In-Network for most US insurance plans. Patients routinely welcomed from across the USA. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer reconstruction patients at www.facebook.com/PRMAplasticsurgery.

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Breast Reconstruction Often Not Discussed

By Megan Rauscher

NEW YORK (Reuters Health) - Women with breast cancer faced with treatment decisions are often not told by their surgeons about the possibility of breast reconstruction after a mastectomy, a study confirms. When these conversations do occur, many more women choose mastectomy, researchers found.

In a survey of 1,178 women who had breast cancer surgery, only 33 percent reported that their surgeon had discussed breast reconstruction with them during the surgical decision-making process.

"We found it surprising that very few patients were informed about their options for breast reconstruction, and that information regarding reconstruction was more likely to be given to younger women who were more educated," Dr. Amy K. Alderman of the University of Michigan Medical Center, Ann Arbor, told Reuters Health.

The survey, posted online Friday by the medical journal Cancer, also indicates that women who had these discussions with their surgeon were four times more likely to have a mastectomy compared to women who did not discuss reconstruction.

"Women need to be fully informed about all of their surgical options for breast cancer: lumpectomy, mastectomy and mastectomy with reconstruction," Alderman said. "All are great options with the same long-term survival."

Breast reconstruction, continued Alderman, "is a personal decision for each woman that is influenced by her body image, sexuality, fear of recurrence, etc. Women should be educated consumers of their healthcare."

She concluded: "We, as physicians, need to make sure that all women, regardless of the patients' education and socioeconomic status, are fully informed of their surgical choices for breast cancer care."

SOURCE: Cancer, February 1, 2008

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The Hype Around DIEP Flap Breast Reconstruction And How To Find A DIEP Flap Surgeon

If you are a woman facing mastectomy you have a decision to make: do I want breast reconstruction? If the answer is “yes”, plastic surgery holds the key. Although reconstruction cannot replace the breast(s) you were born with or allow you to breastfeed, it can restore your natural silhouette and make you feel “whole” again following mastectomy.

Depending on your health, breast reconstruction can be performed immediately after your mastectomy surgery so you can wake up with new breasts already in place. While the cosmetic results with immediate reconstruction are generally superior, breast reconstruction can also be performed at a later time once the cancer treatment has been completed.

The DIEP flap breast procedure is today’s gold standard in breast reconstruction. Advances in breast reconstruction have made it possible to use excess skin and fat from the abdomen (rather like the tissue removed during a tummy tuck) to construct a new breast without the need for implants or the sacrifice of abdominal muscle. This procedure, known as the Deep Inferior Epigastric Perforator (DIEP) flap, is a sophisticated modification of an existing procedure known as the TRAM (Transverse Rectus Abdominus Myocutaneous) flap.

TRAM flap surgery is a common breast reconstruction technique that requires the rectus abdominus (sit-up) muscle to be sacrificed and relocated to the upper abdomen. Unfortunately, this technique can be associated with significant post-operative pain, prolonged recovery, loss of abdominal muscle strength (up to 20%), abdominal bulging (or “pooching”), and even abdominal hernia.

DIEP flap breast reconstruction is similar to TRAM flap surgery but spares the rectus abdominus muscle. SKIN AND FAT ONLY are removed from the abdomen, transplanted to the chest and connected using microsurgery to create the new breast. NO MUSCLE is sacrificed. As the sit-up muscle is left behind in its natural place many of the above complications are avoided and the patient essentially receives a tummy tuck at the same time as the breast reconstruction. There also tends to be far less pain following the DIEP procedure, and a quicker recovery time.

Knowing the significant advantages of the DIEP flap it is easy to understand the reason for all the hype, especially for active individuals who don’t want to sacrifice the strength of their abdomen. A breast that has been reconstructed with fat and skin will also look and feel more natural than an implant reconstruction and will last longer. Unlike an implant, the reconstructed breast also ages like a natural breast.

As with all types of breast reconstruction however, 2 or 3 procedures performed a few months apart are often required to complete the reconstruction process and to obtain the best cosmetic result. Unfortunately, due to the complexity of the DIEP procedure very few centers in the US perform DIEP flap surgery so many patients will have to travel for the procedure. The good news is that many of these DIEP flap centers will accommodate out-of-state and even international patients.

To learn if a breast center or plastic surgeon near you offers DIEP flap breast reconstruction, please check the following websites:
www.breastrecon.com and www.diepsisters.com

The lists on these websites seem fairly thorough but there are plastic surgeons out there who perform DIEP breast reconstruction that have not made the lists (for whatever reason). Having said that, currently there are only about 40 plastic surgeons in the US that routinely perform the DIEP flap procedure. Before choosing a plastic surgeon ensure that he/she is certified by the American Board of Plastic Surgery and has extensive experience with the DIEP flap procedure. Ask about the success rate of the procedure in their hands (most DIEP flap specialists boast a flap survival rate of at least 97%) and how many DIEP flaps they have performed.

Insurance companies are federally mandated to pay for the cost of breast reconstruction. Unfortunately, some patients will still face difficulties in gaining access to a DIEP flap surgeon and the procedure. Here again it pays to seek out plastic surgeons who specialize in the DIEP procedure as typically insurance specialists are available to help patients with insurance issues.

Learn more about the DIEP flap procedure and other breast reconstruction options here.


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Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.

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British Women Over 70 Receive Less Breast Cancer Treatment

Elderly breast cancer care 'poor'.

Older women with breast cancer get poorer care than younger women, a study has found.
Researchers from the University of Manchester found they are less likely to get a range of diagnostic tests and treatments.

Writing in the British Journal of Cancer, they say this is likely to lead to higher rates of cancer recurring, and higher death rates.

Cancer campaigners said women of all ages deserved high standards of care.

They also have a lower chance of surviving the disease - women aged 70-79 have a 76% chance of surviving for five years after their illness, compared to 80% for all ages.

This drops to 61% for women aged 80 or over - a fall which is not explained by their increase in age.


Perceptions 'differ'.

The team reviewed the cases of 480 women aged 65 and over, who lived in Greater Manchester, with invasive breast cancer registered over a one year period.

They found that a woman aged 80 or over was over five times less likely to receive a triple assessment - where the lump is assessed, a mammogram is taken and cell and tissue studies - to say if her cancer is operable, compared to a woman aged 60 to 65.

Her odds of her not receiving surgery are more than 40 times higher.

And they say even women in their early 70s are over seven times less likely to get radiotherapy following surgery, compared to women aged 65-69 years.

The researchers say the variations in care are not explained by differences in their tumours.

And they suggest the findings can be applied nationally because there is little variation in breast cancer survival between regions.

A survey of UK breast cancer surgeons in 2004 found three quarters said they would treat older breast cancer patients in a similar way to younger patients, while 98% said the cut off point for breast cancer surgery was not age related.

However Dr Katrina Lavelle, who led the Manchester research, said: "Women aged 70 and over are less likely to receive the same breast cancer care as younger women and that this is related to their age rather than differences in the biology of their tumour.

"Clearly there is a difference in clinicians' perceptions of how older breast cancer patients should be treated and their actual practice."

She added: "Mortality of elderly breast cancer patients is unlikely to improve where this pattern of management persists."

Dr Sarah Rawlings, of Breakthrough Breast Cancer: "All women should have access to the best possible services and treatments for breast cancer, regardless of age.

"Although breast cancer risk increases with age, older women are more likely to underestimate their chances of developing the disease and may also present with the disease at a later stage, which may affect the treatment options available.

"The earlier breast cancer is caught, the better the chances of successful treatment."

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Source: BBC news

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Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.

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