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Archive for the ‘Breast Surgeon’ Category

Breast Lipoaugmentation Offers Unique Benefits

Tuesday, May 24th, 2011

Saline or silicone implants may be the most well-known approaches to breast augmentation, but autologous fat grafting may be the most viable alternative.

It’s called “breast lipoaugmentation” because the procedure uses your body’s own fat to augment the shape of the breast, allowing the surgeon greater flexibility in shaping the breast.

Breast lipoaugmentation has particular benefits that recommend its use in certain cases, but it’s not for everyone. There is some disagreement about how much transplanted fat can survive the move, and there have been fears about the procedure’s effect on cancer detection methods.

Advantages

There are risks associated with tissue grafts and implants that are avoided through the use of breast lipoaugmentation.
There is no compelling evidence to indicate that the procedure interferes with breast cancer detection, according to a comprehensive literature review published in 2009. Women can have mammograms or MRIs before the procedure to assist radiologists and further ensure their safety.

Disadvantages

Breast lipoaugmentation doesn’t provide the dramatically increased volume made possible by breast implants. The procedure can only upgrade a breast from one-half to a full cup size.
Up to a quarter of the transplanted fat is likely to die as a result of the transplant. Fat is a living tissue and requires nourishment from the blood to survive, and an autologous fat graft may cut portions of the fat from receiving proper circulation. There has been promising research using bodily stem cells and other approaches to enhance the retention rate.

According to ModernMedicine’s Cheryl Guttman Krader, these unique pros and cons make breast lipoaugmentation well-suited to being combined with breast implants. Surgeons can use both techniques to maximize the beauty and natural feel of the breast.

Tags: autologous fat grafting, breast augmentation, breast implants, breast lipoaugmentation, liposuction
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Some Mastectomy Patients May Be Ill-Informed About Breast Reconstruction

Thursday, March 17th, 2011

Are breast reconstruction patients making high-quality decisions about their procedures? This is the question posed by a recent article in the Journal of Plastic and Reconstructive Surgery, which has revealed that women treated with mastectomy were not well-informed about breast reconstruction. This is particularly serious since these patients were highly involved in making treatment decisions with their doctors.

The study was a cross-sectional survey of early-stage breast cancer survivors from four university medical centers. The survey included measures of knowledge about specific reconstruction facts, personal goals and concerns, and involvement in decision making.

Here are the survey questions, followed by the answer and the percentage of participants who answered correctly:

Are women more satisfied with reconstruction at the time of the mastectomy or with delayed reconstruction? (They are equally satisfied, 33.3%)
Are women more satisfied with the look and feel of breast implants or flaps? (Flaps, 15%)
Does an implant use fat and tissue from other parts of the body to make a breast? (No, 13.1%)
Does breast reconstruction with a flap usually require more than one surgery? (Yes, 28.6%)
Which breast reconstruction surgery heals faster? (Implants, 57.1%)
Roughly what percentage of women who have breast reconstruction will have a major complication, such as needing hospitalization or an unplanned procedure, within 2 years? Is it below 25, 25-50, 50-75, or more than 75? (25-50%, with only 3.6% knowing the correct answer!)
How does breast reconstruction affect future screening for breast cancer? (Little to no effect, 35.7%)

A mastectomy is a life-changing experience, and reconstruction surgery offers many women a path to renewal and normality. Before taking that step, however, it’s always a good idea to ask lots of questions to make the best possible decision.

Women considering reconstruction surgery should ask their plastic surgeon about their options, and talk to others who have had similar experiences. They can also view resources from the American Society of Plastic Surgeons (ASPS) website, which has lots of information about breast reconstruction procedures.

Tags: breast reconstruction, flaps, implants, informed, mastectomy
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How Common is Breast Asymmetry?

Wednesday, January 12th, 2011

Size discrepancy between the breasts is actually quite common. Most women exhibit at least some minor asymmetry, while others have as much as a cup size difference or more. In severe cases, a woman may experience difficulty finding the right bra and may be very embarrassed by her condition.

A new study in the European Journal of Plastic Surgery explains the details of over 300 breast augmentation patients and the prevalence of breast and chest asymmetry among that group.

The author, Umar Daraz Khan, found that breasts were symmetrical in only 53.5% of the cases, and the left breast was more often larger than the right breast. Because the asymmetry often stems from a chest wall deformity, the author measured for that as well, finding “thoracic deformities or asymmetries” in over 8% of the patients. Of the 312 breast augmentation patients treated, the doctor used different sized breast implants in 9% of them.

Read the study abstract via

Tags: breast size discrepancy
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Obese Patients Receive Equal Treatment in Breast Reconstruction

Monday, January 10th, 2011

A recent study presented at Plastic Surgery 2010 examined whether physician biases affected the treatment received by obese patients undergoing breast reconstruction.

In this video, Anita Kulkarni M.D. of the University of Michigan Department of Surgery, section of plastic surgery, explains the study, “Patterns of Use and Surgical Outcomes of Breast Reconstruction Among Obese Patients: Results from a Population Based Study.”

She explains that, for certain outcomes like “clothing fit and sexual attractiveness,” obese patients in the study were actually more satisfied with their treatment than normal weight patients. “ASPS (American Society of Plastic Surgeons) members are providing excellent care to this sometimes difficult patient population,” she says.

Tags: breast reconstruction
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How Breast Augmentation Patients Differ By Geography

Thursday, December 23rd, 2010

Do women in different geographical areas have different needs or goals for breast augmentation? They might, according to a study in the Winter 2010 issue of the Canadian Journal of Plastic Surgery, which explores the “physical characteristics and implant details” of breast augmentation patients in different locations.

Breast augmentation cases from Texas, British Columbia and California were assessed. Among the different patient groups, the authors (Janae L Maher et. al) found significant differences in average weight, body mass index and breast implant volume. They also checked for differences in height, age and parity (breast symmetry).

According to results of the study, the average patient in British Columbia was 33 years old with a BMI of 20.8 and a 389ml implant. In California, she was 32 years old with a BMI of 21.6 and a 385ml implant.

Patients in Texas were, on average, slightly older at age 36 with an (slightly higher) average BMI of 22.6. The Texas group also seemed to show preference for a significantly smaller implant of 335 ml.

This article is currently available for free via the Canadian Journal of Plastic Surgery.

Tags: augmentation, implants
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Study Evaluates Alloderm for Prevention of Breast Reconstruction Complications

Tuesday, December 21st, 2010

A recent study published in Plastic and Reconstructive Surgery examines the use of accellular cadaveric dermis (ACD) as an alternative to the total sub-muscular approach in breast reconstruction. During the breast reconstruction study, an Alloderm ACD – a bioengineered tissue substitute – created a “retaining envelope” for the breast implant, which was hypothesized to reduce the risk of capsular contracture.

Capsular contracture is a possible complication with some breast implant patients, occurring when scar tissue tightens around the implant. The cause of capsular contracture is unknown, but inflammatory reaction is thought to be a related problem. Doctors predicted that ACD could work by decreasing the typical inflammatory response that occurs around the breast implant.

Houston plastic surgeon Dr. Bob Basu, along with colleagues Dr. Mimi Leong and Dr. John Hicks, assessed the results of twenty breast cancer patients (average age 47) who underwent two-stage breast reconstruction.

During the two-stage breast reconstruction procedures, the ACD was attached in the breast crease as well as the pectoral muscle. The surgeons then created a space for the tissue expander, the lower part of which was covered by the ACD. After a few months, they removed the tissue expander and replaced it with a breast implant.

Between the procedure stages, Dr. Basu and his colleagues performed biopsies of the integrated ACD, along with histopathologic analysis. They found that, compared to the control group, the samples from the ACD showed significantly reduced levels of granulation tissue formation, among other positive differences.

The doctors concluded that ACD may impede capsule formation, thus possibly inhibiting capsular contracture. Although the findings of this study make a promising case for the continued use of bioengineered tissue in breast reconstruction, Dr. Basu stresses that it is only a snapshot of a process that takes place over several years, and further investigation is necessary to determine the effectiveness of ACD in eliminating capsular contracture.

Read the abstract in PRS Journal

Tags: alloderm, breast reconstruction
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New Study Examines Psychological Results of Breast Augmentation

Tuesday, December 14th, 2010

It’s quite common for women considering breast augmentation to wonder about the physical changes in their appearance. “How will I look?” is a common question, and plastic surgeons have several ways of explaining or visually representing the results.

But how will you feel? Will the procedure change the way you think? Doctors in Berlin sought to find out. In a new study, they evaluate the psychological changes that occur after breast augmentation – specifically sub-muscular breast augmentation, a surgery that involves placement of the breast implant beneath the pectoral muscle.

The physicians outlined the following criteria to assess after surgery:

Attractiveness and self-confidence
Insecurity or anxiety
Emphasis placed on physical appearance
Sexual discomfort

Using a 100-point scale, they rated the responses of 58 patients who completed a body image questionnaire. The authors reported significant improvements in all areas except insecurity or anxiety, which they say exhibited “next to no change.”

How does sub-muscular breast augmentation work?

During breast augmentation, your plastic surgeon has the option to place the implant above or underneath the pectoral muscle. Either option is effective but in many cases, placement is determined by the patient’s body type. For example, a petite woman and a muscular woman might be recommended different placement techniques.

Tags: breast augmentation
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New Law is Intended to Ensure Breast Reconstruction Patients are Informed

Monday, August 23rd, 2010

Breast reconstruction patients will now receive more information about the treatments that are available and how these treatments can be financed, thanks to a new law signed by NY Gov. David Paterson.

The law is intended to ensure that poor or disadvantaged women are informed about their various options in breast reconstruction. Such options include health insurance coverage and a wide variety of surgical techniques that can reconstruct the breasts to restore a normal appearance.

An unfortunate reality is that many patients don’t undergo breast reconstruction because they’re not aware that the procedure has universal health insurance. Doctors pushed for the new law so that a discussion of breast reconstruction options would be required, thus increasing the number of patients undergoing the surgery.

There seems to be a stark contrast in resources between breast reconstruction patients of different backgrounds. Evidently, some are making decisions about treatment with a relative lack of information, while others are independently seeking out advanced microsurgical procedures. According to a recent study in Plastic and Reconstructive Surgery, a growing number of breast cancer patients are using the Internet to find a reconstructive surgeon on their own, and many are choosing advanced microsurgical breast reconstruction procedures.

Tags: breast reconstruction
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Time Intervals for Outpatient Surgery Center and Hospital Compared in Study

Monday, July 19th, 2010

Plastic surgeons often have the option to perform surgery at an ambulatory surgery center or in a hospital setting. While either facility is considered safe, there may be notable differences in the efficiency of each setting. According to a new study published in the American Journal of Surgery, the total facility time and the time intervals before and after surgery were longer in the hospital setting.

Authors of the study had the opportunity to compare both surgical facilities as their breast operations were moved from an ambulatory surgery center to a hospital. The records of 92 hospital patients and 92 ASC patients were retrospectively analyzed to compare time intervals and other information.

Time intervals for surgical care were measured and reviewed by the authors and they found that on average, total facility time was 69 minutes shorter in the ambulatory surgery center. Most significant was the 55-minute difference in the preoperative time period – “the time from the entrance into the holding area to entrance into the operating room.”

Based on the findings, they argue that outpatient surgery is more efficient when performed at a dedicated outpatient center. Also, if the time saving practices used at the surgery center are incorporated at the hospital, it could increase efficiency in that setting.

Source cited: “Outpatient surgery performed in an ambulatory surgery center versus a hospital: comparison of perioperative time intervals” The American Journal of Surgery (2010) 200, 64 – 67

Tags: breast surgery, surgery center
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Nurses Study Informational Needs of Breast Surgery Patients

Tuesday, July 6th, 2010

With so many rich information sources online, the average cosmetic surgery patient can learn a lot before the consultation even begins. During a consultation, your plastic surgeon should answer your questions and provide information in order to help you make an educated decision and manage your expectations about the procedure. However, according to a recent paper published in Plastic Surgical Nursing, some patients are still lacking valuable information.

The authors argue that information about breast surgery post-operative events is “fragmented, incomplete, or lacking.” They reached this conclusion by studying interviews with 48 patient who underwent breast reconstruction, breast reduction, and breast augmentation.

2 predominant themes were seen among breast surgery patients: unexpected outcomes and helpful/unhelpful information. Both themes have some clinical implication for plastic surgeons performing breast surgery – namely, a “need for more comprehensive education to better prepare women undergoing breast surgery and to help create more realistic expectations.”

Patients generally reported positive outcomes for their surgeries, but most of them also reported an unexpected event. Some patients who experienced post-operative swelling, numbness, discomfort and sensations in the skin were not prepared for these events. If they had been educated about these possible events, the patients would have been psychologically prepared, the authors suggest.

However, many patients in the study did receive useful information, either from their surgeons or from a website. Patient stories, before and after photos and online discussion forums were cited as helpful. Although These information is readily available online, you should still seek a plastic surgeon who is willing to provide comprehensive information about breast surgery and what to expect during your recovery.

You can read the article “Not What I Expected: Informational Needs of Women Undergoing Breast Surgery” through PubMed.gov or the journal, Plastic Surgical Nursing.

Tags: breast augmentation, breast reconstructiong, breast reduction
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