Plastic surgery might conjure images of cosmetic implants and reshaping, but it plays an important role in cancer treatment. Plastic surgeons work with medical and radiation oncologists to help patients with mastectomy and breast reconstruction. They might also do a sentinel lymph node biopsy to ascertain whether breast cancer has migrated to the lymphatic system in the underarm (axillary). This may be carried out concurrently with a lumpectomy or mastectomy.
Reconstructive surgery encompasses many procedures that restore physical form and function to body parts affected by injury, disease or congenital disabilities. Specialized training in the creation and transfer of flaps and in the craft of re-sculpting body parts helps plastic surgeons bring damaged tissue back to its former shape.
One of the most common reconstructive surgery is breast reconstruction following mastectomy for cancer. The plastic surgery team works closely with the cancer surgeon to ensure the cosmetic results are safe and healthy, despite possible treatment-related complications like radiation and scarring.
During the procedure, a piece of tissue containing skin, fat and blood vessels is taken from elsewhere on the body-typically the belly-to rebuild a new breast, with or without implants. Sometimes, patients choose to have this procedure done simultaneously with their mastectomy. Breast reconstruction is covered by most health insurance.
Breast reconstruction is one of the most well-known cancer-related surgeries plastic surgeons like Joel Aronowitz, MD, perform. Doctors do many other body tissue moves as part of cancer treatment, restoring bodies that are changed by tumors or radiation therapy.
For example, when a soft tissue sarcoma is removed, doctors generally remove the tumor and a “cuff” of surrounding normal tissue to minimize the chance that cancer will return to the surgical site. This often results in wide resections of skin. Plastic surgeons can reposition healthy tissue over the wound to minimize scarring.
Surgeons can also move fat, blood vessels and muscle from other body parts to reconstruct your breasts using autologous tissue reconstruction or flap surgery. This approach tends to produce more natural-looking results than implant reconstruction. However, it requires more time in the operating room and patients to visit the doctor for weekly office visits to add fluid to a balloon-like device called an expander.
Tissue Expander and Implant Reconstruction
In breast reconstruction with implants, surgeons place a tissue expander implant under or over the chest muscle. The expander has a port (like a tiny valve) on the front wall that your doctor or nurse uses to inject saline through a small needle. The tissue expander slowly fills with saline during each visit and grows larger. This stretches the skin over it, creating a pocket in which your plastic surgeon inserts a permanent breast implant.
Some women with lumpectomy and partial mastectomy can get a permanent implant immediately after surgery (direct-to-implant reconstruction). However, most breast cancer patients must undergo a two-stage procedure using a tissue expander before getting their permanent implant. Thus, it is essential to choose an experienced surgeon like Dr. Joel Aronowitz to achieve a successful operation.
During the expansion process, some women experience mild discomfort from the pressure on their breasts or the stretch of their skin. Newer expanders use a type of remote-controlled gas that may decrease the amount of pain. Once the expander has a firm feel, your surgeon removes it and replaces it with the implant during a second operation.
Autologous Tissue Reconstruction
Autologous tissue reconstruction involves using tissue from your body to rebuild the breast. The surgeon creates a flap of skin, fat and blood vessels from the abdomen (for example, the latissimus dorsi muscle that runs across your back). This procedure is typically performed concurrently with a lumpectomy or mastectomy. Women occasionally opt for both implants and autologous reconstruction.
This technique gives the chest wall a natural look and feel, which is crucial for patients who require radiation.
In addition, with improved anatomical knowledge and surgical techniques, abdominal donor site morbidity associated with the DIEP flap has been significantly reduced.
If you decide to have an autologous procedure, your plastic surgeon will discuss options for the type of skin and tissue needed to reconstruct your breast. Radiation can damage reconstructed breasts, so many people prefer to delay this surgery until after their radiation is completed.