The “throw away” journal Plastic Surgery Practice has two really well written informative article on breast surgery in the February 2009 issue.
The first is “Reconstructing the Radiated Breast” written by Dr Jane Petro. The article makes the point that surgery on the radiated breast includes “all the pitfalls of any breast procedure.” The topic is important as many women opt for breast-conservation therapy (ie lumpectomy followed by radiation therapy) hopeful that they will maintain breast integrity and not need reconstruction.
This works for many, but not all.
In reality, the appearance of the breast after this treatment may be unsatisfactory, due to a number of factors. Lumpectomy may deform the breast, leaving unsightly and poorly planned scars in the upper visible quadrant. Scars from port placement for chemotherapy are often midway between the clavicle and the breast. Resection of lower-quadrant tumors may deform the nipple location, increasing the appearance of breast asymmetry.
Radiation may cause soft-tissue contraction, skin discoloration, and scar-related exaggerated deformity. Reconstruction with an implant has one of the highest complication rates, severely affecting the result due to radiation. Reconstruction with well-vascularized flap tissue, such as a TRAM, is not immune to radiation damage, either. Women disappointed by their result then seek consultation regarding options for achieving a more aesthetically satisfactory result.
If you are interested in this topic, I would encourage you to read the entire article. Dr Petro writes clearly and has included photos of some of the issues and what is possible.
The second article is “Beware the Breast Augmentation and Lift Combo” written by Dr Laurie Casas. The article is a reminder that even for skilled surgeons “this combination may be the most complex plastic surgery procedure to perform.” She makes the point that it is important to understand the patient’s desires, to inform the patient well, and to make sure the patient is realistic in their expectations.
She reminds us all of the following:
The FDA has reported that breast augmentation leads to an 18% to 22% rate of reoperation. The number of complications that can grow out of an augmentation-lift combination procedure makes informed consent a top priority for any woman interested in breast surgery.
These risks from combination augmentation-mastopexy procedures include the following:
Risk of breast implant exposure;
Risk of infection; and,
Risk of excessive scarring.
For women having an augmentation-mastopexy combination surgery:
In 2004, Spear et al produced augmentation-mastopexy outcome data involving 34 patients over a 6-year period. Of the 34 patients, 41% had grade 1 ptosis, 41% had grade 2 ptosis, 3% had grade 3 ptosis, and 12% had grade 4 ptosis.
With 50% of the participants responding, 54% desired revision surgery with an expressed desire for a greater lift of the breasts.
Once again, if you are interested in the above topic, I would encourage you to read the entire article. There are good photos included.
Breast Implants – Some History (March 3, 2008)
Silicone vs Saline Breasts Implants (March 4, 2008)
Silicone Implants and Health Issues (March 5, 2008)
Breast Implant Deflation (Feb 26, 2009)
Mastopexy (November 2007)
Integrating Radiation Therapy & Breast Reconstruction (Feb 9, 2009)