Robert J. Allen M.D.

Immediate Versus Delayed Reconstruction

May 3rd, 2012 admin

A common misconception is that breast reconstruction always takes place as its own procedure, separate from and following the mastectomy operation.  And, while traditionally this may have been true, nowadays, this is often not necessary.  In fact, breast reconstruction can take place at various stages of the breast cancer process.  While breasts may still be reconstructed well after a mastectomy has been performed, what is termed a delayed reconstruction, the reconstruction can also take place simultaneously with the mastectomy, called an immediate reconstruction.  And, immediate reconstruction has many advantages.

Aesthetically, immediate reconstruction offers a better cosmetic result as it allows for a skin sparing mastectomy, which preserves the original breast skin envelope for volume and shape to be immediately restored.  Incisions and scarring can be minimal and excess skin can be built right into the nipple reconstruction.  Additionally, for some patients, the nipple can be preserved with a skin sparing mastectomy, reducing a multi-stage reconstruction to just one stage, and in other words, just one procedure. From a surgical perspective, immediate reconstruction means less surgery by condensing two operations into one.  And lastly, immediate reconstruction makes a very traumatic, disturbing experience a little less traumatic and disturbing.  Patients go to sleep with breasts and wake up with breasts – no need to walk around feeling disfigured, embarrassed or a loss of one’s womanhood.

Depending on the course of cancer treatment, not all patients are candidates for an immediate reconstruction.  This can be discussed and determined by your breast surgeon.

Choosing Your Breast Reconstruction

April 12th, 2012 admin

Choosing Your Reconstruction:  What Is Right For You

When choosing a type of breast reconstruction, the very first thing one must decide upon is method – traditional reconstruction using implants or autologus tissue transfer.  While implants are the traditional, widely accepted method that accounts for nearly 80% of breast reconstruction today, the popularity of autologus tissue reconstruction is rapidly on the rise based on its natural and far more permanent qualities compared to the implant.   If autologus tissue transfer is the method of choice, then one must decide between 2 techniques – traditional methods called the pedicle flap that require the sacrifice and use of muscle, as in the TRAM flap that uses the rectus muscle of the abdomen, or the muscle sparing procedure known as the perforator flap, where only the skin and fat above the muscle is harvested and utilized for the reconstruction.  While perforator flap breast reconstruction is a far more complex procedure than its predecessor the pedicle flap, it is truly considered the state of the art method that leads to better, more natural results and less complications.

Once one has decided to pursue perforator flap reconstruction, determining the flap that is right for you is based upon several variables, the first being body type and fat distribution.  Generally speaking, female body type falls into 2 main categories : apple shaped, in which excess fat and skin are carried in the abdomen with a generally thinner bottom appearance, and pear shaped, in which a female is narrower in the midline and carries excess fat below the waist line in the buttock, hips and thighs.  Therefore, where one’s weight is carried will generally give you an idea of what location a flap can potentially be taken from.  That being said, however, despite body type, most women commonly have enough excess lower abdominal tissue, especially those who have carried children.   The second variable to consider is previous surgery in possible flap site locations.  If one has had a tummy tuck, unfortunately the use of the lower abdomen as in the DIEP flap, cannot be an option.  However, a common misconception is that the same pertains to cesarean sections, which is simply not true.  Both vertical and horizontal c-section incisions do not necessarily rule out the use of the abdomen for a DIEP flap.  Other types of abdominal surgery, depending on location and scarring, may or may not allow for the use of the abdomen but need to be assessed on a case by case basis.  Similarly, extensive liposuction may rule out the use of certain flap sites as well.  Lastly, the third variable that should always considered is personal preference.  This is your life and the body that you need to live in, so being satisfied, comfortable, and fully functional in your lifestyle is extremely important.  Choosing a flap that fulfills not only the medical and surgical criteria, but your own personal criteria should be a high priority as well.

Natural Breasts, Even After Breast Cancer

February 10th, 2012 admin

23 years ago, my mother was diagnosed with breast cancer.  Faced with a possible mastectomy, she would require breast reconstruction in order to maintain her active lifestyle, including various water sports.  Put in charge of her reconstruction, I initially planned the traditional pedicle TRAM procedure, which would force her to sacrifice the complete function of her rectus abdominus muscle and therefore, her active lifestyle as well.  Fortunately for my mother, when re-excising the cancer, she was found to have clear margins, and did not require a mastectomy with reconstruction.  She instead underwent a lumpectomy with radiation.  However, it was this experience that challenged and inspired me to develop better, less quality of life sacrificing options for women and breast reconstruction.  After studying the blood supply to the skin and fat above the muscle in the lower abdomen, I discovered how to use a microsurgical technique to reliably transfer only the skin and fat from the abdomen to recreate the breast, while completely avoiding the use of abdominal muscle altogether.  This was called a perforator flap.  This discovery, called the deep inferior epigastric perforator or DIEP flap, was the first ever developed perforator flap for breast reconstruction, as well as the birth of the entire field of perforator flap breast reconstruction known today.

 

Unfortunately, not all women are as lucky as my mother.  Every year, thousands of women around the world must undergo the traumatic experience of mastectomies and reconstruction, the majority of which still undergoing traditional techniques that often sacrifice function or lead to painful persistent problems.   For that reason, I have dedicated my entire career to the development and continuous refinement of perforator flap breast reconstruction – the only form of breast reconstruction that I believe gives women the most optimal quality of life post mastectomy.  And therefore, I have chosen to write this blog in attempt to reach out, better inform and provide education about this truly wonderful form of breast reconstruction that I believe all women need to know about.