Breast Surgery: What You Need To Know

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By James E. Chappell, MD FACS, Annapolis Plastic Surgery

With regard to breast surgery, plastic surgeons have the opportunity to interact with patients on many different levels. Most of our surgeries are for elective reasons: breast implants, tummy tucks, facelifts, breast reductions and breast lifts. However, we also help patients stricken by breast cancer who need breast reconstruction after mastectomy (breast removal).

Breast reconstruction after mastectomy is much more common than it was 15-20 years ago. Since doctors are finding tumors when they are smaller and smaller, and there are improvements in chemotherapy and radiation therapy, women are living longer after being diagnosed with breast cancer and more women are candidates for breast reconstruction.

The issues to be considered when deciding whether to undergo reconstruction are related to many factors, but often include concerns about diminished femininity and loss of self-esteem after mastectomy. Restoring a breast can return one’s sense of self and take away the need for bulky prostheses.

There are two main methods of breast reconstruction: using a breast implant, or using the woman’s own tissue (skin, fat and muscle). Which procedure is done and when it is done varies according to the patient, the type and stage of the breast cancer, and the possible need for other treatment.

Increasingly, women undergo reconstruction immediately after mastectomy. This allows them to wake up from anesthesia with a newly constructed breast and never have to see the “defect” left by mastectomy. Often the other breast is lifted, reduced or augmented to aid in achieving symmetry between the two breasts. Overall, reconstruction has improved many women’s lives after the devastation of breast cancer.

Breast reduction is another common procedure plastic surgeons perform. Besides causing self-consciousness and difficulty with clothing, overly large breasts are often the source of considerable discomfort, grooving of the shoulders and back pain. Skin problems may develop under the breasts from chronic chafing. Later in life, considerable sagging of the breasts commonly occurs and results in further distortion of breast shape.

Breast reduction surgery can eliminate these problems by reducing the size of the breasts and creating a more normal shape. Most insurances pay for breast reduction and all are required to cover breast reconstruction.

A breast lift, or mastopexy, is similar to a breast reduction, except that usually minimal (if any at all) breast tissue is removed. Similar to breast reduction and breast implants, mastopexy is generally done on an outpatient basis. As with breast implants, insurance does not cover this surgery as it is usually done for cosmetic reasons.

Breast implants are one of the most common procedures plastic surgeons perform. Approximately 200,000 cases are done annually in the USA. Ten years ago, most women had saline (salt-water) filled implants placed. As silicone implants were FDA-approved in 2006 and are now currently available for use in both cosmetic and reconstruction patients, more and more women are having silicone implants placed.

The technology has improved and rupture rates are now lower than they used to be. Descriptors for silicone breast implants include “cohesive,” “gummy bear” and “form stable”. Incision placement, placing implants under or above the muscle, and type of implant surface and shape are all considerations. Your surgeon can discuss these terms and options with you.

Complications can happen with any surgery, so one should have a thorough discussion with their surgeon before undergoing any surgery. Breast implant patients can usually look forward to easier wardrobe fitting and an improved sense of self-esteem. Best wishes for a healthy New Year!

Dr. Chappell is board-certified by the American Board of Plastic Surgery. He has lived and practiced plastic surgery in Severna Park since 1998. His office number is 410-544-2487. For more information, visit www.annapolisplasticsurgery.com

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