Breast Reconstruction 101 by Dr. Caroline Glicksman is one in a  series of video based information for patients featured on THEplasticsurgerychannel.

What exactly is breast  reconstruction?
Breast cancer is the most common cancer occurring in women, affecting one in eight women in the United States.  Improvements in breast cancer screening have led to an earlier stage at which most cancers are detected.  There are also greater surgical options for women today, and when a mastectomy is needed teamwork between the breast surgeon and the plastic surgeon is the key to a successful outcome.  So what do you need to know if you or a loved one has been diagnosed with breast cancer and is considering breast reconstruction?

First of all, all women considering breast reconstruction should be given the opportunity to learn about their reconstructive options. These may include the use of one’s own tissues to reconstruct the breast, or the use of implants in a single of staged procedures.   A breast reconstruction can be performed immediately, at the time of the mastectomy, or delayed until the patient has completed possible chemotherapy or radiation.

Although reconstructive surgery following mastectomy is a federal law as detailed in Women’s Health and Cancer Rights Act of 1998, individual policies do vary and patients may encounter many difficulties in obtaining reimbursement.

How good can a breast reconstruction look?
The goal of early reconstructive surgeries was achieving a satisfactory result in a bra. Today, breast reconstruction can create breasts that look more like augmentations due to improved oncoplastic coordination, better surgical techniques, and advances in implant technology and design.

Plastic Surgery Channel expert Dr. Bruce Van Natta talks about breast lifts / mastopexy in Indianapolis, Indiana.

What exactly is a breast lift/mastopexy?

As a member of The American Society of Plastic Surgeons and The American Society for Aesthetic Plastic Surgery, Bruce W. Van Natta,M.D. has expertise in a variety of cosmetic and reconstructive plastic surgery procedures.

This is a commonly requested procedure that is often misunderstood. Generally when a woman has excess skin around the breast often after pregnancy or weight loss, the breast size has reduced and there is a lot of skin around the area. This can be viewed as a deflation effect in the breast and the treatment for this would be to conduct an operation to remove some of that excess skin. Following pregnancy many women feel that their breast deflate, loose volume and become saggy. Dr Van Natta has been in practice for 20 years in Indianapolis, Indiana. Breast lifts / mastopexy have been one particular area that Dr Van Natta has specialized in his practice.

Who needs a breast lift/ mastopexy?

Dr. Van Natta finds that a lot of times women come in thinking that they need a breast implant or breast lift/ mastopexy when they that would not automatically be the right procedure for them. At times like this, it is important to sit down with the patient and really understand what their goals are in terms of how they want to look and appear without involving names of procedures and technical terms. Sometimes after such consultations, the surgeons can determine that all the patient really wants is a little more fill in the upper part of the breast and this can be achieved easily with an implant. Really taking the time to talk to patients and asking to see before and after pictures can help a surgeon understand what the patient’s goals are and allow them to do the right procedure. Seeking consultation with a board certified plastic surgeon is the 1st important step in patients getting the best outcome with breast lift / mastopexy. Asking questions and also talking to other patients who have use the same surgeon for a breast lift/ mastopexy can be helpful.

As a member of The American Society of Plastic Surgeons and The American Society for Aesthetic Plastic Surgery, Dr. Bruce W. Van Natta,M.D. has expertise in a variety of cosmetic and reconstructive plastic surgery procedures.

Recently an article in the Orange County Register titled “Breast Implants lead to return visits to the OR” started a discussion about the life of breast implants. According to the article, about one third of breast implant patients, i.e roughly 33% have a follow up operation within 4 years. Dr. Van Natta corrects this number saying that the actual figure is around 23.5% which is almost 10% lower than the reported number. 23.5% is still admittedly a high number but it is much lower than what it has been made out to be.

The other controversial discussion in the article was about the fact that breast implants need to be changed/ replaced or removed after 10-15 years. This has certainly not been the case that Dr. Van Natta has observed in his practice. He does caution that breast implants are most certainly not “forever devices”. As with any other device that is inserted into the human body such as knee replacements and pacemakers, the device wears out with age and if the patient lives long enough, the device would need replacement. The breast implants functions in pretty much the same way and may need replacement if the patient lives long enough. However, there is absolutely no restriction of 10-15 years on the life of breast implants

Dr. Elliot feels that every woman who has been diagnosed with breast cancer should at the very least talk to a plastic surgeon before she undergoes surgery. Even though the removal of the tumor would certainly be a multi-team approach,  plastic surgeons are part of the team, one that would definitely add to the information that a general surgeon can provide.   Many women opt for reconstructive surgery after a mastectomy and it would be helpful to all breast cancer patient to have the opportunity for a consultation with a plastic surgeon to  get  as much information as possible  even if they do not  decide to do the  breast reconstruction.   A general surgeon may not be able to give a patient all the options available for reconstructive surgery. A plastic surgeon can fully examine the patient and talk to them about their requirements and then work alongside to patient to ensure that the reconstructive surgery results are what the patient needs and wants.  Many times, there may be new breast reconstruction procedures that may be able to help the patient in a better way and help in achieving optimum results. General surgeons may not know about these procedures or may not be experts in them. Breast reconstruction has been shown to be a great benefit to the quality of life in the breast cancer patient and  providing this information  enables patients  to make an informed choice.

Recently there was an article in American Health and Beauty about Stem Cell Facelift. The news about stem cell research and its uses has become more and more popular and recently its publicity has gained more momentum as it has become known that the body’s fat tissues are a very rich source of adult stem cells. These stem cells show a lot of potential as they are harvested from one’s own body and may be used to treat a variety of diseases at some point in the future.

Dr. Peter Rubin is a renowned plastic surgeon who is a specialist in plastic and reconstructive surgery. He is also at the forefront of cutting edge research in the field of tissue reconstruction and its application to plastic surgery. Dr. Rubin has been at the forefront of the research on stem cells.

However, even though the technology is promising, there is a limitation as to what these cells can do and achieve. More importantly there are safety concerns and government regulations in place and which will be put in place to regulate the usage of these stem cells. Dr. Rubin cautions that while this is a technology which may have far reaching impact, at this point of time, there is not a single FDA approved use for this technology in aesthetic treatments or procedures in the US.  There are also a number of devices that are available internationally to  harvest and produce stem cells, yet none of these are approved in the US as of this post.

Dr. Rubin predicts that stem cell technology will most likely play a very important role in aesthetic surgery and procedures in the future. He advises that there must be careful and cautious steps taken towards the implementation of this technology. For this proper research and studies will have to be carried out and researchers and surgeons will have to work alongside the FDA to ensure that the safety measures are in place so as to achieve the best results possible.

Patients should be aware that terms such as  “stem cell facelift” are  marketing terms and not based in science at this time.  Hopefully with  god  research in the future the  use of  stem cells in facelifts may be  able to be defined.

Dr. Kulick, who is an expert in laser usage in surgery and non invasive techniques in plastic surgery, is at the cutting edge of some very important research being conducted in the field of plastic surgery. Being one of the few people to have done actual research on the treatment of cellulite, he has some unique insights and solutions to this problem faced by numerous women.

Cellulite is a term often misunderstood and one which people are often confused about. Cellulite is the dimpled skin caused by fat deposits that sit just below the surface of the skin. The most common areas for the occurrence of cellulite are the abdomen, pelvic region and the lower limbs. The most prevalent myth and misconception about cellulite is that it is the bulge in the lateral thigh, however, it is not the bulge but the unevenness of the skin and texture which is most often seen in the lateral thigh area. There are a lot of treatments and skin creams out there which claim to smoothen the skin and remove the dimpling; however, there are very few scientific studies that show that any of these treatments have a lasting impact. At the end of the day, patients want long lasting results and would want the problem not to recur.

Dr. Kulick talks about the cutting edge research that he has spearheaded. He just completed a test where he used a Smoothshapes device with 6 month follow up. For 6 months the skin stayed smooth without the help of smaller follow up procedures in the middle. In this study, patients received a total of 8 treatments performed by a nurse a Dr. Kulick’s office and did not require any anesthesia. He uses a very sophisticated analytical tool that compares the contour of the skin before and after treatment. Results of this study were published in the June 2010 issue of the Plastic and Reconstructive Surgery Journal. The results of the study showed that 75% of the patients had smoother thighs 6 months after their last treatment. There was a also a reduction in the thigh fat in the treated area. This is groundbreaking research as this is the first published study if its type using an analytical device to show an improvement in a period of 6 months. The size and weight of the patients did not matter and did not affect the results. In fact some of the study patients had put on weight at the 6 month follow up mark. While Dr. Kulick admits that the thighs of the patients were by no means absolutely flat, he states that there was a significant and very visible improvement in their look and texture.

Patients in the study were not charged due to the fact that it was part of a research study. Patients wanting a larger area to be treated could definitely undergo the treatment for their entire thigh area. This would require a circumferential treatment.  There is a French study that is being conducted currently on circumferential treatment.

The cost of this  technology is around $400 to $1200 depending the area that requires treatment. The treatment averages about 15-20 minutes per session and may take up to an hour at the very maximum. However, since the treatment is not invasive and is not painful, patients may choose to conduct simultaneous treatments one after the other.

Recently a news story reported by examiner.com in Georgia uncovered news about a lady who literally bled to death after a breast augmentation procedure was performed on her by an eye doctor in his office. Dr Grotting discusses this event and the increase in similar episodes across the country owing to procedures being performed by untrained doctors.

The case in Georgia is a classic example of a preventable injury to a patient, due to the lack of stringent regulations in different states governing procedures done in a doctor’s office. State laws were enacted years ago before surgical procedures were being done in doctor’s offices. This worked for a long time as hospitals were regulating which doctors were qualified to perform which procedure. For example, as a plastic surgeon, one can perform only plastic surgery procedures and are not qualified to perform neurosurgery or heart surgery. The trouble is that a lot of plastic surgery techniques can now be performed as outpatient procedures in a doctor’s office and state laws do not cover who should be performing these procedures. Therefore, there are a lot of unqualified and untrained doctors who are advertising themselves as “cosmetic surgeons”. Patients who want to have certain procedures done do not understand that the doctor does not have the qualifications or training required to do the procedure carefully and get good results. Most patients only look at a doctor’s advertising material and do not take the time to do thorough due diligence. This lack of awareness leads to unqualified doctors performing procedures which may potentially cause irreparable harm to patients.

Dr. James Grotting is the author of a major two-volume textbook in Plastic Surgery entitled Reoperative Aesthetic and Reconstructive Plastic Surgery which has helped plastic surgeons around the world learn the latest techniques in cosmetic and reconstructive plastic surgery. He is board certified by the American Board of Plastic Surgery and is a fellow of the American College of Surgeons. Dr. Grotting is a member of the prestigious American Association of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery.

Dr Grotting advises that the buyer must beware and do sufficient due diligence before putting themselves into the hands of a plastic surgeon. One must do one’s homework and research the doctor appropriately. It is important to ensure that the doctor is board certified by the American Board of Plastic Surgery. One must make sure that the doctor is properly trained to do the particular procedure that one is interested in. Another important step is to take the time to check out the before and after results of the surgeries performed by the plastic surgeon. Visiting the doctor’s office is another way of ensuring that the place is a well equipped, clean, healthy and safe surgical facility. It may also be a good idea to speak with other patients and past client to get reviews and feedback. Most importantly, Dr. Grotting advises that one must seek out a well trained, well qualified board certified plastic surgeon who values patient safety and well being.  Surgical  procedures should also be  done in an accredited facility.

Following significant weight loss, a lot of patients want differences to be visible and hence want many areas of their body to be changed. Weight loss patients have usually spent a great deal of time and effort trying to lose weight and once they have achieved their successfully weight loss they would like to look and feel their best. However, with significant weight loss comes its own challenges of lose and excess skin and areas of the body that need lifting.

The challenge that plastic surgeons face is that they want to maintain safety for their patients while at the same time providing them with the best results. This is often times difficult as most patients would push for changes to occur as soon as possible so they may go back to their normal life and enjoy the changes brought on by their weight loss. Post weight loss full body rejuvenation is generally not a single procedure but a series and combination of procedures that are used to contour the body and allow it to look its best.

Dr. Peter Rubin is a renowned plastic surgeon in Pittsburgh, Pennsylvania who is a specialist in plastic and reconstructive surgery. He is also at the forefront of cutting edge research in the field of stem cells and tissue reconstruction and its application to plastic surgery.

Having spent many years looking after patients who have lost tremendous amounts of weight, Dr Rubin has learned that combining many different procedures which target multiple areas of the body into one surgery is definitely possible; however, the surgeon must always be cautious about the safety of the patient and there are a number of factors that he must take into consideration before agreeing to perform such a complicated procedure.

The first aspect is the patient’s overall health status, their BMI (Body Mass Index) and the specific areas that they would like to have changed. While combining treatment for a lot of areas at once is definitely possible, it may not be possible to cover every single area and therefore, it is important that a surgeon talk to the patient about staging these procedures which essentially means doing these procedures in more than one operation.

Therefore, plastic surgeons have the responsibility of ensuring that they can help the patient achieve their dreams through the full body rejuvenation procedure where it is possible to combine a lot of treatments; however they must be careful to check if the patient’s body can take on the stress of such a surgery.

Sometimes, we find young adults who are perfectly healthy and who have a good body weight struggling with fat deposits and a thicker looking jowl and neck area. Often times, this is seen in patients who are quite young and are in their 20s or 30s. Some of these people have an inherited tendency towards a heavier and rounder jowl area and neck area. This rounder appearance is therefore genetic and has nothing to do with being overweight. Young people who are genetically predisposed to this condition will have a neck and chin area which is rounder and heavier than the rest of their body. This makes them look heavier than they really are. Looking at some of their parents, we would find the same trend of a fatty neck and chin.

Dr. James Grotting is the author of a major two-volume textbook in Plastic Surgery entitled Reoperative Aesthetic and Reconstructive Plastic Surgery which has helped plastic surgeons around the world learn the latest techniques in cosmetic and reconstructive plastic surgery. He is board certified by the American Board of Plastic Surgery and is a fellow of the American College of Surgeons. Dr. Grotting is a member of the prestigious American Association of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery.

Surgeons are always looking for better techniques which are minimally invasive and can leave as little scarring as possible through smaller incisions and smaller operations. Dr. Grotting explains that an exciting new treatment for improving the fatty neck and chin and the jowl area is through a procedure that may be referred to as Micro Liposuction including ultrasonic liposuction techniques. The procedure basically involves carefully controlled refined sculpting of the jowl and neck area. The most effective way to go about this treatment is with the use of ultrasound and tiny probes that are inserted at the base of the ear through small incisions. Through this set up, the surgeon can go in and slowly and systematically melt away the fat deposits. Most often it isn’t the amount of fat that is removed that is important but the area and exact location it is removed from. Removing it from the correct location would result in a more sculpted neck and jaw area and give the jowl area a more triangular appearance. This procedure can really improve the way the neck looks and make the patients look as if they have lost weight and also look aesthetically better.

Dr. Grotting also talks about an older group of patients that tend to have a lot of heavy fat and tissue around their neck and jowl area which contributes to a fatty neck and chin. This combined with the laxity of skin that comes with the normal aging process creates some concern for older individuals. Such patients would benefit from a combination of procedures. He recommends a micro liposuction procedure for sculpting and refinement of the fatty tissue around the jaw and neck area along with a lifting procedure. Most times, the removal of fat in the area allows the lifting procedure to be done through a shoulder incision which makes the recovery time faster.

The most important thing to remember when it comes to surgical improvements for a fatty neck and chin is that often times making the face look younger and slimmer isn’t just about pulling and lifting of the skin but most often it is about shaping the face and the precision involved in the same.

With the increase in demand for breast augmentation procedures and the development and advancement of the types of breast implants available, a lot of women are opting to surgically enhance the size of their breasts. However, given the large increase in the number of breast augmentation procedures, the number of women who get breast implants that are too large for them is also increasing. It is not uncommon now to find women who have had implants that are too large for their body and they later suffer from negative health consequences due to this, requiring a  revision of the  augmentation.

For many years of women underwent breast augmentation with the misconception that bigger is better. While breast augmentation gave women the option to alter their appearance to achieve a desired look and also resulted in positive lifestyle changes, it also caused a trend to develop where women asked for breast implants in sizes larger than their bodies could handle – this being a result of beauty trends over the past  15-20 years. The problem was  further complicated as plastic surgeons were also willing to cater to their demands of patients  and put in quite large implants.  Breast augmentation with relatively large breasts did look good on a lot of women -  for  a period of time; however,  long-term man of these patients require breast augmentation revision due to the weight and tissueeffects of the  large implant over time.

While short term results are great, the problems of over augmented breast augmentation do not show up immediately, but over time can cause significant health concerns. After time passes, the breast implant can put considerable amount of stress on the breast tissue. With the effects of gravity and weight the breast gradually drops on the chest wall and the tissues stretch out so that after a few years, the breast implants don’t look so good anymore. Also, a woman’s body undergoes many changes during her lifetime. She may have one or more pregnancy and may gain weight which would contribute to the sagging of breast downwards and to their weight being put on the chest wall.

Dr. Grotting sees may patients for  revision breast augmentation in Bimingham, as well as  Alabama and   other  areas of the United States.  He explains that in spite of all the problems associated with over augmented breast augmentation, fortunately, today; there are a lot of surgical options and procedures that can act as solutions to this problem. The most common procedure that he uses is to simply remove the old implant and put in smaller and more appropriate implants through a short incision lift procedure. In case the patient has had a saline implant initially, the solution becomes simpler as the removal of saline from the implants is a very easy clinical procedure. All that needs to be done in this procedure is that a needle needs to be inserted into the implant to evacuate the saline. Post this, Dr. Grotting allows for the tissues to shrink up back on its own and leaves the breast to cure and lift up on its own over a period of 3 -4 weeks. A plastic surgeon can then go in a few weeks later for the definitive operation which would be removing the implant, lifting the breast and introducing a smaller and more appropriate implant, often times a silicone gel implant in patients that still need a little bit of size increase.

Dr. James Grotting practicing plastic surgery in Bimingham, AL is the author of a major two-volume textbook in Plastic Surgery entitled Reoperative Aesthetic and Reconstructive Plastic Surgery which has helped plastic surgeons around the world learn the latest techniques in cosmetic and reconstructive plastic surgery. He is board certified by the American Board of Plastic Surgery and is a fellow of the American College of Surgeons. Dr. Grotting is a member of the prestigious American Association of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery. He is a known authority in the field of breast surgery.