Breast cancer treatment is a difficult time for many women, and deciding when to have breast reconstruction is not at the forefront of every patient’s mind. I try to give each patient I see for breast reconstruction in California personal advice to help determine the right time for her surgery.

Women have two options for breast reconstruction, and deciding which is best is based primarily on personal needs. Here’s information regarding both options to help you understand the benefits and drawbacks of each:

• Immediate Breast Reconstruction: Many women feel this method helps them transition from a mastectomy to their normal routines more easily. Surgeons are able to immediately re-create breast shape after a mastectomy, which cuts down on the overall recovery time when compared to undergoing separate procedures.
• Reconstruction After Recovery: Some patients decide to wait until after recovering from the mastectomy to have breast reconstruction. This may be necessary due to the treatment needs of the patient, or it may be a personal decision she makes.

Women interested in breast reconstruction have two primary options to choose from:

• Tissue Expansion is the most popular option among my patients. I use a tissue expander below the chest muscle to make room for a breast implant.
• Flap Surgery uses a flap of muscle, skin and fat from some other area of the body to re-create the breast. I usually transplant the material from the back, abdomen or buttocks.

Patients interested in re-creating nipple and areola color will have to wait 2 months after surgery. If you are considering breast reconstruction and want advice concerning the right time for your operation, I highly recommend speaking with an experienced surgeon who specializes in breast reconstruction.

Visiting a doctor for regular checkups is important, but women can take equally important steps while they’re at home. An example: self-exams for breast cancer. Too few women perform this essential task. I believe that if women understand how simple it is to perform a breast self-exam, they’ll be more likely to add it to their routine.

Here’s a step-by-step overview:

• Perform a self-exam at least once a month.
• First, stand in front of the mirror with your hands on your hips. Look for a difference in size, shape, or color. Keep an eye out for dimpling or puckering of the skin, changes in nipple position or an inverted nipple, nipple discharge, and redness or rash.
• Look for these same conditions with your arms raised over your head.
• Lay down. Use your right hand to feel your left breast and your left hand to feel your right breast. With a firm touch, keeping your fingers together, use a circular motion to cover your entire breast from top to bottom and side to side. Instead of a circular motion, some women prefer to move fingers up and down in vertical rows. This is an acceptable option. Cover the entire breast from the collarbone to the top of the abdomen, from your armpit to your cleavage.
• In the shower, repeat the directions above.

Early detection of breast cancer can vastly improve prognosis. A self-exam is an easy step that can make a big difference. Along with my Orange County breast cancer patients, women who know firsthand the importance of early detection, we’re spreading the message about the value of self-exams.

Most women feel overwhelmed by the many decisions that must be made after a breast cancer diagnosis. Choosing a breast reconstruction surgeon is often one of the most important. In order to help you make this choice, I’ll share a few factors that I consider especially crucial when choosing a surgeon in Newport Beach for breast surgery.

To get started, before you even meet with a surgeon, do the research about their credentials. Look at their educational experience, training, society memberships, and board certifications. If they have a Web site, you can also take a look at their before and after photos to see the quality of their results.

When you meet a surgeon in person, you’ll be considering their bedside manner and character. Is this surgeon honest and up-front? Can you trust them? Do they treat you with respect? You shouldn’t feel rushed, so watch out for surgeons that keep glancing at the clock.

I can offer guidelines, but there’s one factor that outweighs all others: does this person feel like the best surgeon for you. To put it simply, some people connect while others do not. There’s no formula. If you feel comfortable with your surgeon, you will be open to asking sensitive questions, communicate your needs, and feel more confident on the day of surgery.

Breast cancer diagnosis leaves women with many questions, plans to make, and decisions to consider. After consultation with doctors and specialists, patients may decide to pursue breast reconstruction. To get the most from their breast reconstruction consultation, women should educate themselves about what they can expect.

The primary components of a breast reconstruction consultation at my California practice are: an explanation of breast reconstruction options, essential factors to consider before deciding on breast reconstruction, and an opportunity for women to ask any questions they may have.

We may delve into specifics such as:

• Timing of breast reconstruction
• Types of breast reconstruction
• Implant options
• Obtaining insurance coverage
• Preparing for surgery
• Recovering from surgery
• Results

This is only the beginning of a close, communicative, and trusting relationship. Subsequent appointments will allow us to make specific plans and proceed at each woman’s comfort level.

The current issue of the medical journal The Lancet contains an editorial that digs back through the journal’s archives to an editorial piece written a century ago. The editorial (found here) inspired me to look back too, but at plastic surgery in particular. My, how far we’ve come!

The early beginnings of plastic surgery were largely reconstructive. Procedures were intended to restore form and function to individuals who had suffered traumatic injuries or were born with deformities. This was seen as early as 800 B.C. in India, and gained more traction in the late 1800s and early 1900s as soldiers required reconstructive procedures to treat severe war wounds. The results were far from flawless, but provided life-changing (and sometimes life-sustaining) improvement.

It wasn’t until much later that cosmetic surgery saw widespread popularity. In fact, the prominence of purely cosmetic procedures didn’t occur until about the 1950s to the 1970s. Since that time, much has changed. For instance, anesthesia has become safer and more effective, results have become more precise and natural-looking, procedures can be performed more quickly, and there are far more procedural options to treat a much wider array of concerns.

I look forward to the next century in plastic surgery. I think there’s much we can do, in terms of growing non-surgical options, “quick recovery” techniques, and (as always) further improving safety. These are just the beginning – truly, the sky is the limit for what we can accomplish. Now that I’m finished looking back, I’m looking forward to another fantastic year at my Detroit plastic surgery practice.

A common question I am asked by patients considering plastic surgery in Chicago is whether using their own body tissue during breast reconstruction is safer or more natural-looking than an implant. The answer is that one technique is not necessarily better than the other; the two are simply different. I’ve found that both of these procedures are chosen by patients in my practice for different reasons, depending on their individual circumstances. A few general pros and cons to each technique are as follows:

Autologous Reconstruction

Benefits:

• Because autologous breast reconstruction uses existing body fat to rebuild the breast, the results often feel more natural.
• Your new breast will adapt accordingly during normal weight fluctuations.

Possible Disadvantages:

• Recovery may be longer and more difficult.
• Some women may not be candidates for the procedure, particularly very thin or overly obese women.

Implant Reconstruction

Benefits:

• Implant reconstruction is typically a shorter procedure than autologous reconstruction.
• Recovery time is often faster with implant reconstructions.

Possible Disadvantages:

• Implant-related concerns may arise, such as capsular contracture and the need for replacement.
• Implant reconstruction can sometimes require multiple surgeries to achieve the desired results.

There are many factors to consider when deciding between autologous or implant breast reconstruction. It is best to discuss your personal needs with a qualified surgeon in order to better understand which procedure is best for you.

It is common for many women to have fat deposits underneath the waist and above the hips. While some curse their genetics for these, a recent Johns Hopkins study shows that these “love handles” can be valuable in flap methods of breast reconstruction, particularly in athletic women with little fat on their midsection (read more about it here).

Athletic, slender women may not have enough fat in other areas of their bodies to use for flap methods of breast reconstruction (which takes a flap of fat and skin from one area of the body to use in reconstructing the breast), and in some cases the only option for these women has been implant reconstruction. But this new research shows that the love handles represent a viable area for tissue reconstruction, and better still, surgery using this approach may be less complicated than other techniques.

This is an exciting advance for slender women who want breast reconstruction but would prefer not to have an implant used as part of their reconstruction. I’ll be interested to see if the method catches on with reconstructive surgeons nationwide in the coming years.

The issue of breast reconstruction after mastectomy is one that I find particularly important. It can be extremely valuable for the mastectomy patient and extremely rewarding for the reconstructive surgeon. However, surprisingly few women actually choose to undergo reconstruction, even though legislation requires all insurance policies to cover it. According to a study performed by Alicia Holt, MD, Surgical Fellow at City of Hope Medical Center in Duarte, California, only about 20% of eligible women opted for this procedure in 2007.

Why is this? As an Alabama plastic surgeon with years of experience performing breast reconstruction procedures, I have some ideas. I believe the main reason for the low percentage of women pursuing the procedure is lack of information. There are plenty of resources out there, but evaluating the information and understanding the options can be difficult. Here, the guidance of a qualified and caring doctor is absolutely essential.

Physicians should be clearly articulating the benefits of the procedure, which are substantial. First, there’s the obvious aesthetic improvement – breasts regain their shape, looking better both in and out of clothes. Then, there are the emotional and psychological benefits. After breast reconstruction, women report improved self-confidence. They also explain that breast reconstruction helped them feel “whole” again – so that they weren’t reminded of the trauma of their illness every time they looked in the mirror. Reconstruction can be an important stepping stone on the road to emotional, psychological and spiritual recovery.

At the end of the day, despite all the benefits, breast reduction is optional – and a woman’s informed choice not to pursue the procedure should be respected. However, women should actually be informed so that they can make the decision for themselves. They should know their options for reconstruction, even before mastectomy has been performed.

If you are a woman who has had a mastectomy, or if you have been told that you will need one, talk to your doctor about breast reconstruction. Don’t be afraid to ask questions and obtain more information about the different types of procedures offered, the benefits/drawbacks of reconstruction, and the various procedural options before making a final decision. It is important that you take the time to assess if this surgery is right for you, because every woman deserves a choice.

In this article from the Houston Chronicle, the author writes that a breast reconstruction patient (and breast cancer survivor) “likes that her breasts came, basically, via a tummy tuck.” While I support efforts in the media to educate women about breast reconstruction options, there’s a clear differentiation between the abdominal component of certain breast reconstruction procedures and a “tummy tuck” that I think is worth clearing up.

My abdominoplasty procedures in the Ft. Myers area are performed to reduce unwanted fat and skin in the abdomen while tightening abdominal muscles. They are strictly cosmetic (although similar procedures may be performed for massive weight loss patients and may be considered reconstructive). What the article is referring to is a method of breast reconstruction that uses skin and fat from the abdomen. This is a reconstructive procedure, NOT a cosmetic procedure.

Here’s how this method of breast reconstruction (superficial inferior epigastric artery, or SIEA) is performed: blood supply, skin, and fat are tunneled from the abdomen to the breast. Abdominal muscles remain unaffected. This is where the author of the Chronicle may see a tummy tuck connection: this method of breast reconstruction leaves the patient with a scar below the bikini line (as with a tummy tuck) and a slimmer belly (as with a tummy tuck) because tissue is removed from this area.

However, the primary goal of this type of breast reconstruction is to create a new, thriving breast mound from the patient’s own tissue. It’s not seen as (or marketed as) a “two for one” special for women who want a tighter tummy along with their reconstruction.

Ultimately, if a breast reconstruction patient also wants a tighter, slimmer abdomen, she may need to discuss paired or combined procedures with her plastic surgeon. Because, unlike SIEA breast reconstruction, a tummy tuck in the Fort Myers / Naples area will also mend weakened or separated abdominal muscles, completing the cosmetic improvement.

The Discovery Channel’s “MythBusters” covers a wide range of topics across the globe, but as a plastic surgeon, one episode that evaluated a myth about breast implants stood out to me.

The Myth: Silicone breast implants can explode at high altitude or low air pressure.

The Result: They “busted” the myth, proving it inaccurate. They discovered that, when measured at 35,000 feet, the silicone implants expanded negligibly compared to their size on the ground. This expansion is caused by the lower air pressure at that altitude, but it’s important to point out a few details. The cabins of airplanes are pressurized so that the air pressure in them is very similar to the air pressure a person would experience at ground level. Also, they measured the implant in test conditions that simulated the air pressure outside of an airplane at 35,000 feet – an environment and altitude in which humans cannot survive.

What it means for my patients with breast implants in Sacramento is that there’s absolutely no need to worry about air travel. On an airplane there is absolutely no risk of your implants expanding, let alone exploding.