Posted on January 18, 2010 in AlloDerm(R), Breast cancer, Breast reconstruction, Tissue expanders
Advances in breast reconstruction techniques for the correction of deformities resultant from treatment for breast cancer have shown great potential and results. This specifically relates to the usage of acellular dermis which is specially treated human tissue devoid of cells, infective agents and immunogenic potential (can’t be rejected by one’s body). Used for several years now, it has established a great track record in this usage.
Several biomedical companies offer this tissue though there are clearly differences in the products, results and risks. AlloDerm® by LifeCell Corp. has been the most studied of these with the results being superior.
In the December issue of Plastic and Reconstructive Surgery (Vol. 124 Number 6), a study from the University of Rochester delineated several advantages of acellular dermis in breast reconstruction. For immediate breast reconstruction using tissue expanders, they noted that the expanders could be filled to far greater amounts when AlloDerm® was employed as compared to a different technique. Postoperative inflations were fewer and completed much sooner and allowed for the insertion of the final breast implant at an earlier date. This translated into an accelerated rate of reconstruction, more predictable and satisfactory results and the potential for a better aesthetic appearance. Best of all, there was no significant difference in complication rates with its usage.
I have been using AlloDerm® in my patients undergoing immediate as well as late breast reconstruction procedures and have found it to be an incredibly invaluable addition. It allows for clearly superior and more predictable results in configuration, positioning and softness and reduces the need for subsequent procedures to further refine the results.
If you would like to obtain additional information on breast reconstruction including the usage of tissue expanders or on any other plastic surgery procedure that I perform or if you want to schedule a consultation with me, you can contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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Posted on January 11, 2010 in Breast cancer, Breast reconstruction, Radiation treatment, Tissue expanders
In breast reconstruction, the ultimate goal is to recreate a breast that is as close as possible to the remaining breast. Perfect symmetry is naturally impossible. Even in situations where the reconstructed breast may be somewhat “similar” to the remaining breast in appearance in the immediate postoperative period, the two sides will invariably change or age differently over time, thereby increasing the differences.
Women who have undergone bilateral mastectomies inherently have better odds of obtaining symmetry in their breast reconstruction. Why? The reason is that they are often starting with similar deformities on each side, thereby allowing for the same reconstructive technique to be utilized for both breasts. This is true whether reconstruction is performed with the simple insertion of implants, usage of tissue expanders or with flaps such as a TRAM flap.
One notable caveat to this is if one side had been irradiated as an adjunct treatment of the breast cancer. As I noted in an earlier post (Problems With Tissue Expansion Breast Reconstruction In Previously Irradiated Tissue), the ionizing effects of the radiation treatments damages the skin resulting in scarring, thickening, increased rigidity and less suppleness of the tissues which often also show visual signs of the damage. This translates into tissue that is more resistant to the stretching that is necessary with tissue expansion breast reconstruction as well as breasts that often feel quite rigid or hard.
The following case illustrates this exact scenario. The patient underwent a bilateral mastectomy with radiation subsequently performed on the left side. In the photos, you may be able to appreciate the slightly darker color and firmness of the skin.
a.) Bilateral mastectomies with left breast irradiation. Pre-op
b.) Bilateral mastectomies with left breast irradiation. Post-op insertion and inflation of tissue expanders
c). Pre-op
d.) Post-op insertion and inflation of tissue expanders
e.) Pre-op
f.) Post-op insertion and inflation of tissue expanders
She elected to undergo bilateral breast reconstruction using tissue expanders. Despite using identical tissue expanders, there is a significant difference in appearance between the two sides. Ironically, though the irradiated left side is inflated with more saline than the right, it actually appears less voluminous. That is an effect of the radiation damage.
If you would like to obtain additional information on breast reconstruction, breast implants or any other plastic surgery procedure that I perform or to schedule a consultation, you can contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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Posted on August 31, 2009 in Breast cancer, Breast reconstruction, Radiation treatment, Tissue expanders
Radiation treatment following a mastectomy in the treatment of breast cancer is fairly common. Though refinements have been made in the radiation therapy that have significantly reduced both short and long term sequelae to the skin and underlying tissues, permanent consequences nevertheless exist which will affect the tissue expander breast reconstruction.
What does radiation do to the skin and soft tissues? The ionizing effects damage healthy cells causing scarring and thickening with increased rigidity of the tissues and less suppleness. The result is firmer feeling skin that is more rigid and more resistant to the stretching which is necessary with tissue expansion breast reconstruction. The small blood vessels in the field of treatment are also permanently damaged resulting in a reduction of blood supply to the tissues. Less oxygen and nutrients available to the tissues translates into an increased the risk of infection, greater susceptibility to trauma and prolonged healing times from surgery and injury. .
As a consequence of these changes, it is far more difficult to expand irradiated tissue in facilitating the breast reconstruction as compared to normal tissue. The increase in size obtained may be less than ideally desired and it can take much longer. Qualitatively, it often feels firm and appears darker than the surrounding skin. There is also an increased incidence of infections, formation of scar tissue around the expander, separation of recently closed incisions and even extrusion and exposure of the tissue expander through the skin.
Though tissue expander breast reconstruction can yield satisfactory results in tissue that has been previously irradiated, there are many attendant risks that need to be considered before selecting this option.
If you would like to obtain additional information on breast reconstruction or any other surgical procedure that I perform or to schedule a consultation, you can contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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