The decision to undergo breast reconstruction surgery following a mastectomy is a very personal one. There are a variety of factors a woman must consider before making such a choice, including her expectations, possible risks and emotional state following the procedure.

What are the top reasons women choose to undergo breast reconstruction following a mastectomy?

Women choose breast reconstruction surgery for a variety of reasons, but some of the most common factors include:

• Sadness, insecurity or even embarrassment about losing one or both breasts;
• Dissatisfaction with the way clothes look and feel following a mastectomy;
• Dissatisfaction with the way the body looks without clothes following a mastectomy; and
• Reconstruction offers the chance to feel as “normal” as possible following a bout with breast cancer and breast cancer treatment.

What are my breast reconstruction treatment options?

A variety of procedures are available for women considering breast reconstruction surgery. They are as follows:

• Breast Implants- Depending on a woman’s preference, breast implants come in the form of silicone gel or saline (salt water) implants. Some women may be candidates for one-stage implant reconstruction. Or others, the insertion of the implant (s) is typically done in two steps, with the first being the insertion of a temporary tissue expander at the tie of the mastectomy. The temporary expander is then given time to stretch and prepare the skin/breast tissue for the implant’s permanent placement. Once this step is complete, the Dr. Weinstein will then do a second procedure to put the final saline or silicone implant in place.
• TRAM Flap Surgery- This procedure uses a woman’s own muscle and tissue from the lower abdominal area to reconstruct a new breast without using implants. During the actual TRAM flap surgery, skin, fat and muscle from the lower abdomen will be tunneled under the skin to the chest area, in which the surgeon will then build a tissue only breast. This procedure is admittedly more complicated then breast implants, but it’s a wonderful choice for women that wish to retain a more natural look and feel to their breasts. Furthermore, the removal of fat, skin and muscle from the lower abdominal area often results in an aesthetically pleasing “tummy tuck” for an added bonus.
• Latissmius Flap Surgery- As in the case of the TRAM flap procedures listed above, the Latissmimus Flap procedure also uses a woman’s own skin, fat and tissue to naturally reconstruct the breast without implants. However, in the Latissmius procedure, the surgeon will use the latissimus  (or the long muscle that runs beneath the armpit and diagonally across the back) instead of tissue from the abdominal wall. This once popular technique is used much less with the use of tissue expander reconstruction techniques.

What are the benefits and risks of breast implants vs. autologous tissue reconstruction?

As with any procedure, there are a variety of pros and cons that accompany each of the techniques listed above. Some of the most common benefits and risks that accompany breast implants and flap procedures are as follows:

Procedure	Pros	Cons
Breast Implants	1. Less complicated than Flap reconstruction   2. Excellent cosmetic results 3. Implants can easily be adjusted to match the size and shape of the remaining breast	1. Although implants are safe medical devices, no medical devices last forever; they may need to be replaced at a later time   2. Risks include infection, rupture/deflation, and scar formation around the implant (capsular contracture). 3. If radiation therapy is required, there may be increased risks of scar tissue formation and implant related problems
Autologous Tissue	1. Will last permanently   2. The use of your own tissue gives a more natural look and feel to the breasts 3. Excellent cosmetic results 4. Additional benefit of tummy tuck closure with TRAM procedure	1. More complex surgery   2. Small risk (< 2-3%) that part or all of the tissue used to reconstruct breast may not live if the blood supply is compromised. 3. Surgery performed in another portion of the body (i.e. belly or back)




Breast Reconstruction, Morristown: Is the breast reconstruction covered by insurance?

Yes. Insurance companies are required by Federal law to cover all of the above-mentioned procedures for breast reconstruction following a mastectomy.

Also, insurance companies should cover reconstructive options for women who have also undergone partial mastectomy/lumpectomy.




Do I have to undergo breast reconstructive surgery at the same time as my mastectomy?

Breast reconstructive surgery does not have to be done at the same time as a woman’s mastectomy. Similarly, some women report feeling “overwhelmed” by the mastectomy and need additional time before making such a decision; whereas others are seeking to immediately begin their reconstructive journey and wish to awake from her mastectomy with an immediately reconstructed breast.

Dr. Weinstein will make recommendations as to the timing of reconstruction based on your cancer diagnosis. Ultimately, timing of reconstruction is a personal decision and choice.




Are there any benefits to having the reconstructive surgery done at the same time as my mastectomy?

Yes, there are a variety of benefits in having the procedures done all at once. First, the surgeon can use the same incision from the mastectomy to avoid creating an additional scar during the reconstruction process. Also, having breast reconstructive surgery at the same time as a mastectomy is a great option for women suffering emotional trauma at the thought of waking up in the recovery room without a breast.




I’d like to speak with someone further about the options available to me for breast reconstruction. How do I get started?

Our team at Weinstein Plastic Surgery Center is happy to answer any additional questions or concerns you may have regarding breast reconstruction following a mastectomy. We realize the personal nature of such a decision and wish to empower you with the information necessary to make the best choice for you and your body.

 

After breast mound reconstruction surgery, Dr. Weinstein usually recommends nipple and areola reconstruction to complete the process of a more natural breast appearance.

After the nipple reconstruction, a tattoo is used to create the look of an areola. The tattoo can be repeated if the areola color fades over time as tattoos usually do. The areola is often slightly darker than the desired pigment to compensate for the expected fading. Sometimes tattooing the opposite areola is recommended to achieve symmetry.

 

Implant breast reconstruction can be a simpler restoration process than with autologous (tissue-only) reconstruction and usually involves less operative time than autologous procedures. However, implant reconstruction can be a process that requires several weeks to months.



FDA approved implants are made of a silicone outer shell, and filled with silicone gel or saline (salt water). Usually, implant reconstruction requires two stages. The first stage is to place a temporary tissue expander implant at the tie of the mastectomy. This is a saline filled temporary implant that can be subsequently filled in the office to expand the mastectomy skin to the patient’s desired volume.

The second stage surgery involves removing the temporary tissue expander (which is often hard) and place a softer final saline or silicone gel implant and to tune the result.

There are options for single-stage implant reconstructions utilizing Alloderm®. Alloderm® is a cellular dermal matrix that is a donated human tissue from which the cells have been removed washing away all immune components. Alloderm helps create a new envelope for the implant often facilitating a more natural looking breast.

Both saline and silicone gel implants are FDA approved for widespread use. Both saline and new generation silicone gel implants are safe medical devices, but no medical devices last forever. Extensive research has shown that implants do not cause or increase the risk for illnesses.

Although very safe, implants are foreign bodies and do have risks which include: infection, rupture/deflation, and scar formation around the implant (capsular contracture). Patients with reconstructive breast implant may require revisional surgery in the future. Those women who do not wish to face the potential for revisional surgery secondary to implant related issues often choose autologous tissue only reconstruction

Breast restoration may include the need for nipple reconstruction. Nipple reconstruction uses small, local skin flaps and fat that are pulled from the breast mound. This creates a projecting nub which has a more natural breast appearance.

Nipple reconstruction is not mandatory, and some patients choose not to undergo this final stage of breast reconstruction. However, patients are encouraged to undergo nipple reconstruction because it adds so much to the appearance of the breast. Nipple reconstructions are also covered by your insurance.

Revision surgery is to be expected as part of the breast reconstruction process. It is require to fine-tune your results. Remember, breast reconstruction is a process to build an aesthetically pleasing breast from what mastectomy took away; it is not an overnight process. Breast reconstruction revisions may be needed to reduce the breast size, improve breast projection or shape, reduce excess tissue, to achieve better symmetry or revise mastectomy/lumpectomy/IV port scars.

Revisions of a breast made of autologous tissue are often thought to be one of the most artistically challenging surgeries in breast reconstruction. It is an area in which the patient’s choice of plastic surgeon is an important choice. With a revision, an experienced and proven plastic surgeon can often turn a mediocre reconstruction into an excellent restoration.

 

For breast restoration, women may consider the TRAM flap. TRAM stands for “transverse rectus abdominis myocutaneous,” named after a muscle located in the lower abdomen. There is generally enough skin, fat, and muscle in this area that can be used to reconstruct a new breast.

The TRAM flap takes the excess lower abdominal skin and fat. A relatively insignificant abdominal muscle is used to carry the blood vessels that feed the overlying skin and fat reside inside the muscle.

Pedicle TRAM Outline	Pedicle TRAM Incision Sites

After Pedicle TRAM surgery

The skin/fat/muscle unit is then tunneled under the skin up to the breast to build a tissue only breast. In a pedicled TRAM procedure, the tissue’s own blood supply remains attached and the lower abdominal tissue is rotated into position on the chest. The tissue is then tunneled under the skin to the chest area, where it is brought through the mastectomy incision. There is usually no need for microvascular surgery in a pedicle TRAM procedure.

 

Reconstruction of the breast is an option for most women who have had a mastectomy. You may choose immediate reconstruction, in which the process is started during the same surgery as the mastectomy. Or you may delay reconstruction and start the procedures after your initial surgery and other treatments are complete. Some women say that starting reconstruction right away helps reduce the trauma of losing a breast; immediate reconstruction also eliminates the need for an additional hospitalization and anesthesia.

There are two methods for reconstruction: using an implant to replace the lost tissue or using tissues from elsewhere in the body to replace the lost tissue. The new breast will not function like a breast, and it will not have much sensation. But depending on the method of reconstruction, in clothes it can look almost exactly like the other breast. In the final step, a new nipple-areola complex is built and the nipple area can be tattooed to have a similar color to the other.

Radiation therapy can sometimes cause damage to the skin that makes breast reconstruction challenging. Dr. Weinstein has extensive experience with reconstruction for patients who have already had radiation therapy.

As of October 1998, a federal law requires insurance companies to cover all aspects of reconstruction, including operations to match the reconstructed breast to the opposite breast.

Implant Surgery

Saline is injected into an expander sac to slowly stretch the skin and muscle to prepare for a permanent breast implant.

Implants are best for women with small- to medium-size breasts and those who have not had any radiation therapy to the breast area. In the first step, a pocket is formed from the pectoralis muscle and an expander is placed in that space. Over the next several months, saline is injected through a valve into the expander sac to slowly stretch the skin and muscle in preparation for the permanent implant. During a second, shorter operation, the expander is removed and the implant is inserted in its place.

Implants come in different shapes and sizes and are made of saline or silicone. A plastic surgeon will help determine which type of implant is best for you.

Tissue Transfer

Another method for reconstructing the breast is to use tissue transferred from somewhere else in the body. The new breast mound is built using muscle from one of three locations:

• TRAM (transverse rectus abdominus myocutaneous) Flap

  An oval-shaped section of fat and skin is removed from the abdomen and shaped into a breast on the chest wall.

• Latissimus Dorsi Flap

  Skin and muscle are moved from the upper back to the chest area and shaped into a breast.

The type of reconstruction that is most appropriate for each patient depends on the amount of skin remaining on the chest wall, the size and shape of the other breast, the amount of body fat and tissue available elsewhere, the patient's general health, her smoking history, and her personal preferences. If you know that you will want a reconstruction, you should talk to your doctor about it early in your treatment -- even before you have a surgical biopsy, if possible. Your choice might influence where incisions are made.

Once the breast mound is completed, the other breast may be altered (with an implant, a reduction, or a lift) to achieve symmetry. In the final step, a new nipple-areola complex is built, and the area can then be tattooed to have a similar color to the other side.

Prosthesis

Women who decline or cannot undergo breast reconstruction can use a silicone breast prosthesis for symmetry. Breast prostheses come in firm, medium, and soft silicone textures, as well as a variety of sizes, shapes, and skin tones to match the other breast. Prostheses can be placed in a special pocket in a bra or bathing suit. A properly fitted and weighted prosthesis provides the balance needed for correct posture. Custom-made prostheses are now also available.

To purchase a prosthesis, visit the boutique in The Dane Shop in Morristown, New Jersey or call the local office of the American Cancer Society. These stores specialize in breast prostheses and post-mastectomy bras and have experienced, sensitive, certified fitters who will help you find the perfect prosthesis for your body. The fitter will consider the type of surgery you had as well as the size, shape, and texture of your remaining breast to select the prosthesis that is best for you. Fitters also provide instructions for care of the prosthesis.

Before purchasing a breast prosthesis, make sure that you have a prescription from your doctor. Both prostheses and post-mastectomy bras are often covered by insurance.

 

Breast reconstruction is achieved through several plastic surgery techniques that attempt to restore a breast to near normal shape, appearance and size following mastectomy.

Although breast reconstruction can rebuild your breast, the results are highly variable:

• A reconstructed breast will not have the same sensation and feel as the breast it replaces.
• Visible incision lines will always be present on the breast, whether from reconstruction or mastectomy.
• Certain surgical techniques will leave incision lines at the donor site, commonly located in less exposed areas of the body such as the back, abdomen or buttocks.

A note about symmetry: If only one breast is affected, it alone may be reconstructed. In addition, a breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry of the size and position of both breasts.

 

Breast Reconstruction to Help You Move Forward
Over 180,000 women in the US each year are diagnosed with breast cancer. You are not alone. Like you, many women have the option of Breast Reconstruction after their mastectomy. There is a growing acceptance and popularity for breast reconstructive surgery among mastectomy patients and in the medical community. Be sure to ask your breast surgeon or general surgeon about your Breast Reconstruction options early on in your treatment plan.

While not everyone chooses to have Breast Reconstruction, women with Breast Reconstruction have reported an increase in self-confidence, gained emotional well-being, renewed body image and an increased sense of femininity and sexuality.

While you're considering your treatment options, empower yourself and make an informed decision about Breast Reconstruction. This is a personal choice that your breast surgeon (or general surgeon) and plastic surgeon are ready to discuss with you, and plan for, right at the
onset of your treatment for breast cancer.

Fully exploring your options will help you make the best choice for your body and your life after cancer. And research has shown that the more informed you are about Breast Reconstruction upfront, the better your plan will be. This look at Breast Reconstruction provides insight for a knowledgeable decision.

While Breast Reconstruction can be performed at the time of your mastectomy or delayed months or even years, knowing your options now can reduce your fear and strengthen your decision. Once
you have read this information, be sure to consult with your breast/general surgeon and plastic surgeon to determine what option is right for you.

 

The Women's Health and Cancer Rights Act (WHCRA) requires group health plans and health insurers that provide medical benefits covering mastectomy to also cover the cost of breast reconstructive surgery for women who have undergone mastectomy. Coverage must also include all stages of reconstructive surgery of the diseased breast, procedure to restore and achieve symmetry on the opposite breast, and the cost of prostheses and complications of mastectomy. For more detailed information about WHCRA, please refer to the Department of Labor's "Your Rights After Mastectomy" website at www.dol.gov/ebsa/Publications/whcra.html.         A Look at the Most Commonly Performed Breast Reconstruction Procedures Your plastic surgeon may offer the following Breast Reconstruction procedures. At the end of the overview you will find a summary chart for these surgical options. Two-Stage Reconstruction with Breast Implants           Two-Stage Breast Reconstruction procedure use tissue expanders to create pockets for the placement of breast implants.       This process creates a new breast shaped pocket in preparation for your next stage of reconstruction: placement of the implant.                                     Stage One - A tissue expander is a silicone shell that is filled slowly over time with saltwater to stretch the skin and make room for your implant. The expander is placed under your chest skin at the site of your planned reconstructed breast. A small needle is used to fill the expander with sterile saline. The needle is inserted through the skin to a "fill port" located inside the expander. Gradually over time, the overlying tissues expand, much like a woman's abdomen during pregnancy.       Stage Two - The placement of your breast implant is the second part of the Two-Stage Breast Reconstruction process. After your tissue expander has reached an ideal pocket size, your plastic surgeon will perform surgery to remove the tissue expander and place your saline or gel-filled breast implant. This is a routine procedure that usually takes 1 to 2 hours and should require no hospital stay. You should fully recover from the procedure in 2 to 3 days, completely able to resume your normal activities.         Before nipple-sparing mastectomy   Stage1 with Natrelle® Tissue Expander   Stage 2 with Natrelle® Style 20 500cc gel-filled Beast Implant         Before total mastectomy   Stage1 with Natrelle® Tissue Expander   Stage 2 with Natrelle® Style 20 400cc gel-filled Beast Implant, and Nipple Reconsruction           BACK TO TOP       Your Breast Reconstruction Choices with Breast Implants     • Volume Options: The Natrelle® Collection features a full variety of widths and volumes. The size and volume that's right for you is based on existing breast tissue, your body type and frame. The question of size is NOT just about picking a specific volume of breast implant. Your plastic surgeon will help you pick a diameter and projection of implant that fits your needs. For example, Natrelle® gel-filled breast implants come in four different profiles, or projections: Moderate, Moderate-Plus, High, and Extra-High. Only Natrelle® breast implants are available with an Extra-High profile option. The Natrelle® Style 20 implant is the most common implant used in breast reconstruction because usually some or all of the breast tissue has been removed. The profile of the implant is an important factor in how far out your breasts will “project” after your reconstruction. And each choice has a different volume. See the Natrelle® gel-filled breast implant examples below and notice how each one can deliver a distinctly different profile: NATRELLE® Style 10 Moderate Profile Diameter (cm) Projection (cm) Volume (cc) 12.2 3.3 270 NATRELLE® Style 15 Moderate-Plus Profile Diameter (cm) Projection (cm) Volume (cc) 11.9 4.0 304 NATRELLE® Style 20 High Profile Diameter (cm) Projection (cm) Volume (cc) 12.0 5.2 425 NATRELLE® Style 45 Extra-High Profile Diameter (cm) Projection (cm) Volume (cc) 11.9 5.7 500   • Shell Options: There are two shell options available, textured or smooth. Your plastic surgeon can determine which option is best for you based on their technique and the shape of the breast implant that best fits your personal profile goal.   • Filler Options: Women in the United States currently have two distinct filler options approved by the FDA. The FDA has approved both saline and silicone gel-filled breast implants after determining that each are safe and effective options for women undergoing breast aesthetic surgery, breast reconstructive surgery or revision surgery. Ultimately, it is up to you, along with your surgeon, to decide what breast implant option will provide the look and outcome you desire from surgery.   BACK TO TOP   Silicone Gel vs. Saline   .           A further look at the Safety of Silicone Gel-Filled Implants Like many other medical devices on the market today, silicone gel-filled breast implants have evolved substantially over the last two decades. Today's Natrelle® silicone gel-filled breast implants have an advanced technology and enhanced safety profile thanks to several refinements in product design and manufacturing. The most significant advancements available today include a more cohesive silicone gel and a thicker, yet supple shell with an additional barrier layer that is distinct from earlier breast implant devices.               • Low long-term rupture rates: To assess the long-term safety of Natrelle® breast implants, Allergan conducted extensive clinical studies both in the United States and in Europe. These studies show that silicone gel-filled implants have low long-term rupture rates. In fact, the results of the European research found that after 11 years, 92 percent of implants were still intact.   “The reason was simple: my breasts had been with me for the first 50 years of my life and I wanted them there, in place, for the next 50 years as well. My goals for surgery were to look and feel like myself again and to feel ‘whole again.’ It was my way of dealing with the trauma I, along with many other women, had suffered and prevent my disease from leaving a permanent imprint on my body.” Dr. Christine Rodgers, cancer survivor and plastic surgeon           • Rigorous testing: Today's breast implants in the Natrelle® Collection undergo thorough testing and meet the very high standards of Allergan quality. They are backed by an unsurpassed warranty that reflects the Allergan commitment to quality.         • Ongoing research: Through ongoing research Allergan is constantly assessing the impressive long-term safety record of our full line of elegant silicone gel-filled breast implants.           Natrelle® silicone gel-filled breast implants are one of the most studied FDA approved medical devices in existence. There have been hundreds of peer-reviewed studies and published reports involving silicone gel-filled breast implants, including robust epidemiological studies supporting their use. The Institute of Medicine of the National Academies (IOM), concluded in its landmark report (IOM, 1999) that "a review of the toxicology studies of silicones and other substances known to be in breast implants does not provide a basis for health concerns." More information about the safety of silicone gel-filled implants can be found in the IOM report at www.iom.edu/CMS/3793/5638.aspx. For safety data on implants go to www.fda.gov/cdrh/breastimplants and please read the complete patient information at www.natrelle.com/safety_info.aspx.   BACK TO TOP       Tissue Flap Breast Reconstruction Options Breasts can also be reconstructed by surgically moving a section of skin, fat and muscle from one area of your body to your chest, this is referred to as an Autologous Reconstruction. In Autologous Reconstruction, tissue is taken from your abdomen, upper back, upper hip or buttocks. Depending on your plastic surgeon's surgical plan, the tissue flap may be left attached to the blood supply and moved to the breast area through a tunnel under the skin called a Pedicle Flap, or it can be removed completely and reattached to the breast area by a microsurgical technique called a Free Flap. The advantage of flap surgery is the replacement of chest area tissue. This is an important consideration if:   “A plastic surgeon specializing in Breast Reconstruction, worked in tandem with my surgical team so that I came out of the mastectomy with ‘expanders’ where my breasts had been, which would make room for my permanent silicone implants. I chose NATRELLE® silicone gel-filled breast implants because I felt that they were the most natural appearing option.” Alex, age 49, Denver, CO, underwent breast implant surgery following her double mastectomy             • Your chest tissue has been damaged and is not suitable for tissue expansion   • Extra tissue is needed to recreate a large breast without a breast implant   • Extra tissue coverage is needed over a breast implant       Unlike Two-Stage Breast Reconstruction with breast implants, Flap Reconstruction is a major surgery. It requires a hospital stay of several days and longer recovery time than the tissue expander and implant reconstruction process. Flap surgery also creates scars at the site where your flap was taken and additional scars are possible at the site of your reconstructed breast. It is important to reinforce that tissue flap surgery, particularly the TRAM and DIEP flaps, are major surgeries, more extensive than your mastectomy. They require good general health and strong emotional motivation. If you are very overweight, smoke, have had previous surgery in the area the flap would be taken, or have any circulatory problems, you may not be a good candidate for a tissue flap procedure. If you are very thin, you may not have enough tissue in your abdomen or back to create a breast using this method.

The Three Most Frequent Types of Flap Surgery TRAM Transverse Rectus Abdominus Myocutaneous Flap   TRAM surgery involves moving fat, skin and muscle from the lower abdomen (C) to create a new breast mound (A). The surgery is approximately 3 to 6 hours long, requires a hospital stay of 2 to 5 days and 6 to 8 weeks to resume normal daily activity. Some women refer to this as the "tummy tuck" procedure, because a flatter stomach is often part of your result. Obtaining the flap for your new breast will leave a scar on your abdomen.       BACK TO TOP

BACK TO TOP       Latissimus Dorsi Flap Sometimes called the Latiss Flap, this procedure involves taking the latissimus muscle from your back and rotating it around to your front to create, or help create a breast mound. Usually an implant is used because the muscle isn't large enough to produce the desired size. This will leave a scar on your back. The surgery is approximately 2 to 4 hours, requires a hospital stay of about 2 to 3 days and 2 to 3 weeks before you can resume normal activity.

Summary Chart of Surgical Options             BACK TO TOP             Improving Symmetry If you have a unilateral mastectomy, it may be difficult for the surgeon to exactly match the remaining breast, particularly if you have large breasts or if your breasts have sagged with age or from bearing children. In order to help improve symmetry between your natural and reconstructed breasts, your plastic surgeon may recommend:   • Mastopexy: A breast lift   • Mammoplasty: A breast reduction   • Augmentation Mammoplasty: A breast enlargement   All of these are quite common plastic surgeon considerations.

Questions Your Plastic Surgeon Can Answer If you are considering breast reconstruction, Dr. Weinstein will provide you with information that fully explains the risks and complications associated with breast implants, tissue flaps and with breast reconstruction surgery itself. It is recommended that you read all of the information provided before scheduling your surgery, so that you have plenty of time to ask questions and evaluate all of your options.           • What are all my options for breast reconstruction?   • What are the risks and complications of each type of breast reconstruction surgery and how common are they?   • What if my cancer recurs or occurs in my other breast?   • Will reconstruction interfere with my cancer treatment?   • How many steps are there in each procedure, and what are they?   • How long will it take to complete my reconstruction?   • How much experience do you have with each procedure?   • Do you have before and after photos I can look at for each procedure?   • What results are reasonable for me?   • What will my scars look like?   • What kind of changes in my reconstructed breast can I expect over time?   • Can I talk with other patients about their experiences?   • What is the estimated total cost of each procedure? How much is my insurance expected to cover?   • How much pain or discomfort will I feel, and for how long?   • How long will I be in the hospital?   • Will I need blood transfusions, and can I donate my own blood?   • When will I be able to resume normal activity (or sexual activity or athletic activity)?   • Where can I get more information?   •

This information gives you an understanding of breast reconstruction and should help you make an informed decision. But it is not meant to replace a thorough consultation with a plastic surgeon. It is you general surgeon and plastic surgeon working together on your plan for your mastectomy and reconstruction procedures that will give you the best possible result.       Additional Resources 1. Cancer Care: www.cancercare.org 2. Susan G. Komen for the Cure: www.komen.org 3. Y-ME, Breast Cancer Organization: www.networkofstrength.org 4. Share: www.sharecancersupport.org 5. American Cancer Society: www.cancer.org 6. Cancer Connection: www.cityofhope.org 7. American Society of Plastic Surgeons: www.plasticsurgery.org The primary part of the procedure can often be carried out immediately following the mastectomy. As with many other surgeries, patients with significant medical comorbidities (high blood pressure, obesity, diabetes) and smokers are higher-risk candidates. Surgeons may choose to perform delayed reconstruction to decrease this risk. The infection rate may be higher with primary reconstruction (done at the same time as mastectomy), but there are psychologic and financial benefits to having a single primary reconstruction. Patients expected to receive external beam radiation as part of their adjuvant treatment are also commonly considered for delayed autologous reconstruction due to significantly higher complication rates with tissue expander-implant techniques in those patients. Breast reconstruction is a large undertaking that usually takes multiple operations. Sometimes these follow-up surgeries are spread out over weeks or months. If an implant is used, the individual runs the same risks and complications as those who use them for breast augmentation but has higher rates of capsular contracture (tightening or hardening of the scar tissue around the implant) and revisional surgeries. Outcomes based research on quality of life improvements and psychosocial benefits associated with breast reconstruction [1][2] served as the stimulus in the United States for the 1998 Women's Health and Cancer Rights Act[1], which mandated health care payer coverage for breast and nipple reconstruction, contralateral procedures to achieve symmetry, and treatment for the sequelae of mastectomy. This was followed in 2001 by additional legislation imposing penalties on noncompliant insurers. Similar provisions for coverage exist in most countries worldwide through national health care programs. [edit] Techniques There are many methods for breast reconstruction. The two most common are: Tissue Expander - Breast implants This is the most common technique used worldwide. The surgeon inserts a tissue expander, a temporary silastic implant, beneath a pocket under the pectoralis major muscle of the chest wall. The pectoral muscles may be released along its inferior edge to allow a larger, more supple pocket for the expander at the expense of thinner lower pole soft tissue coverage. The use of acellular human or animal dermal grafts have been described as an onlay patch to increase coverage of the implant when the pectoral muscle is released, which purports to improve both functional and aesthtic outcomes of implant-expander breast reconstruction.[3][4] In a process that can take weeks to months, saline solution is injected to progressively expand the overlaying tissue. Once the expander has reached an acceptable size, it may be removed and replaced with a more permanent implant. Reconstruction of the areola and nipple are usually performed in a separate operation after the skin has stretched to its final size. Flap reconstruction The second most common procedure uses tissue from other parts of the patient's body, such as the back, buttocks, thigh or abdomen. This procedure may be performed by leaving the donor tissue connected to the original site to retain its blood supply (the vessels are tunnelled beneath the skin surface to the new site) or it may be cut off and new blood supply may be connected. The latissimus dorsi muscle flap is the donor tissue available on the back. It is a large flat muscle which can be employed without significant loss of function. It can be moved into the breast defect while still attached to its blood supply under the arm pit (axilla). A latissimus flap is usually used to recruit soft-tissue coverage over an underlying implant. Enough volume can be recruited occasionally to reconstruct small breasts without an implant. Abdominal flaps The abdominal flap for breast reconstruction is the TRAM flap (Transverse Rectus Abdominis Myocutaneous flap). In a TRAM procedure, a portion of the abdomen tissue group, including skin, adipose tissues, minor muscles and connective tissues, is taken from the patient's abdomen and transplanted onto the breast site. Both TRAM and DIEP/SIEP use the abdominal tissue between the umbilicus and the pubis. The DIEP flap and free-TRAM flap require advanced microsurgical technique and are less common as a result. The TRAM can provide enough tissue to reconstruct large breasts. The TRAM procedure is preferred by some breast cancer patients because they result in an abdominoplasty (tummy tuck), and allow the breast to be reconstructed with one's own tissues instead of a foreign implant. To prevent muscle weakness and incisional hernias, the portion of abdominal wall exposed by reflection of the rectus abdominis muscle may be strengthened by a piece of surgical mesh placed over the defect and sutured in place.  The TRAM Flap Procedure Identification of the target and donor sites Raising the flap and transposing it to the target site The result of the reconstruction   Nipple-Areolar Composite Graft (Sharing) - if the contralateral breast has not been reconstructed and the nipple and areolar are sufficiently large, tissue may be harvested and used to recreate the nipple-areolar complex on the reconstructed side. Local Tissue Flaps - a nipple may be created by raising a small flap in the target area and producing a raised mound of skin. To create an areola, a circular incision may be made around the new nipple and sutured back again. The nipple and areolar region may then be tattooed to produce a realistic colour match with the contralateral breast. Local Tissue Flaps With Use of AlloDerm - as above, a nipple may be created by raising a small flap in the target area and producing a raised mound of skin. AlloDerm (cadaveric dermis) can then be inserted into the core of the new nipple acting like a "strut" which may help maintain the projection of the nipple for a longer period of time. The nipple and areolar region may then be tattooed later.[6] One of the challenges in breast reconstruction is to match the reconstructed breast to the mature breast on the other side (often fairly 'ptotic' - droopy.) This often requires a lift (mastopexy), reduction, or augmentation of the other breast. Recovery from implant-based reconstruction is generally faster than with flap-based reconstructions, but both take at least three to six weeks of recovery and both require follow-up surgeries in order to construct a new areola and nipple. All recipients of these operations should refrain from strenuous sports, overhead lifting, and sexual activity during the recovery period. TRAM flap patients can show abdominal-muscle weakness on EMG studies, but clinically most patients who have undergone unilateral and bilateral breast reconstruction (reconstruction of one or both breast) return to normal activities after recovery.. There is little information about upper body exercise post-mastectomy. Issues such as simple mastectomy, mastectomy with reconstruction, and mastectomy with lymph node excision and reconstruction all factor into limitations to amount and extent of upper body exercise. Generally, cardiac exercise (treadmill, walking, etc.) are approved for rehabilitation post-surgery and for weight control. Women who have undergone breast reconstruction must still be followed for local or regional recurrence of their cancer with manual exams of the breast/chest wall and axilla.   Introduction There are many decisions and choices involved in the process of breast reconstruction, but perhaps the most important question to ask is the following: Is breast reconstruction right for you? For tens of thousands of breast cancer survivors, the answer has been yes. Not every woman facing a mastectomy may feel the need for breast reconstruction, but for many women it is an important part of their recovery. There are many options available today for women who decide that reconstruction is right for them. The more you know about the procedure and the options involved, the better equipped you will be to make a decision that is best for you. There are many factors to consider about breast reconstruction and a great deal of information to learn and understand. The purpose of this brochure is to help you in making an informed decision about having breast implants for reconstruction (restoration) or breast revision-reconstruction (replacement) surgery. This brochure is not intended to replace consultation with your surgeon. This educational brochure is set up to provide you with information about the risks and benefits of Mentor saline and MemoryGel™ breast implants. Choosing Breast Reconstruction Today, most women who have mastectomies are good candidates for breast reconstruction. Women choose to have their breast(s) reconstructed for many different reasons. Following a mastectomy, some women feel a lack of wholeness or a loss of femininity, while others simply don’t like the hassle or worry associated with wearing a breast prosthesis. Whatever the reason for reconstruction, every woman’s decision is different and must ultimately be made by her, based on her needs, desires and expectations. The breast reconstruction procedure that is best for you will vary depending on the results you desire, your particular situation and other physical and mental determinations. Whatever procedure is decided upon, it’s important that you take part in making the necessary decisions. Keep in mind that any breast reconstruction process will require multiple procedures. Because each patient and procedure is different, the actual number of surgeries and recovery time will vary. Be sure you select a surgeon who is experienced in breast reconstruction. If your general surgeon works closely with your

the Breast

The breast consists of milk ducts and glands, surrounded by fatty tissue that provides its shape and feel. The chest muscle (pectoralis major muscle) is located beneath the breast.

Breast Cancer Facts

Simply stated, breast cancer is an uncontrolled growth of breast cells. Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. It differs by individual, age group, and even the kinds of cells within the tumors themselves.

How Does Breast Cancer Occur?

Cancer is a result of mutations, or abnormal changes, in the genes responsible for regulating the growth of cells and keeping them healthy. The genes are in each cell’s nucleus, which acts as the “control room” of each cell. Normally, the cells in our bodies replace themselves through an orderly process of cell growth: healthy new cells take over as old ones die out. But over time, mutations can “turn on” certain genes and “turn off” others in a cell. That changed cell gains the ability to keep dividing without control or order, producing more cells just like it and forming a tumor.

Breast Cancer is Caused by a Genetic Abnormality

According to cancer socieites, only 5 to 10% of cancers are due to an abnormality inherited from your mother or father. About 90% of breast cancers are due to genetic abnormalities that happen as a result of the aging process and the strain of life in general.

Did you Know That Not All Tumors are Cancerous?

A tumor can be benign (not dangerous to health) or malignant (has the potential to be dangerous). Benign tumors are not considered cancerous: their cells are close to normal in appearance, they grow slowly, and they do not invade nearby tissues or spread to other parts of the body. Malignant tumors are cancerous.

The Term "Breast Cancer" Refers to a Malignant Tumor that has Developed from Cells in the Breast.

Usually breast cancer either begins in the cells of the lobules, which are the milk-producing glands, or the ducts, the passages that drain milk from the lobules to the nipple. Less commonly, breast cancer can begin in the stromal tissues, which include the fatty and fibrous connective tissues of the breast.

Over Time, Cancer Cells can Invade Nearby Healthy Breast Tissue and Make their way into the Underarm Lymph Nodes, Small Organs that Filter out Foreign Substances in the Body.

If cancer cells get into the lymph nodes, they then have a pathway into other parts of the body. The breast cancer’s stage refers to how far the cancer cells have spread beyond the original tumor.

Types of Breast Cancer

There are different types of breast cancer and some are more common than others. Knowing your type can help you and your doctor make decisions on treatment and therapy.

Invasive or Infiltrating Ductal Carcinoma (IDC)

IDC is the most common type of breast cancer representing 78% of all malignancies. These lesions appear as stellate (star-like) or well-circumscribed (rounded) areas on mammograms. The stellate lesions generally have a poorer prognosis.

Invasive or Infiltrating Lobular Carcinoma (ILC)

Infiltrating lobular carcinoma is a type of breast cancer that usually appears as a subtle thickening in the upper-outer quadrant of the breast. This breast cancer type represents 5% of all diagnosis. Often positive for estrogen and progesterone receptors, these tumors respond well to hormone therapy.

Inflammatory Breast Cancer (IBC)

Inflammatory breast cancer is a rare and very aggressive type of breast cancer that causes the lymph vessels in the skin of the breast to become blocked. This type of breast cancer is called “inflammatory” because the breast often looks swollen and red, or “inflamed.” IBC accounts for 1% to 5% of all breast cancer cases in the United States.

Stages of Breast Cancer

Determining the stage of your breast cancer is fundamental for planning your treatment and understanding the most likely outcome. If you have been diagnosed with breast cancer, your doctor will decide what additional tests may be helpful to find out if the disease has spread outside the breast.

About Stages

• The cancer stage — shown as a number from O to IV — is based on the size of the tumor and whether the cancer has spread to the lymph nodes.
• To determine your cancer stage, your doctor will ask questions about your medical history, perform a careful physical examination and review all prior tests as well as the results from the biopsy of the tumor or suspected area.
• Additional tests, such as X-rays and blood work, may be needed. In general, the stage isn't fully known until after the operation to remove the tumor in your breast and sample the lymph nodes under your arm.
• Breast cancer staging is complicated, and the classification system sometimes changes as doctors learn more about breast cancer.

Stages 0 to IV: What They Mean

Once the surgery is completed, your doctor can determine the stage of your cancer. Breast cancer stages range from 0 to IV, with many subcategories. Lower numbers indicate earlier stages of cancer, while higher numbers reflect a late-stage cancer.

This stage describes noninvasive breast cancer. It hasn't spread within the breast or to other parts of the body.

This stage is an early stage of invasive breast cancer in which:

• The tumor measures no more than 2 centimeters or about ¾ an inch in diameter
• No lymph nodes are involved — the cancer hasn't spread outside the breast

This stage, subdivided into IIA and IIB, describes invasive breast cancers in which one of the following is true:

• The tumor measures less than 2 cm but has spread to lymph nodes under the arm
• No tumor is found in the breast but cancer is found in the axillary lymph nodes
• The tumor is between 2 cm and 5 cm (about 1 to 2 inches) and may have spread to lymph nodes under the arm
• The tumor is larger than 5 cm but hasn't spread to any lymph nodes

Stage III breast cancers are subdivided into three categories — IIIA, IIIB and IIIC — based on a number of different criteria. By definition, stage III cancers haven't spread (metastasized) to distant sites

For example, a stage IIIA tumor is larger than 5 cm and has spread to one to three lymph nodes under the arm. Other stage IIIA tumors may be any size and have spread into multiple lymph nodes. The lymph nodes clump together and attach to one another or to the surrounding tissue.

In stage IIIB breast cancer, a tumor of any size has spread to tissues near the breast — the skin and chest muscles — and may have spread to lymph nodes within the breast or under the arm. Stage IIIB also includes inflammatory breast cancer, an uncommon but aggressive type of breast cancer.

Stage IIIC cancer is a tumor of any size that has spread:

• To 10 or more lymph nodes under the arm
• To lymph nodes above or beneath the collarbone and near the neck
• To lymph nodes within the breast itself and to lymph nodes under the arm

Stage IV breast cancer has spread to other, distant parts of the body, such as the lungs, liver, bones or brain.

Treatment Types

There are many breast cancer treatment options. By working closely with your physician, and by voicing your needs and concerns, you can find the one that’s right for you.

Surgery

Most patients with breast cancer have surgery to remove the cancer from the breast. Some of the lymph nodes under the arm are usually taken out and examined to see if they contain cancer cells.

Breast-Conserving Surgeries

• Lumpectomy: Surgery to remove a tumor and a small amount of normal tissue around it.
• Partial mastectomy: Surgery to remove the part of the breast that has cancer and some normal tissue around it. This procedure also is called a segmental mastectomy.

Non-Breast Conserving Surgeries

• Total mastectomy: Surgery to remove the whole breast that has cancer. This procedure also is called a simple mastectomy. Some of the lymph nodes under the arm may be removed for biopsy at the same time as the breast surgery or after. This is done through a separate incision.
• Modified radical mastectomy: Surgery to remove the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.
• Radical mastectomy: Surgery to remove the breast that has cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm. This procedure is sometimes called a Halsted radical mastectomy.

Care Team

During the course of your treatment for breast cancer, there will be several different physicians who will work together to plan your surgery and reconstruction procedure so that you get the best possible result. Your team should include:

• Surgeon: He or she will perform the biopsy of the breast tumor and the lumpectomy or mastectomy
• Pathologist: This doctor studies the tumor to determine the degree of malignancy
• Medical oncologist: This specialist administers anticancer drugs or chemotherapy
• Radiation oncologist: He or she administers radiation therapy
• Plastic surgeon: This physician performs your breast reconstruction

Risks

Statistics Show That 1 in 8 Women Will Develop Breast Cancer

In general, 13% of women in the United States can expect to develop breast cancer over the course of an entire lifetime. Regardless of these numbers, your individual risk may be higher or lower depending on many different factors like family history, reproductive history, lifestyle, environment, and others.

Although many risk factors may increase your chance of developing breast cancer, it is not yet known exactly how some of these risk factors cause cells to become cancerous.

Risk Factors You Cannot Change

• Gender: Simply being a woman is the main risk for breast cancer. While men also get the disease, it is about 100 times more common in women than in men.
• Age: The chance of getting breast cancer increases as a woman gets older. About 2 out of 3 women with invasive breast cancer are age 55 or older when the cancer is found.
• Genetic risk factors: About 5% to 10% of breast cancers are believed to be linked to inherited mutations in certain genes. The most common gene mutations are those of the BRCA1 and BRCA2 genes. Women with these mutations have up to an 80% chance of getting breast cancer during their lifetimes. Other gene changes may raise breast cancer risk as well.
• Family history: Breast cancer risk is higher among women whose close blood relatives have this disease. The relatives can be from either the mother's or father's side of the family. Having a mother, sister, or daughter with breast cancer about doubles a woman's risk. (It's important to note that 70% to 80% of women who get breast cancer do not have a family history of this disease.)
• Personal history of breast cancer: A woman with cancer in one breast has a greater chance of getting a new cancer in the other breast or in another part of the same breast. This is different from a return of the first cancer (which is called recurrence).
• Race: White women are slightly more likely to get breast cancer than are African American women. But African American women are more likely to die of this cancer. At least part of the reason seems to be because African American women have faster growing tumors. Asian, Hispanic, and American Indian women have a lower risk of getting breast cancer.
• Dense breast tissue: Dense breast tissue means there is more glandular tissue and less fatty tissue. Women with denser breast tissue have a higher risk of breast cancer. Dense breast tissue can also make it harder for doctors to spot problems on mammograms.
• Menstrual periods: Women who began having periods before the age of 12 or who went through menopause after the age of 55 have a slightly increased risk of breast cancer. They have had more menstrual periods and as a result have been exposed to more of the hormones estrogen and progesterone.
• Earlier breast radiation: Women who have had radiation treatment to the chest area (as treatment for another cancer) earlier in life have a greatly increased risk of breast cancer.
• Treatment with DES: In the past, some pregnant women were given the drug DES (diethylstilbestrol) because it was thought to lower their chances of miscarriage. Recent studies have shown that these women and their daughters, who were exposed to DES while in the womb, have a slightly increased risk of getting breast cancer.

Prevention

There are things you can do to help lower your risk of breast cancer, including some lifestyle choices. Learn more to inform your decisions around risk factors that are more within your control.

Lifestyle Choices and Breast Cancer Risk

• Alcohol use: Use of alcohol has been linked to an increased risk of getting breast cancer. Women who have one drink a day have a very small increased risk. Those who have 2 to 5 drinks daily have about 1½ times the risk of women who drink no alcohol. The American Cancer Society suggests limiting the amount you drink to one drink a day.
• Being overweight or obese: Being overweight or obese is linked to a higher risk of breast cancer, especially for women after menopause and if the weight gain took place during adulthood. Also, the risk seems to be higher if the extra fat is in the waist area. But the link between weight and breast cancer risk is complex, and studies of fat in the diet as it relates to breast cancer risk have often given conflicting results. The American Cancer Society recommends you maintain a consistently healthy weight throughout your life without periods of excess weight gain.
• Lack of exercise: Studies show that exercise reduces breast cancer risk, but exactly how much exercise is needed is undetermined. One study found that as little as 1 hour and 15 minutes to 2½ hours of brisk walking per week reduced the risk by 18%. Walking 10 hours a week reduced the risk a little more. The American Cancer Society suggests exercising 45 to 60 minutes, 5 or more days a week.
• Not having children or having them later in life: Women who have had not had children, or who had their first child after age 30, have a slightly higher risk of breast cancer. Being pregnant more than once and at an earlier age reduces breast cancer risk. The reason may be because pregnancy reduces a woman's total number of lifetime menstrual cycles.
• Recent use of birth control pills: Studies have found that women who are using birth control pills have a slightly greater risk of breast cancer than women who have never used them. Women who stopped using the pill more than 10 years ago do not seem to have any increased risk. Get more information specific to you from your doctor about the risks and benefits of birth control pills.
• Postmenopausal hormone therapy (PHT): Postmenopausal hormone therapy (also known as hormone replacement therapy), has been used for many years to help relieve symptoms of menopause and to help prevent thinning of the bones, or osteoporosis. There are two main types of PHT:
  • For women who have a uterus, doctors generally prescribe estrogen and progesterone, known as combined PHT. Estrogen alone can increase the risk of cancer of the uterus, so progesterone is added to help prevent this.
  • For women who no longer have a uterus (those who've had a hysterectomy), estrogen alone can be prescribed. This is commonly known as estrogen replacement therapy (ERT).
• Combined PHT: It has become clear that use for several years or more of combined PHT increases the risk of breast cancer and may increase the chances of dying of breast cancer. Breast cancer may also be discovered at an advanced stage, perhaps because PHT seems to reduce the effectiveness of mammograms. Five years after stopping PHT, the breast cancer risk has been shown to drop back to normal.
• ERT: The use of estrogen alone does not seem to increase the risk of developing breast cancer much, if at all. But when used for more than 10 years, some studies have found that ERT increases the risk of ovarian and breast cancer.
• Not breast-feeding: Some studies have shown that breast-feeding slightly lowers breast cancer risk, especially if the breast-feeding lasts 1½ to 2 years. This could be because breast-feeding lowers a woman's total number of menstrual periods, as does pregnancy.

Myths

There is a lot of information out there about breast cancer and its risk factors. While it can be challenging to sort truth from myth, here are some risk factors you may have heard about that have not been proven completely factual.

Unproven But Widely Considered Risk Factors

• High fat diets: Studies of fat in the diet have not clearly shown that this is a breast cancer risk factor. Most studies have found that breast cancer is less common in countries where the typical diet is low in fat. On the other hand, many studies of women in the United States have not found breast cancer risk to be linked to how much fat is in their diets. More research is needed to better understand the effect of the types of fats eaten and body weight on breast cancer risk.
• Abortions: Several studies show that induced abortions do not increase the risk of breast cancer. Also, there is no evidence to show a direct link between miscarriages and breast cancer.
• Breast implants: Silicone breast implants can cause scar tissue to form in the breast, but several studies have found that this does not increase breast cancer risk. If you have breast implants, you might need special x-rays during mammograms.
• Pollution: Research is currently underway to learn how the environment might affect breast cancer risk. At this time, research does not show a clear link between breast cancer risk and environmental pollutants.
• Tobacco Smoke: Most studies have found no link between active cigarette smoking and breast cancer, although it has been link to other cancers. Research continues on whether secondhand smoke may increase the risk of breast cancer. But even a possible link to breast cancer is yet another reason to avoid secondhand smoke.

Symptoms

Often there are no outward signs of breast cancer that you can see or feel, but there are some common symptoms you should be aware of as you monitor your breast health.

• A lump or thickening in or near the breast, or in the underarm, that persists through the menstrual cycle.
• A mass or lump, which may feel as small as a pea.
• A change in the size, shape or contour of the breast.
• A bloodstained or clear fluid discharge from the nipple.
• A change in the feel or appearance of the skin on the breast or nipple (dimpled, puckered, scaly or inflamed).
• Redness of the skin on the breast or nipple.
• An area that is distinctly different from any other area on either breast.
• A marble-like hardened area under the skin.

Outward Signs May Not Tell the Entire Story

Even if you have one or more of these signs, it still doesn't mean you have breast cancer. Remember that most breast lumps turn out to be benign. Still, it's extremely important that you see your doctor right away if you're concerned.

Self-Exam

A breast self-exam is one of key steps women of all ages can take to become active in prevention and the early detection of breast cancer – and it only takes 10 minutes, once a month. By becoming proficient at breast self-examination and familiar with the usual appearance and feel of your breasts, you may be able to detect changes that could signal early signs of cancer.

• Learn how your breasts typically look and feel and watch for changes.
• If you detect a change, promptly bring it to your doctor's attention.
• Have your doctor review your examination technique if you'd like input or you have questions. Simply stated, self-exams have been shown to save lives.

Follow These Simple Steps

1. Before you shower, lie down with a pillow under your right shoulder and place your right arm behind your head.
2. Use the finger pads of the three middle fingers on your left hand to feel for lumps in the right breast. It’s normal for breasts to feel lumpy – over time you’ll identify your own natural “lumps,” and know if something feels different.
3. Press firmly enough to know how your breast feels. A firm ridge in the lower curve of each breast is normal. If you’re not sure how hard to press, talk with your doctor or nurse.
4. Move around the breast in a circular, up and down line, or wedge pattern. Be sure to do it the same way every time, check the entire breast area and remember how your breasts feel from month to month.
5. Repeat the exam on your left breast, using the finger pads of the right hand – after moving the pillow to under your left shoulder.
6. In the shower or bath, repeat step 1 using soapy hands. Simply place one arm behind your head as you examine each breast.
7. In front of the mirror, look for changes in the size and shape of each of your breasts – as well as the position of each nipple. Remember, it is normal for one breast to be larger than another.

Mammograms and Other Tests

Having the regular, recommended screenings before signs or symptoms appear is the key to finding breast cancer in its early, treatable stages. Depending on your age and risk factors, screening may include clinical breast exam by your nurse or doctor, mammograms or other tests.

Types of Screenings:

• Clinical breast exam: Unless you have a family history of cancer or other factors that place you at high risk, the American Cancer Society recommends clinical breast exams once every three years until age 40. After that, the American Cancer Society recommends having a yearly clinical exam. Your doctor will examine your breasts for lumps or other changes and may be able to feel lumps you have missed. He or she also will check for enlarged lymph nodes in your armpit (axilla).
• Mammogram: A mammogram, which uses a series of X-ray images of your breast tissue, is currently the best imaging technique for detecting tumors before you or your doctor can feel them. For that reason, the American Cancer Society has long recommended screening mammography for all women over 40.
  • Screening mammograms are performed on a regular basis — about once a year — to check your breast tissue for any changes since your last mammogram.
  • Diagnostic mammograms are used to evaluate a breast change detected by you or your doctor. During a diagnostic mammogram, the radiologist performing the exam can take additional views to evaluate the area of concern more closely.

Mammogram Limitations

• A certain percentage of breast cancers, sometimes even lumps you can feel, don't show up on X-rays – or give a false-negative result. The rate is higher for women in their 40s because women of this age and younger tend to have denser breasts, making it more difficult to distinguish abnormal from normal tissue.
• Mammograms may indicate a problem when none exists, or give a false-positive result. This can lead to unnecessary biopsies, to fear and anxiety, and to increased health care costs.
• The skill and experience of the radiologist reading the mammogram also may have a significant effect on the accuracy of the test results. In spite of these drawbacks, however, most experts agree mammography is the most reliable screening test for most women.

Tips for Your Next Mammogram

• During a mammogram, your breasts are compressed between plastic plates while a radiology technician takes X-rays. You may find mammography somewhat uncomfortable and if you experience too much discomfort, inform the technician. If you have tender breasts, schedule your mammogram for a time after your menstrual period. Avoiding caffeine for two days before the test may help reduce breast tenderness.
• Also available at some mammography centers is a soft, single-use, foam pad that can be placed on the surface of the compression plates of the mammography machine, making the test less uncomfortable. The pad doesn't interfere with the image quality of the mammogram.
• If possible, try to schedule your mammogram around the same time as your annual clinical exam. That way the radiologist can specifically look at any changes your doctor may discover.
• If you lack health insurance, don’t skip your mammogram. Many state health departments and Planned Parenthood® clinics offer low-cost or free screenings.

Other Helpful Tests

• Computer-aided detection (CAD). In traditional mammography, a radiologist reviews your X-rays. Therefore, the skill and experience of the radiologist play a large part in determining the accuracy of the test results. In CAD, a computer scans your mammogram after a radiologist has reviewed it and identifies highly suspicious areas on the mammogram, allowing the radiologist to focus on specific spots. Using mammography and CAD together may increase the cancer detection rate.
• Digital mammography. In this procedure, a radiologist uses computer technology to alter contrast and darkness of images, making it easier to identify subtle differences in tissue. Digital images can be transmitted electronically, so mammograms can be read by remote experts, if desired. Digital mammography has been found to be helpful in evaluating dense breast tissue.
• Magnetic resonance imaging (MRI). This technique uses a magnet and radio waves to take pictures of the interior of your breast. Although not used for routine screening, MRI can reveal tumors that are too small to detect through physical exams or are difficult to see on conventional mammograms. MRI doesn't take the place of mammograms, but rather is performed as an additional (adjunct) study of the breast.
  • MRI isn't recommended for routine screening on women at average risk because it has a high rate of false-positive results. It's also expensive, not readily available and requires interpretation by an experienced radiologist. However, the American Cancer Society now recommends annual screening MRI for women with a lifetime breast cancer risk of 20 percent or higher, women who received chest radiation between ages 10 and 30, and women with a strong family history of breast and ovarian cancers.
  • Recent recommendations propose that women with newly diagnosed breast cancer in one breast have a one-time MRI. MRI can detect breast tumors in the opposite (contralateral) breast missed by mammograms. The test can also detect additional lesions in the affected breast. However, whether finding early tumors in this situation improves treatment outcomes — and deaths from breast cancer — is still unknown.
• Breast ultrasound (ultrasonography). Your doctor may use this technique to evaluate an abnormality seen on a mammogram or found during a clinical exam. Ultrasound uses sound waves to produce images of structures deep within the body. Because it doesn't use X-rays, ultrasound is a safe diagnostic tool that can help determine whether an area of concern is a cyst or solid tissue. But breast ultrasound isn't used for routine screening because it has a high rate of false-positive results — finding problems where none exist.

What is a Pathology Report?

To classify exactly what kind of breast cancer you have, your doctor may take a biopsy of your tumor, which is a sample taken from the tumor either during surgery or using a needle. That sample tissue is then studied in a lab to determine exactly what kind of tumor it is. Tests look for different substances in the tumor, and each test result is assigned a status – such as positive or negative. The results are called your pathology report. Knowing the details about the tumor helps the doctor understand how quickly or slowly the cancer might grow and what treatments may deliver the best results.

For breast cancer, a doctor wants to know a cancer's hormone-receptor status and HER2, or Human Epidermal growth factor Receptor 2 protein, status.

• About hormone-receptor status: Hormones such as estrogen and progesterone play a role in the growth of many breast cancers, and it is important to know whether a tumor is positive or negative for either of these hormone-receptors. An estrogen-receptor-positive tumor is called “ER+,” and a progesterone-receptor-positive tumor is called “PR+.” Tumors that are positive for either of these hormone-receptors may benefit from hormonal therapy.
• About HER2 status: Similarly, HER2 status can tell you if the breast cancer is a more aggressive form and what treatments may provide the most benefit. HER2 status and hormone-receptor status are not the same thing, and being positive for one does not mean the cancer is positive for the other.

Reconstruction with Breast Implants

What about breast reconstruction with implants?

Your health and medical condition are important factors you and your surgeon will consider while deciding if you make an appropriate candidate for breast reconstruction. Your doctor also may recommend breast implantation of the opposite, uninvolved breast in order to make them more alike, or he or she may suggest breast reduction (reduction mammoplasty) or a breast lift (mastopexy) to improve the symmetry of your breasts.

Mentor Implants Overview

For more than 20 years, Mentor Worldwide LLC has been recognized as a leading manufacturer of the highest quality breast implants, globally. Solid science, industry firsts, innovative product designs and groundbreaking research are the trademarks of Mentor. While other manufacturers have come and gone, Mentor has a record of continually producing leading-edge, heavily researched, FDA approved breast reconstruction products. And all of our implants are manufactured here in the United States.

We offer two basic types: MemoryGel® Breast Implants and Saline

Beautiful and Safe: MemoryGel® Breast Implants

• MemoryGel® Breast Implants have been successfully used and trusted for 20 years by millions of women worldwide. Why? Because our implants feel more like natural breast tissue - without compromising reliability or safety.
• After decades of research and testing, MemoryGel® Breast Implants are now FDA approved for women in the U.S. MemoryGel® Breast Implants come in either a textured or smooth surface shell and are available in a wide range of sizes and profiles to fit your body.

 

 

We have cut a MemoryGel® Breast Implant in half to demonstrate how the gel material holds together uniformly. MemoryGel® Breast Implant is a cohesive, gelatin-like substance that acts as a solid rather than a liquid thereby maintaining its shape.

Read Important Safety Information

 

Saline Breast Implants

Mentor’s superior saline-filled breast implants come in a variety of shapes, sizes, profiles and surface textures. They are filled with a saltwater solution that is very similar to the fluid that makes up most of the human body. Saline implants are inserted into the body without fluid, and then filled during surgery through a fill-tube to the desired size. When the fill-tube is removed, the implant automatically seals itself.

Read Important Safety Information

 

Implant size and shape: You have lots of choices.

A common myth is that breast implants are measured in bra cup sizes. Not so. Breast implants are measured in cubic centimeters, or cc’s.

As a rule of thumb, the larger you want your cup size, the larger the breast implant your surgeon will consider. Because the size of the implant used depends on the size and shape of the individual woman’s chest you should work with your physician to determine the best size breast implant to reach your desired size.

Implant profile is just as important to your outcome as size

In addition to size and shape, breast implants are available in different profiles, or the amount of forward projection of the breast off of the chest wall.

Round or Contoured?

Round implants are the most popular choice, and are available as saline-filled or MemoryGel® Breast Implants. Both types come in a variety of profiles: Moderate, Moderate Plus and High. High profile implants provide the greatest forward projection for a more prominent silhouette, and are designed for a narrower chest area.

Contoured implants are only available with a saline fill. They provide a more mature, sloped breast shape, and they come in Moderate and High Profile styles. However, it’s important to know that when contoured implants are placed beneath the chest muscle, they may assume a round shape.

Mentor also offers you and your surgeon more innovative options including both smooth and textured surfaces to help achieve the best match for your body…and your ultimate desired results.

 

Let’s compare your Mentor options. How do MemoryGel® Breast Implants compare to Saline filled?

MemoryGel® Breast Implants
Unique benefits. Beautiful results.

Here’s a summary:

•  MemoryGel® Breast Implants are FDA approved
• Each implant is filled with Mentor’s proprietary cohesive gel
• The gel filler holds together uniformly and retains a natural give that resembles breast tissue
• The implants have a set fill volume for the most predictable results
• MemoryGel® Breast Implants comes in three projection options: Moderate, Moderate Plus and High Profile to give you just the look you want
• They come in two shell surface options: smooth and textured
• Our implants are covered by Mentor’s Standard, Premier or Enhanced Limited Warranty and Lifetime Replacement Policy

 

Saline Breast Implants
Another quality choice from Mentor.

Here’s a summary:

• FDA approved
• These implants are filled with a saltwater solution similar to the fluid that makes up most of the human body
• Saline implants have a slightly firmer feel than gel-filled implants
• They have a flexible fill volume that can be adjusted by the surgeon during the procedure
• You can choose from three projection options: Moderate, Moderate Plus and High Profile; and two shell surface options: smooth and textured
• Our saline implants are covered by Mentor’s Sandard or Enhanced Limited Warranty and Lifetime Replacement Policy

 

A Revolution: An innovative line of adjustable implants
MENTOR SPECTRUM® Adjustable Saline Implants

Often, one of the most difficult decisions for most women regarding breast augmentation after reconstruction is choosing the breast size. Mentor’s innovative line of SPECTRUM® Breast Implants makes the process easier because the surgeon can adjust the size after surgery. In fact, SPECTRUM® Implants are the only post-operatively adjustable saline-filled breast implants that allow your physician to adjust the size of your implant for up to six months after your procedure.

Read Important Safety Information

The facts about the reconstruction procedure

Information and communication is essential when it comes to what may affect your particular implant procedure, your recovery and your results. Be sure to discuss each of these factors with your physician:

• The stage of development of the cancer when it was discovered
• The follow-up treatment that you will require
• Your overall health
• Your chest structure and overall body shape
• Your healing capabilities (which can be affected by smoking, alcohol and various medications)
• Prior breast surgeries
• Bleeding tendencies
• Infections
• Possible shifting of the implant
• Scarring from the incision
• Predisposition to develop a hardened capsule around the implant

A few facts

• Reconstruction surgery is usually performed on an inpatient basis in an operating room when it begins at the same time as your mastectomy.
• Some of the stages, such as nipple reconstruction, or placement of the implant after soft tissue expansion, can be done as an outpatient procedure.
• General anesthesia is most often used.

 

How is the incision site selected?

In reconstructive surgery, the incision placement and length is decided by your surgeon and should be communicated to you. It is largely influenced by the type of cancer surgery that is planned for you.

What will recovery be like?

Depending on the type of surgery you have (immediate or delayed), your postoperative recovery period will vary. Possible complications that may occur have been described throughout this booklet. Ask your surgeon to advise you on your specific postoperative care instructions.

Please note

If you experience fever or noticeable swelling and/or redness in your breast(s) after implant surgery, you should contact your surgeon immediately.

Reconstruction with Tissue Expanders

Tissue expansion

This method of breast reconstruction involves the use of a tissue expander and a breast implant.

• Placement: A tissue expander is a balloon-like device made from elastic silicone rubber. To place the expander during a mastectomy, the general surgeon removes skin as well as breast tissue, leaving the chest tissues flat and tight. To create a breast-shaped space for the breast implant, a tissue expander is placed under the remaining chest tissues.
• The process: It is inserted unfilled, and over time sterile saline fluid is added by inserting a small needle through the skin and into the tissue expander’s filling port. As the tissue expander fills, the tissues over the expander begin to stretch gradually. The tissue expander creates a new breast-shaped pocket for a breast implant.
• A few facts:
  
  • Tissue expander placement is usually performed under general anesthesia in an operating room.
  • The procedure could require a brief hospital stay, or could be an outpatient procedure.
  • Typically, you can resume normal daily activities after two to three weeks.

 

 

Mentor Tissue Expanders

CONTOUR PROFILE® Tissue Expander

The CONTOUR PROFILE® Tissue Expander is used to expand the skin and create a shaped pocket for implantation. This product is designed to expand primarily in the lower portion of the breast, so the resulting pocket will accommodate the implant and slope like a mature breast. It also has an integral injection dome that allows your surgeon to add saline solution to the expander and gradually stretch the breast tissue over several months. Expansion is typically performed in an office procedure.

For some patients, the secondary surgery for the expander/breast implant exchange can be avoided by using an implant that is postoperatively adjustable, or is a combination type of expander and mammary implant. In a simple office procedure after your surgery, the fluid volume of postoperatively adjustable implants can be increased or reduced. This helps you to achieve the final breast size you desire.
Read Important Safety Information

Smooth and SILTEX® SPECTRUM® Expander/Breast Implants

The SPECTRUM® Implant functions as both a tissue expander and a long-term saline breast implant. It can be placed with minimal volume during your initial surgery, with the fluid volume gradually being increased over time, which expands the breast’s tissues. This implant contains a fill tube and remote injection dome that can be removed when the final volume is reached. They are then left in place as the long-term breast implant.

Placing the breast implant

After the tissue expander is removed, the breast implant is placed in the pocket that it has created. In reconstruction following a mastectomy, a breast implant is most often placed submuscularly. The surgery to replace the tissue expander with a breast implant (implant exchange) is usually done under general anesthesia in an operating room. It may require a brief hospital stay or can be done on an outpatient basis.

How much pain can I expect?

Because the chest skin is usually numb from the mastectomy surgery, you may not experience much pain from the placement of the tissue expander or from the needle that initially fills it with saline solution.

However, you may experience feelings of pressure, tightness and discomfort after each filling of the expander. These sensations usually stop after several days, once the tissue expands, but they may last for a week or more. The tissue expansion process typically lasts four to six months.

Reconstruction with Tissue Flap Procedures

Can breast reconstruction be done without implants?

Yes, in some patients, the breast may be reconstructed by surgically moving an area of skin, fat and muscle from one area of the body to another. The section of tissue can be taken from such areas as the abdomen, upper back, upper hip or buttocks. This may be required to provide enough tissue to match the size of the remaining breast – or to replace tissue removed or damaged at the time of a mastectomy or following radiation therapy.

• The tissue flap may be left attached to the blood supply and moved to the breast area through a tunnel under the skin (a pedicle flap).
• Or it may be removed completely and reattached to the breast area by microsurgical techniques to reconnect the tiny blood vessels from the flap to vessels on the chest area (a free flap). Operating time is generally longer with free flaps due to the microsurgical requirements.

 

Advantages

• Is able to replace tissue in the chest area, which may be useful when the chest tissues have been damaged and are not suitable for tissue expansion.
• Another advantage over implantation is that symmetry can be improved without altering the unaffected breast.

Disadvantages

• Flap surgery requires a hospital stay of several days and generally takes a longer recovery time than implant reconstruction.
• Flap surgery also creates scars at the site where the flap was taken and on the reconstructed breast.

 

 

The Most Common Types of Tissue Flaps

• The TRAM (transverse rectus abdominus musculocutaneous flap), which uses tissue from the abdomen
• In most patients, the TRAM flap can provide enough tissue to completely rebuild the breast mound.
• The latissimus dorsi flap, which uses tissue from the upper back.
• Breast implants are frequently needed to complete breast reconstruction for patients having latissimus flaps because there is rarely enough fatty tissue in the flap to completely rebuild the breast mound.

 

Who is a good candidate?

Flap surgery, particularly the TRAM flap procedure, is a major operation, and more extensive than a mastectomy. It requires good general health and strong emotional motivation.

Who isn't a good candidate for a tissue flap procedure?

Working with your doctor, your lifestyle and health factors will determine if this procedure is safe for you and your best option. If you are very overweight, smoke cigarettes, have had previous surgery at the flap site, or have any circulatory problems, you may not be a good candidate for a tissue flap procedure. In addition, if you are very thin, you may not have enough tissue in your abdomen or back to create a breast mound with this method.

The TRAM Flap

Step 1: Mastectomy is performed and the donor site is marked
Step 2: The flap of rectus muscle and tissue is tunnelled to the breast
Step 3: Final result

During the TRAM flap procedure, the surgeon removes a section of tissue from your abdomen and moves it to your chest to reconstruct the breast. The TRAM flap is sometimes referred to as a “tummy tuck” reconstruction because it may leave the stomach area flatter.

A Few Facts

• A pedicle TRAM flap procedure typically requires a three to six hour operation under general anesthesia
• A free TRAM flap procedure generally takes longer.
• The TRAM procedure may require a blood transfusion.
• The hospital stay is typically two to five days.
• You can resume normal daily activity after six to eight weeks.
• You may have temporary or permanent muscle weakness in the abdominal area. If you are considering pregnancy after your reconstruction, you should discuss it with your surgeon.
• You could have a large scar on your abdomen and may also have additional scars on your reconstructed breast.

 

The Latissimus Dorsi Flap With or Without Breast Implants Procedure

Step 1: A skin flap and muscle are taken from the donor site in the back.
Step 2: The tissue is tunnelled to the mastectomy and used to create a breast mound.
Step 3: An implant can also be used to create the breast mound.

During a latissimus dorsi flap procedure, the surgeon moves a section of tissue from your back to your chest to reconstruct the breast. Because the latissimus dorsi flap is usually thinner and smaller than the TRAM flap, this procedure may be more appropriate for reconstructing a smaller breast. This flap is frequently used when there is not enough skin available to use a soft tissue expander alone, or when there is too much tightness after the mastectomy or when radiation therapy has been used. Latissimus flaps may be combined with soft tissue expanders in a variation of the two-stage breast reconstruction technique.

A Few Facts

• It typically requires a two to four hour operation under general anaesthesia.
• The hospital stay is normally two to three days.
• You can normally resume daily activity after two to three weeks.
• You may have some temporary or permanent muscle weakness and difficulty with movement in your back and shoulder.
• You will have a scar on your back, which can usually be hidden in the bra line.
• You may also have additional scars on your reconstructed breast

 

The Buttocks Flap

The Buttocks Flap is a less common method of reconstruction that removes skin and tissue from the buttocks or thigh area and transfers it to the breast area. This method requires a micro operation to reattach blood vessels, which create a blood supply for the newly formed breast mound.

Reconstruction with Combination Implants &
Tissue Flap

There are several options where a breast implant can be used in conjunction with tissue flap procedures for better outcomes, especially if the transferred tissue does not provide enough mass or produce the desired results. Depending on the type of mastectomy, sometimes a breast implant can be placed without flap reconstruction or the use of a tissue expander. This is possible only in cases where adequate tissue is left intact and the implant to be placed is relatively small.

When Only One Breast is Involved

In cases where breast cancer only affects a single breast, women with ptosis, or sagging breasts, may choose to have a mastopexy (breast lift) of the opposite breast. This will help to achieve symmetry with the reconstructed breast.

Any breast reconstruction process will require multiple procedures.

Because each patient and procedure is different, the actual number of operations and recovery time will vary.

Nipple Reconstruction

Creating the nipple areola is the final component to completing your breast reconstruction.

There is no one absolute best method of nipple reconstruction for all patients and you should work with your surgeon to find the best option for you.

• Some patients are comfortable without having a nipple, and do not wish to have further surgery.
• Others choose the non-surgical option of tattooing without reconstruction. This allows color pigmentation to simulate the nipple areola without the contour of an actual nipple.
• While others consider the reconstruction of the nipple areola the finishing touch on the new breast after a long journey in reconstruction.

 

There are a number of considerations that help determine which method of nipple reconstruction is right for you.

These include the quality of tissue on the reconstructed breast, and whether you are having nipple reconstruction with or without a surrounding graft. Also important is your surgeon’s preference.

In modern approaches to nipple reconstruction, the nipple mound is created from skin taken as a local flap on the reconstructed breast.

Various local flaps have been described, including the Skate flap, the C-V flap and the Star flap. Regardless of which approach your surgeon chooses, the outcome will be a nipple mound. The areola can then be either tattooed, or it can be reconstructed with a skin graft taken from elsewhere on the body. Common donor sites for the graft include the abdominal scar from a flap reconstruction, the inner thigh, or the buttock crease.

All nipple reconstructions lose some projection over time as part of the normal wound healing process. The risk of wound complications in nipple reconstruction is very low in patients with no history of prior radiation, but common in the radiated breast. In the case of failed nipple reconstruction, it may be necessary to revise the reconstruction with another local skin flap. Sometimes, the use of dermis or fat grafts, and fillers such as Radiesse, may be necessary to improve nipple projection.

Nipple reconstruction is typically done as an outpatient, ambulatory procedure.

The rate of recovery depends on what other revisions are done simultaneously, and where the donor site for the areola graft is located. Once you have healed, if you choose to, you will have the tattooing done in your surgeon's office.

Is Reconstruction for you?

Know the benefits… and consider the risks.

There are other options for breast reconstruction that do not involve breast implants. Be sure to ask your surgeon for a detailed explanation of each alternative to help you decide which reconstruction option is most suitable for you and your lifestyle.

Breast reconstruction depends on your own individual case including factors like your medical condition, general health, lifestyle, emotional state as well as breast size and shape. You should consult your surgeon to discuss your personal goals for breast reconstruction. Consult your family, friends, breast implant support groups, and breast cancer support groups – people who have been through it – to help you make the right decision.

What are the alternatives to breast reconstruction?

Should you decide that breast reconstruction surgery isn’t for you, there are still options. You may or may not decide to wear an external breast form (prosthesis) inside your bra. Breast forms are available in a variety of shapes, sizes and materials, such as foam, cotton and silicone. Custom prostheses are also available to match the size and shape of your breast.

What are other personal considerations?

There are medical, financial and emotional considerations in choosing between immediate and delayed reconstruction. These should not be taken lightly. You should discuss thoroughly with your general surgeon, reconstructive surgeon and oncologist, the options available in your individual case.

Frequently Asked Questions about Breast Implants

• What exactly is a breast implant?
  A breast implant is a sac (implant shell) of silicone elastomer which is filled with either silicone gel or saline solution. Breast augmentation and reconstruction surgeons implant these shells under breast tissue or under the chest muscle to create a fuller looking and feeling bust line. Mentor’s silicone and saline implants come in a variety of shapes, sizes, profiles and surface textures to achieve the best results for any body type.
• Saline-filled breast implants
  Saline implants are elastomer shells filled with saline (a saltwater solution) that is very similar to the fluid that makes up most of the human body. Saline implants are inserted into the body without fluid and then filled with the saline fluid through a fill-tube during the surgery to adjust and achieve optimal volume. MENTOR® Saline-Filled Breast Implants also allow for adjustments after surgery.
• MENTOR® MemoryGel® Breast Implants
  MENTOR® MemoryGel® Breast Implants contain the current generation of silicone. They are pre-filled with Mentor’s proprietary cohesive silicone gel, which is neither a liquid nor a semi-liquid, that holds safely and uniformly together to deliver that “natural feel” that more closely resembles breast tissue.
• What is the average life expectancy of a breast implant?
  It’s important to know that breast implants don’t last a lifetime. While it varies from woman to woman, it is likely they may need to be replaced at some time. Replacement is usually prompted by choice, such as a size change or an implant style change. Some women have breast replacement because of a complication, such as deflation or rupture.
• What is silicone?
  Silicone is derived from silicon, a semi-metallic or metal-like element that in nature combines with oxygen to form silicon dioxide, or silica. Beach sand, crystals and quartz are silica. Silica is the most common substance on earth. Heating silica with carbon at a high temperature can produce silicon. Further processing can convert the silicon into a long chemical chain, or polymer, called silicone, which can be a liquid, a gel or a rubbery substance. Various silicones are used in lubricants and oils, as well as in silicone elastomers. Silicone can be found in many common household items, such as chewing gum, nail polishes, suntan and hand lotions, antiperspirants, bath soaps and processed foods.
• Are silicone implants safe?
  In November of 2006, the FDA determined that MemoryGel® Silicone Breast Implants for breast augmentation and reconstruction were safe and effective. This decision was primarily supported by the PMA Core clinical study. After nearly two decades of research and testing with surgeons and patients all over the world, and The Mentor Adjunct Study Report results, MemoryGel® Breast Implants became available to women in the U.S. Mentor currently has eight silicone gel breast implant clinical studies in progress. Over 200,000 women have participated in Mentor’s studies in order to provide a significant body of clinical evidence which results have demonstratied the safety and effectiveness of silicone-filled breast implants. As we have to date, Mentor remains committed to providing objective, clinical information about breast implant safety.
• Good news from the scientific community
  The Institute of Medicine in a highly respected study concluded that, "There is no evidence that silicone implants are responsible for any major diseases of the whole body. Women are exposed to silicone constantly in their daily lives."
  For more information regarding the safety of silicone, please refer to the Institute of Medicine Report (IOM) at: www.nap.edu.
• Is it possible to have an allergic reaction to silicone?
  Silicone allergies are quite rare but possible – just as it’s possible to be allergic to anything science or mother-nature created. The truth is, we are all exposed to silicone in our environment every day. It is found in many household items, such as chewing gum, nail polishes, suntan and hand lotions, antiperspirants, bath soaps and processed foods.
• Do MENTOR® breast implants include latex?
  No. Because latex allergies are so common, Mentor never uses latex in any of the breast implants we manufacture.
• Is there active platinum in breast implants?
  The manufacture of silicone breast implant shells and gel fill does include using platinum as a catalyst. Because small amounts of platinum remain in the product following its manufacture, concerns have been raised that platinum may enter the body and cause adverse effects—either by diffusing through the intact shell, or through an implant rupture. *source: www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/UCM064040
• How do breast implants affect mammography?
  Breast implants can add some difficulty to routine screenings for breast cancer. The implant may interfere with finding breast cancer during mammography and generally requires additional X-rays – and unfortunately, more exposure to radiation. That being said, if you are of the proper age for mammography screening, you should absolutely continue to undergo routine mammography screenings as recommended by your primary care physician. When you do, be sure to inform the mammography technologist that you have implants.
• Do implants increase the occurrence of breast cancer?
  According to medical literature reports, no. Patients with breast implants have not been found to be at a greater risk of developing breast cancer than those without breast implants.
• What affect does smoking have on the healing process following surgery?
  Smoking can compromise recovery by causing the blood vessels to constrict, reducing blood flow, and the oxygen it carries, to the surgical area. Your tissues need this blood and oxygen supply to heal properly. When your blood supply is reduced, tissues heal more slowly and irregularly. That’s why doctors ask patients to refrain from smoking for one to five weeks prior to and after surgery. It is important that you ask your doctor what his or her specific recommendation for you would be.
• Can I go to tanning salons, infrared saunas or sunbathe if I have breast implants?
  There are no serious dangers for women with breast implants who visit tanning salons, infrared saunas or sunbathe. These activities will not hurt the breast implants in any way, but they may make scarring more prominent.
• When can I fly and/or scuba dive?
  Once fully recovered, you can feel free to scuba dive and fly in airplanes with some minor considerations since there may be slight expansion and contraction of the shell with changes in pressure. With saline-filled implants, this may result in a minimal amount of air bubbles in the implant, and you may feel or hear fluid sounds (gurgling). This should correct itself within 24 to 48 hours.
• How much do breast implants weigh?
  You can use this formula to estimate the weight of your MENTOR® MemoryGel® Breast Implants and Saline-Filled Breast Implants: 1 ounce = 30 cc’s. Example: A 300 cc implant = 10 ounces.

• Will health insurance cover my breast reconstruction surgery?

  Yes, most insurance carriers cover reconstruction.
  In general, private insurance that covers medically necessary mastectomies will also cover breast reconstructive surgery. Insurance coverage for re-operation procedures or additional surgeon visits following reconstruction may not be covered, depending on the policy. For example, a re-operation may include temporary removal of the implant to facilitate the oncologist’s ongoing surveillance for breast cancer recurrence.

  Because coverage policies vary and can change over time, we can’t offer guidance with respect to coverage under any particular health plan. We recommend that you contact your health plan provider to obtain specific information regarding its coverage policies before deciding to proceed with reconstructive surgery.

  Note: When you talk to your health insurance carrier, we suggest keeping records of your conversations and all written communications. They may help with future concerns or coverage discrepancies.

• Preferred Use of the Ipsilateral Pedicled TRAM Flap for Immediate Breast Reconstruction: An Illustrated Approach
  Aesthetic Plastic Surgery, 07/18/2011

  Tan BK et al. – The ipsilateral TRAM flap was a reliable flap with low complication rates and short surgery time. It was authors' preferred choice for pedicled breast reconstruction in all cases, except for the ptotic breast or if abdominal scarring excludes its use.

  Methods

  • A prospective evaluation of 89 patients who underwent immediate breast reconstruction following skin-sparing mastectomy for breast cancer was performed.
  • All patients underwent ipsilateral TRAM reconstruction.
  • The innate insetting advantage of the ipsilateral TRAM flap is illustrated in the article.
  • The key steps of the technique were as follows:
    • The ipsilateral corner of the flap was used as the axillary tail, leaving the more bulky part to form the main body of the breast.
    • The ipsilateral corner of the flap was used as the axillary tail, leaving the more bulky part to form the main body of the breast.
    • This flap was subsequently tunneled into the breast pocket while preserving the inframammary fold.
    • The opposite maneuvers were done for the left side.
    • If the flap was congested, venous augmentation was performed where the tributary of the axillary vein or the thoracodorsal vein was anastomosed with the inferior epigastric vein from the flap with an interposed vein graft (17% of cases).

   

  Results

  • All flaps survived and flap-related complications included partial necrosis of tissue across the midline (2.2%), palpable fat necrosis (22%), and hematoma requiring drainage (2.2%).
  • All flaps were raised concurrent with the resection, and the combined operative time ranged from 3.5 to 6 h, with a mean hospital stay of 7 days.

  Ps Note in Dr. Weinstein's hands hospital stays are closer to 5 days. It is rare to need additional blood vessel input to the flap.