Sebastian Winocour, MD, a plastic surgeon at Baylor College of Medicine in Houston, Texas and Baylor St. Luke’s Medical Center, talks about alternative breast reconstruction plans for those facing partial or total mastectomies.
After somebody is diagnosed with breast cancer and they’re going to treat, they have a lot of things that they need to consider in terms of injuries and reconstruction. So, tell me a little bit about that.
Dr. Winocour: So, it’s obviously a very challenging situation when someone is diagnosed with breast cancer and there’s a lot of emotions that go through people’s minds at that time and the priority is always to address the cancer first. When surgery is necessary, it usually entails performing either a partial or total mastectomy depending on the situation. We offer, as plastic surgeons, a variety of different reconstruction techniques to try to restore the natural breast of a woman. When a woman is faced with those options, they often meet with members of a multidisciplinary team, which consists of medical oncologists, radiation oncologists, surgical oncologists, and a plastic surgeon to discuss the different options for their treatment. When they’ve decided on their treatment and if that treatment is a total mastectomy, there are a couple of different types of reconstruction options that a plastic surgeon typically offers them. I would meet with the patient and discuss really two major categories and types of reconstruction, either implant-based reconstructions or reconstruction that uses a patient’s own tissue. Each has its pros and cons, and we discuss what those are. I provide the patient with the necessary information so that they can collectively come to a decision of what option is best for them. Implant-based reconstructions typically are shorter surgical procedures that are able to restore the natural shape of a breast. Short-term, however, they often require some sort of revision surgery further down the road, typically 10 to 15 years later. In an autologous reconstruction or using a patient’s own tissue, we typically use the abdomen to provide that tissue, we use the skin and the fat in that unnecessary part of the abdomen. Patients typically want, if they have that tissue, to get rid of that tissue and it’s a perfect opportunity to use that tissue to restore the breast that has been removed for the cancer treatment. The patients get the added benefit of getting a similar procedure to a tummy tuck, where they remove the lower part of the abdominal tissue and give a better contour to the belly, but we also transfer that tissue to restore the breast. That typically gives a much more natural shape and feel to the breast and has a better longevity to the reconstruction compared to an implant-based construction, patients typically don’t need any revision surgery after the initial period of reconstruction for a further lifetime. Studies have shown that patients are generally more satisfied long-term with this type of reconstruction and it’s a type of reconstruction that I specialize in doing. I find that my patients are extremely satisfied with the reconstruction.
Who qualifies for this type of procedure?
Dr. Winocour: In general, we want patients, because this procedure typically takes longer, we want our patients to have no other significant medical problems. We’re looking for patients that have already had children, or who have no further plans to have children, and who have unwanted belly tissue that we can use to achieve and restore the breast that would be removed during the cancer surgery.
You said that the surgery is a little longer, so can you give an idea of the timeline and the recovery?
Dr. Winocour: The length of the surgery really depends on if the patient’s having a unilateral or a bilateral mastectomy depending on the particular circumstances for the patient. A unilateral reconstruction, we take half of the belly reconstruction and discard the other half in order to achieve the tummy tuck result. On a bilateral reconstruction, we use both sides of the belly to create two breasts. Obviously, a bilateral reconstruction takes longer. We typically say that a unilateral reconstruction takes between six and eight hours and a bilateral reconstruction takes about eight to ten hours to perform.
What about recovery?
Dr. Winocour: So, patients typically spend anywhere between three and five days in the hospital. The length of time spent in the hospital really depends on if this was a unilateral or bilateral reconstruction and how fast the patient is able to recover following the surgery. After that period of time, recoveries are typically about a month. Patients initially will walk a little bit hunched over because of the extra tissue that was removed from the belly, but over a couple of weeks, they will gradually be able to stand up fully. They’ll be sore particularly from the abdominal part of the surgery, but the soreness and the pain typically improve over the first week or two. Usually, at about four to six weeks at the latest, patients are able to return to all of their baseline functions, which is pretty incredible. They have a better contour to their abdomen and obviously a restored one or two breasts.
What about scarring? I feel like that’s something patients might, may ask you a lot about.
Dr. Winocour: For sure. Everyone scars a little bit differently. We close our incisions very meticulously as plastic surgeons using all buried stitches that don’t need to come out typically. Nevertheless, some people do have unfavorable scarring and what we offer patients is usually, once they’ve recovered from the initial surgery, a touch-up surgery usually around three months after. Here we can do a nip and tuck, we can revise scars, improve scar locations, remove excess tissue either through direct excision or liposuction, we can even harvest fat from liposuction and use that fat to improve contour in areas of the breast that may be deficient. So, there are lots of opportunities to improve that. That surgery is typically a day surgery and they go home the same day. The recovery for that surgery is usually a week or two at the most and so that’s an opportunity for us to improve the scars if patients do suffer from unfavorable scarring and to improve the overall cosmetic result of the reconstruction.
Is there anything that patients ask you about this procedure that we haven’t covered?
Dr. Winocour: Whether or not this surgery is performed at the same time as the mastectomy or in a delayed reconstruction, it really depends on the particular disease pathology that the patient has. Ideally, most patients, if they have the opportunity to have this as an immediate reconstruction, choose that as it’s a single surgery to have everything done. And overall the studies have shown that we achieve a better cosmetic result if we can replace the breast at the time of the mastectomy. Nevertheless, some patients have initially chosen not to undergo reconstruction, but they’re still candidates for this type of surgery. In other situations, we have patients that have chosen an implant-based breast reconstruction, and they present to us either unhappy with their implants, or desiring a different type of reconstruction, or may have had issues with the implants that need to be corrected and one way to correct that is by using their own tissue from their belly.
Are there any other reasons as to why this is a longer surgery?
Dr. Winocour: The reason why the surgery takes anywhere between six and ten hours is that when we harvest the tissue, we need to preserve the blood supply to that tissue so that it stays alive. We take a small artery in a small vein from that tissue and we hook it up to a small artery in a small vein in the next – in the breast where we’re working to put the tissue. That procedure is very meticulous. It’s done under the microscope and these blood vessels are only a few millimeters in diameter. It’s a very specialized procedure and it requires attention to detail that typically only plastic surgeons or microsurgeons are comfortable doing. And that’s one of the reasons why it takes that period of time to do it.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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Dipali Pathak, Public Relations
Baylor College of Medicine
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