I recently gave a talk to health care professionals on the latest innovations in reconstructive and cosmetic surgery. The one topic that generated the most interest was breast reconstruction after mastectomy and the advances that have been made in the past several years or so. The reconstruction options are and continue to be dictated by the type of mastectomy that is performed by the cancer surgeon. However, new advances in technology have made way for the new skin sparing mastectomy and immediate breast reconstruction.
Over the past few years, the types of mastectomy procedures have become much less aggressive. We have gone from the Radical Mastectomy to the Modified Radical Mastectomy to Simple Mastectomy, and over the past ten years to the lumpectomy procedure, followed by radiation of the breast. It is important to note that the cure rate from the most radical procedures is no greater that the less aggressive mastectomy procedures. However, these more radical procedures were accompanied by several problems: more-invasive surgery with a sacrifice of breast skin, longer hospital stays, longer recovery and a less that desired cosmetic outcome.
There is now a focused movement toward a less invasive skin sparing mastectomy as cancer surgeons and reconstructive surgeons have come to realize that skin involvement in breast cancer is extremely rare. By leaving the skin envelope, the reconstructive surgeon can now create the removed breast mound at the same sitting and the non-involved skin envelope is then redraped over the mound to complete the reconstruction. In the past, the reconstructive process could take up to 3 to 4 months and could require up to 2 or 3 operations. This new combination of the mastectomy and immediate reconstruction method is an extremely significant improvement – mostly because it is a single-staged procedure where the mastectomy and reconstruction are done at once. Additional reasons the new method is an extremely significant improvement are:
- It is an overnight stay only in the hospital
- The recovery is significantly reduced
- The cure rate is essentially not affected
- The final result produces an improved cosmetic result.
We should all be grateful to live in a society that is always trying to improve our health care options. This is highlighted by a recent study in Canada that has found that immediate breast reconstruction use is not widely available and is relatively underused compared with the United States. I, for one, hope that these unfortunate trends in government delivered health care, as noted in Canada, will not affect the quality of the greatest health system on the planet that we currently have in the United States.
Joseph W. Rucker M.D. F.A.C.S