Breast Reconstruction
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Somebody is not getting the word.
The struggle to require all insurance policies to cover breast reconstruction with breast plastic surgery after mastectomy was a big deal and literally required an act of Congress a little over a decade ago.
So you could call it the law of the land.
But Alicia Holt MD, a surgical fellow at the Hope Medical Center in Duarte, California, started counting heads of how many breast cancer patients in California choose breast reconstruction after their breast surgery to remove them via mastectomy.
Dr. Holt studied reconstruction rates after breast cancer surgery in California from 2003 to 2007. She saw a slight improvement, with 21.4 percent of women choosing reconstruction in ’07 while ’08 saw 29.3 percent of breast cancer patients going back under the knife for breast augmentation.
Reporting on her study at the annual meeting of the American Society of Breast Surgeons (ASBS) in Las Vegas, Dr. Holt found some limiting factors that influence a woman’s decision including:
- Insurance type
- Ethnicity
- Hospital type
Not surprisingly, Dr. Holt found women under 40 had the highest rates of breast reconstruction.
However, African-Americans were half as likely as Anglo background women to opt for breast rebuilding right away.
Patients with private insurance go in for plastic surgery breast reconstruction before women with Medi-Cal, the California health insurance program for low-income women.
Finally, patients at teaching or National Cancer Institute-qualified facilities were more likely to have breast surgery reconstruction.
According to Dr. Holt, breast cancer patients were just not getting the word that reconstruction is a right afforded them by national legislation.
One participant in the study, a breast cancer surgeon, says she requires her patients to see a plastic surgeon, even if they have decided to forego breast reconstruction.
But Deanna Attai, MD, director of Burbank’s Center for Breast Care said another difficulty could be getting trained plastic surgeons – who normally work on a cash upfront basis – to do the procedure and accept insurance payments.
Concluded the doctors: “We need to get more information out, not only to patients but to the providers of plastic surgery.
Amen to THAT!
May 19, 2010
Techniques
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Plastic surgeon professor-researchers have found another source for creating breasts – they are using those pesky love handles found on the flanks.
Until now, women who wanted breast augmentation or breast reconstruction after cancer had the choices of:
- Saline and silicone implants
- Flaps of fat and skin from the tummy or the sides
Some surgeons, reconstructing breasts for cancer patients have also taken large flaps of skin and fat from the patient’s buttocks to use as breasts.
But that causes a scooped out, flat appearance on the haunches and, usually, the need for yet another plastic surgery to create more rounded buttocks.
During one surgery, Ariel Rad, M.D., an assistant professor of plastic surgery at Johns Hopkins University School of Medicine noticed during one operation a blood vessel that would make the surgery to transplant love handles to breasts and recovery easier.
Any time plastic surgeons transplant fat, they must place it close to an existing blood supply — or else create a new blood supply. Without blood, the transplanted fat will die. Because dead fat tends to calcify, mammograms readings are blocked and may hide evidence of returning cancer in the future.
Professor Rad and his colleagues then decided to find out if everybody had that particular blood vessel. So they studied corpses and performed CT scans on living patients and found it present in 60 percent of patients.
The next step was using the method on 12 slim, athletic women who had lost their breasts to cancer. The surgeons were also thrilled to find the critical blood vessel needed to connect the blood supply in the mammary area was twice as long as the one used in buttocks grafts.
The new surgery was performed on the dozen patients from February, 2008 to one year later. All had good cosmetic results, according to Dr. Rad
The operation is performed with a microscope to connect blood vessels and provides a bonus in addition to reconstructed breasts, including:
- An improved contour of the waist
- An improved contour of the hips
(Read more about the love handle breast augmentation procedure in ScienceBlog.com)
April 22, 2010
Weird and Wacky News
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Plastic surgeons always encourage patients to ask lots of questions about the procedure they want. That way, everybody is on the same page about the expected results.
A recent survey revealed that some patients have very active imaginations and can come up with some, well, very unusual questions.
Here are the top 5 off-the-wall questions that patients have asked:
1.) If I ski or camp in the snow, can breast implants freeze?
In a word, no. That is, unless the rest of your freezes, too!
Breast implants are in a very warm, comfy environment. Even if your whole body, your silicone implants – being oil based – would not freeze. Your saline implants – being largely salt water – would only freeze if you succumbed while sleeping outside in below zero weather.
2.) If my husband gets, ah….excited during, ah, intimate moments and squeezes my breasts hard, can the implants break or take a different shape?
Again, no way, unless your hubby’s name is Superman. Provided the implant has been put in under the pectoral, or chest, muscle, your main man feels your natural breast tissue.
3.) I only see women in your office, doctor. Has a man ever had breast implants?
A professional gambler once took a $100,000 bet that he could not survive one year with size 38C breast implants in his chest. He took the bet, collected the 100K and then wrote a book, The Man with the $100,000 Breasts. The gambler/author said women were fascinated.
4.) Can a guy tell if I’ve had breast enhancement? Will he care?
He will be able to tell if:
- Each nipple points to the closest armpit
- Ripples show through the skin
- The breasts are two different sizes
- You have no cleavage
- Scar tissue forms around the implants, making the breasts hard
According to a woman’s magazine survey, 83 percent of guys don’t like breast enhancements.
5.) How can guys tell if I’ve had breast enlargement?
When a breast implant patient moves around or reaches up, her breasts keep the same shape. Natural, unaugmented breasts will flatten when you put the arms over your head or fall forward when you lean over. Not-so-good implants look round and hard like a grapefruit halves. Undoctored breasts hang, more like water balloons.
March 16, 2010
Weird and Wacky News
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In manufacturing, there is the Law of Unintended Uses.
That means people find uses for products the manufacturers completely missed. Any New Yorker knows right how valuable kitty litter is for getting a grip on icy sidewalks.
The latest law of unintended uses? Breast implants as body armor.
Back in 2006, Israel was undergoing rocket attacks. Emergency surgeons at Nahariya Hospital reported they found shrapnel from an exploded rocked imbedded in the silicone breast implants of a 24-year-old. “The fragments were just inches from her heart so the implants saved her life,” said a spokesman. (Read a blog about shrapnel-catching breast implants.)
Our take: silicone is very thick, most shrapnel fragments are jagged but flat and don’t penetrate the body very deeply. Mostly likely true.
Another instance happened in Bulgaria, also in 2006, when a woman had a head on collision with another car. A policeman reported her double D implants absorbed most of the impact, protecting the driver’s ribs and vital organs.
Our take: Probably true. (We sure wish a doctor had backed up the police report.) Read the breast implants as airbags story.
The most current implant-as-body-armor instance happened when an L.A. woman was shot point blank by a crazed gunman who attacked a dental office where his wife was working. Another victim was shot in the arm and then played dead. But the gunman allegedly aimed directly at her heart and fired. A cosmetic surgeon later reported the implants saved the woman’s life.
Our take: it probably did not happen like that. Most assault rifles fire a high velocity bullet that, at close range, would zip through any implant, through the victim and then into and through yet another person.
What probably happened: The hospital spokesman where the victim was treated reported spotting bullet fragments only millimeters from her heart in a CT scan. So she was probably hit by a ricochet bullet that had lost most of its energy. Or the bullet struck the victim’s necklace and broke up. (Read the size D Implants article.)
Nonetheless, she should consider herself very, very lucky.
Adding to her luck was a kindly Beverly Hills cosmetic surgeon who offered to do for no, or low, fees a reconstructive surgery when the victim healed.
Morale? Nobody should ever get saline implants or silicone implants with the idea of acquiring an internal bulletproof vest!
March 3, 2010
Removal
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One of the latest personalities to have her breast implants removed is Australian hurdles champ, Jana Rawlinson, who decided her implants would hold her back from 2012 Olympic gold.
Jana, a former two-time world champ in the 2003 and 2007 400 meter hurdles, only had the implants for 14 months before, in her own words, “I’m back to being as flat as a pancake.”
Dancers are another group of athletes that feel large breasts only get in their way.
Other celebrities have opted to go through explant surgery, the procedure to remove or replace breast implants.
For instance, former Spice girl, Victoria Beckham, had her large implants downsized during the summer of 2009. Victoria has a tiny frame and her implants just did not compliment her body.
O.C. Real Housewife Tamara Barney found she was having back pains due to her large implants so she had them replaced with a smaller set which also proved to be a pain in the back. At one point, Tamara was thinking she would lose the implants altogether.
New York City Real Housewife Jill Zarin reduced her implants from a 32 G to a 32D.
Some women having explant surgery, the procedure to remove implants, opt to have a breast lift (or mastopexy) at the same time.
According to the American Society of Plastic Surgeons (ASPS), the average cost of implant removal in the U.S. is $2435. With 20,967 breast augmentation patients having explant surgery in 2008, about $51,044,485 was spent.
(2008 is the most recent year for which statistics have been compiled. 2009 statistics will be released in March, 2010.)
The three most common reasons for breast implant removal include:
- A change in size or shape
- Implant leak
- Capsular contracture, a type of internal scarring that hardens the implant and breast
Other famous women who had their breast implants removed or had a considerable reduction in implant size include:
- Britney Spears
- Demi Moore
- Jenny McCartney
- Courtney Love
- Jenna Jameson
- MTV’s Kacey Long
- Denise Richards
(Read our previous post about how Denise Richards first got uncomfortably large breast implants, and then received even larger implants – due to bad communication with the plastic surgeon — before going just right for her size.)
February 5, 2010
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