Posts Tagged mastectomy
Reader Laura’s Comment:
“The woman in this story was doing Pilates and her breast implant slipped between her ribs. The woman was a breast cancer survivor and had reconstruction surgery with implants after a double mastectomy. What role do you think this played in this happening and how likely will it be to happen again? What could be done to keep this from happening again?”
A cancer survivor has had to have further surgery after her body ‘swallowed’ her breast implant during a Pilates exercise. The 59-year-old from Baltimore, Maryland, had been performing the ‘Valsalva’ manoeuvre when she felt the implant disappear into her body. She was taken to the Johns Hopkins hospital in the city where surgeons found the implant and reinstated it.
I have heard of something like this happening but have never seen such a case. It makes sense that it happened to a breast reconstruction patient. In these cases the tissues are often thin as some of the tissue has been removed with the breast cancer surgery (mastectomy.) The remaining tissue in an implant reconstruction is stretched usually with a tissue expander before a permanent implant is placed.
This amounts to a thin covering of patient tissue housing a breast implant at least on the side of the cancer surgery. A recurrence of this woman’s problem is possible, but might be made less likely by adding some tissue whether it be tissue from the patient (autologous reconstruction) or grafting with an available skin substitute to the thin side. Smaller implants are another option.
John Di Saia MD
Despite the benefits of immediate post-mastectomy breast reconstruction, only a small minority of women, regardless of age, choose this option, a new study indicates. Research has shown that compared with a delayed procedure, immediate post-mastectomy reconstruction improves psychological well-being and quality of life. The new study, headed by Dawn Hershman, M.D., associate professor of medicine and epidemiology at Columbia University Medical Center, indicates that only about one-third of women opt for the procedure, according to the American Association for Cancer Research.
Immediate breast reconstruction does lead to better results in patients with early stage breast cancer. That is a pretty much well known fact. This statistic of less than a third of women seeking this type of reconstruction in this light seems kinda sad, but keep reading:
The study notes that although overall rates of reconstruction have increased since 2000, the greatest increases were seen among women with commercial insurance (from 25.3 to 54.6 percent) and women under age 50 (from 29 to 60 percent). Among women younger than 50 who had commercial insurance, 67.5 percent underwent immediate breast reconstruction. Overall, women with commercial insurance were more than three times as likely to opt for immediate reconstruction compared with women without health insurance.
Well of course women with health insurance are going to be more likely to have breast reconstruction than those without particularly in a recession. Breast reconstruction is expensive and nobody does it for free. The good news is that amongst those who have insurance coverage breast reconstruction (whether immediate of delayed) is on the rise.
Level-headed analysis kinda takes the wind out of the big headline doesn’t it. When reading media takes on study results, it helps to read the studies themselves. Some media outlets are better than others of course.
John Di Saia MD
Giuliana Rancic has revealed she will undergo a double mastectomy, after being diagnosed with breast cancer in October. America’s popular morning show updated its Twitter feed today, saying: ‘”I’m going to go ahead and move forward with a double mastectomy.” -@GiulianaRancic’. In October, the 36-year-old initially underwent a double lumpectomy to removed cancerous growths in both breasts as well as her lymph nodes – but now she is taking extra measures after doctors failed to ‘get all the cancer out’.
Thin women do not always do well with lumpectomy. A traditional lumpectomy takes about a quarter of the breast tissue away. In smaller breasted women, a mastectomy although it represents larger scale surgery may be less deforming and usually clears the field for reconstruction.
The piece is a bit funky as it seems to blame the surgeon for not “getting all of the cancer” with the original lumpectomy surgery. Lumpectomy takes tissue out. Sometimes lumpectomy is targeted by mammograms. This is not an exact science as the cancer is not always obvious by feel. If the tissue removed does not clearly include the whole cancer, then something additional should be done. Some women choose irradiation (which makes later reconstruction very difficult) and others have a more complete operation in hopes of removing the whole tumor. This circumstance plagues even the best surgeons at times.
Breast reconstruction in thin women (should she choose this) can be difficult although small implants can occasionally be placed early with good results. I will add my hopes that Mrs Rancic has a positive outcome from her additional surgery.
John Di Saia MD
After mastectomy breast reconstruction can be challenging. Then again the alternative is here for you to see. This woman has a mastectomy defect of her right breast and her left breast had had a cosmetic implant years prior. She elected to not reconstruct her mastectomy-treated breast and was considering surgery on the other side to make it smaller. There is no one treatment for a patient after a mastectomy. It is a matter of that patient’s philosophy. Mastectomy without reconstruction doesn’t look all that appealing.
When some think to complain about plastic surgery complications after breast reconstruction, consider this alternative.
John Di Saia MD
Originally posted 2011-01-06 07:30:02.
Dear Dr. I had a double mastectomy in mid December. I had tissue expanders and alloderm put in right away. My problem is I am not healing. I had surgery six weeks later to try to close the wounds again but here I am with open wounds again. You can see the alloderm. It is very painful also. I am so afraid because it has been so long. I see a regular surgeon and a plastic surgeon. Do you have any thoughts that might help! Please I am so afraid. Thank you so much.
After mastectomy breast reconstruction can be challenging. It is usually performed in multiple operations or Stages. In these cases the overall goals of surgery are to remove all the cancer but still leave enough tissue to allow for a good reconstruction. When tissue expanders are chosen for that reconstruction, the condition of the remaining tissue after the mastectomy is crucial to the success of the operation.
Your images (which I placed on the following page for those who may not want to look) show that soon after the mastectomy and tissue expander placement surgery skin necrosis appeared. When this develops it is concerning as it indicates that the wound may have the blood flow needed to heal. You show this problem on both sides.
At six weeks following your first operation, the skin necrosis started separating from the other tissues and the wound seemed to open on at least one side. Your surgeon at that point decided to go back to the operating room to try to remove this non healing tissue and salvage the reconstruction. In cases like these my concern is whether or not these wounds even if they are able to heal can do so without excessive scarring and hardening. Depending upon how things looked on examination, I would consider removing your expanders to allow the wounds to heal and the tissues to soften to allow reconstruction at a later date. This is a clinical judgment that your surgeon needs to make. He or she may have discussed something like this with you already.
Although I have not been involved in your care I am sorry you have had such difficulties and hope that things can be improved later down the line.
John Di Saia MD