Bioengineered Breast: Hybrid Breast Reconstruction

 
 
 
 
 
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𝘋𝘦𝘷𝘦𝘭𝘰𝘱𝘪𝘯𝘨 𝘢 𝘩𝘺𝘣𝘳𝘪𝘥 𝘤𝘰𝘯𝘤𝘦𝘱𝘵 𝘪𝘯 𝘪𝘮𝘮𝘦𝘥𝘪𝘢𝘵𝘦 𝘴𝘵𝘢𝘨𝘦 𝘣𝘳𝘦𝘢𝘴𝘵 𝘳𝘦𝘤𝘰𝘯𝘴𝘵𝘳𝘶𝘤𝘵𝘪𝘰𝘯. ⁣⁣⁣

I was first introduced to the concept of “bioengineered breast” in 2009 by Dr. Pat Maxwell and colleagues. He originally coined this term to describe an enhanced breast form consisting of a combination of cohesive gel breast implant, regenerative scaffold, and regenerative cells. ⁣⁣⁣

The implant and the soft tissue covering it can both be enhanced to achieve the optimal female breast form.

Enhancing the soft-tissue cover not only supplements volume and shape but also further alters how the recipient’s host tissue responds to the foreign body implant. ⁣⁣⁣

This powerful combination of constructs better allows us to achieve the ultimate goal of breast reconstruction: to recreate a breast that appears and feels like the natural breast. ⁣⁣⁣

This patient had large breasts and underwent bilateral skin-sparing mastectomies. She opted for one-stage reconstruction to minimize downtime. This was achieved using a hybrid concept after the mastectomy flap perfusion was evaluated. ⁣⁣⁣

I was able to pair an anterior acellular dermal matrix sheet with a posterior stable Galaflex base to provide the patient with both softness and stability. ⁣⁣⁣

She plans on having fat grafting during her nipple-areolar reconstruction to further augment her soft tissue envelope and soften her breast borders.⁣⁣⁣
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Breast Augmentation and Cancer: Is There a Link?

Breast implants do not cause or increase the risk of breast cancer, but they have been linked with Anaplastic Large-Cell Lymphoma (ALCL), a rare cancer of the immune system. According to the Food and Drug Administration (FDA), the use of breast implants with textured surfaces and polyurethane outer shells has a very low but increased risk of ALCL. The cancer is also called Breast Implant-Associated Anaplastic Large-Cell Lymphoma (BIA-ALCL) because of its link with certain breast implants.

What is BIA-ALCL?

Breast Implant-Associated Lymphoma is not breast cancer. It is a type of non-Hodgkin’s lymphoma, a cancer of the immune system. Most cases of the cancer occur around the scar tissue and fluid near the breast implant. However, in some cases, it can spread throughout the body. Though the risk of developing BIA-ALCL is very low, the cancer is serious and can lead to death, particularly if not treated early.

How is BIA-ALCL associated with breast implants?

While the link between breast implants and Anaplastic Large-Cell Lymphoma is still unclear, it is believed that the growth of bacteria on the surfaces of breast implants can, eventually, result in increased stimulation of lymphocytes. The stimulated lymphocytes may then trigger an immune response that leads to BIA-ALCL.

Since only 1 in 50,000 women with breast implants develop the disease, the chance of BIA-ALCL being triggered by implants is considered very low. Also, the risk does not increase with either silicone or saline-filled implants.

Because the immune response that causes BIA-ALCL depends on the growth and proliferation of bacteria, the risk of cancer is related to the surface area of the implant. Textured implants and expanders have a higher surface area compared to smooth implants, resulting in a higher risk of BIA-ALCL compared to smooth surface implants. In fact, up to 96% of cases of the cancer are reported in patients with breast implants with textured (bumpy) surfaces and polyurethane outer shells.

What are the warning signs?

When BIA-ALCL occurs, it tends to arise more than one year after breast augmentation surgery. Patients develop chronic swelling, a mass (lump), pain, or fluid buildup around the implant. The breast may harden, have new scar tissue, or may be painful around the vicinity of the implant. Plus, there may be hair loss, skin rash near the breast, and exhaustion (a sign of a weakened immune system).

Is BIA-ALCL curable?

ALCL is curable, particularly when discovered early. To diagnose ALCL, the doctor will perform a needle biopsy and an imaging test (mammogram or ultrasound). Early treatment typically involves the removal of the implant and the surrounding scar tissue. But, in some cases, chemotherapy and radiotherapy may be necessary.

What should you do?

If you are considering breast augmentation, reconstruction, or replacement (revision) with breast implants, you should discuss your goals and expectations with your plastic surgeon. Your surgeon will also explain the benefits and risks of having breast implants, the need to monitor implants for complications, and their eventual replacement or removal.

If you already have breast implants, concerns related to BIA-ALCL should not mean you remove them. If there are no symptoms, no need to worry. Instead, you should speak with your plastic surgeon about the risk of developing the cancer. But if you do have symptoms, talk to your doctor about further evaluation, confirmation, and treatment of the cancer.

At Politis Plastic Surgery, we do not use breast implants and tissue expanders that the FDA has listed as a potential cause of BIA-ALCL. During the consultation, we inform our patients about the risks associated with breast implants, including BIA-ALCL. When treating patients with suspected BIA-ALCL, we develop individualized treatment plans in coordination with experts in the diagnosis and treatment of the cancer.

Do you have questions or concerns about the use of breast implants in breast augmentation or reconstruction? Dr. Effie Politis will answer your specific questions and help you make an informed decision about cosmetic surgery. For more information on breast implants and associated risks and complications, visit the Politis Plastic Surgery website.

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Breast Augmentation Risks and Complications

Breast augmentation is a surgical procedure to make breasts appear larger and fuller. Performed using either special implants or by fat transfer from a different area of the body, the procedure helps to restore breast fullness after pregnancy or weight loss, correct asymmetrical breasts, or enlarge smaller breasts. It is also valuable as reconstructive surgery after a mastectomy or other breast surgery.

A safe, effective procedure

When done by a skilled and experienced board-certified plastic surgeon, breast augmentation is a safe and effective procedure. The surgeon takes the necessary measures to minimize the risks of the operation, and the majority of women have no issues after the surgery. In fact, among millions of women with breast implants, complications have been observed in fewer than 1% of patients.

However, like every surgery, the procedure has general surgical risks, including temporary pain, swelling, bruising, tightness in the chest, bleeding, infection, poor scarring, allergic reaction to anesthesia, hematoma, changes in breast or nipple sensation, or need for revision surgery.

Besides, breast implants are designed to be temporary devices which wear out, degrade chemically, and release their content. So when getting breast implants, women should know that they are temporary devices that will need removing or replacing at a later date—the longer you have the implants, the higher the chances of complications.

What are the specific risks and complications of breast augmentation?

1. Pain

You will experience some pain or contraction for a while after the operation. Your surgeon can prescribe pain-relieving medication to help you manage pain which should be gone after 7-10 days. Do not take any other medication apart from the painkillers and additional medications prescribed by your doctor.

2. Seroma

Seroma — a buildup of fluid under the skin surface—may occur after the procedure, often at the site of the incision. The fluid is called serum and may begin to accumulate soon after surgery or several weeks later. Seromas pose a risk of infection and are resolved by draining the fluid buildup, especially when they are large.

3. Breast Implant-Associated Illness

Breast implant illness (BII or BIAI) is a self-reported complication and not an official medical diagnosis. Patients who believe they have the condition have reported a number of common symptoms, including fatigue, chest pain, hair loss, chills, headaches, chronic pain, rash, anxiety, photosensitivity, brain fog, and sleep disturbance.

There is still a need for research to find out why the symptoms occur and how they can be remedied. Many patients reporting these symptoms have also reported that the removal of breast implants alleviates the symptoms.

4. Implant rupture and deflation

Although breast implants have changed significantly since their inception and are now more durable than before, they can still rupture or burst under trauma or extra pressure. Most implant ruptures occur between 10-15 years after initial surgery, but this depends on the type of implant.

Silicone gel-filled implants have thicker liquid, so they do not deflate completely after rupture. But a hole or tear in saline-filled implants can cause a complete deflation, as the fluid escapes into the surrounding tissue.

Silicone implant rupture comes with risks such as pain, lumps, tenderness, and swelling. The breasts are also deflated in a manner visible to the eyes. Therefore, for patients with silicone gel-filled implants, it is advisable to have regular MRI scans after the procedure to detect possible rupture. If rupture is found, the implants are removed and replaced to prevent infections, discomfort, and cosmetic deformities.

5. Capsular contracture

The natural tissue of the body may react to the breast implants through an immune response. When this occurs, the collagen fiber around the implant forms a scar tissue (membrane) around the implant, resulting in hardening, stiffness, implant deformity, and pain in the breast over time.

Capsular contracture is classified into four grades: I to IV. Grade I contracture can go away with massaging and usually does not need treatment as it causes minimal problems. Grade II contracture creates more firmness in the breast and requires ultrasonic massage instruments. Grade III and IV contracture makes the breast hard and unnatural and requires surgery to remove and replace the implant.

6. Hypertrophic scarring

Breast augmentation is associated with a severe form of scarring, called hypertrophic scarring. It is a small but notable risk—only observed in 5% of patients. It is characterized by a thick, red-colored scar that is raised above the skin. Surgical scars tend to occur around the nipple and the lower part of the nipple. Your plastic surgeon may carry out renovation procedures to eliminate or reduce these scars.

7. Breast Implant-Associated Anaplastic Large-Cell Lymphoma

Though there is a low risk of Breast Implant-Associated Anaplastic Large-Cell Lymphoma (BIA-ALCL) occurring after breast augmentation, patients should still be aware of the risk. BIA-ALCL is a cancer of the immune system and is not related to breast cancer.

The condition is curable, with early detection offering patients the best chance for a quick recovery. Women considering breast augmentation should speak with their plastic surgeons about the risk of BIA-ALCL.

8. Surgical site infections

Infection may develop in or around the surgical site if bacteria enter the surgical wound either from the skin or in a contaminated saline solution or implant. The infection may be mild or severe, with the potential of infiltrating into deeper layers of the skin. Symptoms include pain in the surgical area and high fever. The implant may need to be removed to allow for the treatment of the infection before it is eventually replaced.

At Politis Plastic Surgery, we understand that the possible risks and complications of breast augmentation vary depending on your medical history, body type, allergies, medication, and other individual factors. We uphold the highest standards of medical care and take the necessary steps during the procedure to minimize the risks associated with the surgery. And after the procedure, we will keep in touch with you to ensure that any issues are promptly resolved.

Want to meet with a plastic surgeon to have your specific questions and concerns addressed? Dr. Effie Politis will listen to your cosmetic goals, explain available options, and guide you through your preparation for the surgery and your post-surgical journey. For more information on breast augmentation, visit the site Politis Plastic Surgery website.

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What to Expect During Breast Augmentation Recovery

Breast augmentation is a great way to regain breast fullness, enlarge smaller breasts, or correct asymmetrical breasts. If you are healthy, you will tolerate the surgery quite well and enjoy more self-confidence after the procedure.

Good rapport with your plastic surgeon

A successful recovery begins with a good relationship with your plastic surgeon. Like any other surgery, breast augmentation has risks and possible complications. As a patient, you need as much support and information as possible to minimize the risk of complications after the procedure.

Finding a skilled and experienced board-certified plastic surgeon is advisable. You should also look for a surgeon with whom you feel comfortable so that you can communicate honestly and know what to expect. At Politis Plastic Surgery, we have a compassionate, patient-centered approach to breast augmentation. This allows our patients to quickly establish a good rapport with their surgeon, something that is valuable during and after the procedure.

What should you expect soon after surgery?

Breast augmentation is typically an outpatient procedure. You can expect it to be completed within 1 to 3 hours. Once the surgery is done, you will be moved to the recovery area and monitored for a while. If your plastic surgeon is satisfied with your response to the procedure, you will be allowed to go home the same day.

You can expect some pain and soreness after the anesthesia wears off. Gauze, a surgical bra, or an elastic bandage will be wrapped around your chest. You may also have drainage tubes attached to your breasts for three days. Prescriptions for pain-relieving medication help ease the pain, and antibiotics can prevent infection. You will be provided with instructions to follow during the recovery period until the follow up visit.

How long will it take to recover?

The recovery period varies from one person to another. Generally, if you do not experience complications after the procedure, then you should expect a full recovery in six weeks, but your plastic surgeon will assess your overall health and give you a personalized recovery timeline. Make sure to speak with your surgeon about this before the procedure. At home, eating a balanced diet and drinking plenty of water is essential for good healing and faster recovery.

How much discomfort occurs during recovery?

It is normal to have some discomfort and disrupted sleep during the first few days or weeks after breast augmentation. Actually, the first three to five days can be quite uncomfortable, and you may need prescription pain medication. After the first week, the discomfort should be minimal, allowing you to slowly ease back into a normal daily routine with light exercise.

While residual discomfort and breast scar incisions may take months to improve, be aware that severe pain, redness and swelling need immediate medical attention. To minimize post-surgical pain and speed up your recovery, avoid strenuous or jarring activity such as running or rigorous workouts. If you have a labor-intensive job, you should remain out of work for at least three weeks.

Follow your surgeon’s instructions

The incision wound will need proper care. During the first week after surgery, all bandages and dressings remain intact, and you will need to follow your surgeon’s instructions on caring for the wounds. At Politis Plastic Surgery, we remove dressings to check your healing progress after one week. At that time, we will show you how to care for the wounds to achieve the best healing and minimal scarring.

As you follow these instructions, make sure to listen to your body, particularly to warning signs. For instance, a manageable amount of pain and nausea tend to occur after breast augmentation, but extreme pain and nausea may be a warning sign of complications. Make sure to always speak with your surgeon whenever something unusual or extreme occurs.

When should you expect to resume normal activities?

Two weeks is the usual amount of time away from work, but that depends on the physical demands of your job. Speak with your surgeon for details on what you can do to speed up your recovery. As a rule, it is best to have your surgeon’s approval before resuming normal activities, especially strenuous exercise, high-impact sports or saunas.

At Politis Plastic Surgery, we will customize your breast augmentation procedure to best suit your needs and desired surgical outcomes. Working with Dr. Effie Politis, you can expect natural-looking cosmetic surgery results and a comprehensive guide to recovery.

If you are considering breast augmentation, we encourage you to schedule your consultation session well in advance. The one-on-one session with a plastic surgeon allows you to discuss all of your concerns and become informed about what to expect. For more information about breast augmentation, visit the Politis Plastic Surgery website.

Breast Augmentation: What to Expect

Breast augmentation is cosmetic surgery to increase breast size. The procedure typically involves placing breast implants under the breast tissue or chest muscles. It is done on an outpatient basis and rarely requires a hospital stay. While it is commonly performed with the patient under general anesthesia, it can also be done under local anesthesia with the patient awake and the breast area numbed.

What can breast augmentation do for you?

If your breasts are naturally small, breast augmentation is a great way to enhance their size, shape and appearance. The procedure is also effective in correcting uneven or asymmetrical breasts. If you are uncomfortable with one of your breasts being smaller than the other, the surgery can make them even and in turn boost your self-confidence. It is also a good option to help you adjust for a reduction in breast size following pregnancy, weight loss, or breast surgery for other conditions.

What should you expect during the consultation?

The consultation with a plastic surgeon will help you determine whether you really want the procedure. The surgeon will listen to your goals and expectations to make sure you are realistic about what breast augmentation can and cannot help you achieve. The surgeon will also explain what the surgery involves, including the benefits, risks, complications and follow-up care. The surgeon will also discuss your preference for size, shape and feel of your breasts, and guide you on how to prepare for the surgery.

What can you expect during the procedure?

After you are placed under anesthesia, the surgeon will make incisions in the crease under your breast (inframammary), under your arm (axillary), or around your nipple (periareolar). The surgeon then separates the breast tissue from the muscles and connective tissue of the chest to create a pocket either in front or behind the outermost muscle of the chest wall (pectoral muscle).

The breast implant is inserted into this pocket and then centered behind the nipple. While silicone breast implants are usually pre-filled with silicone gel, saline implants are inserted when empty and filled with sterile salt water after they are in place. Once the implant is in place, the surgeon will close the incision—usually with sutures (stitches)—before bandaging the surgical site with skin adhesive and surgical tape.

What should you expect after breast augmentation?

Soon after the anesthesia wears off, you can expect pain, soreness, and swelling which may last for a few weeks after surgery. Because your breasts may be sensitive to jarring movements and physical contact, your surgeon will prescribe pain-relieving medication to keep you comfortable, and you will also need to wear a compression garment to provide extra support and positioning of your breasts as they heal.

Should you experience redness and warmth in your breasts, a fever, shortness of breath, or chest pain, contact your surgeon as soon as possible. You should also follow your surgeon’s instructions, particularly on returning to regular activities. Avoid strenuous activities—anything that can raise your pulse or blood pressure—for at least two weeks.

Remarkable results

Breast augmentation will change the size and shape of your breasts, improve your body image and boost your self-esteem. At Politis Plastic Surgery, we endeavor to meet each patient’s expectations. You can rest assured that you will achieve your desired breast volume and realize your aesthetic goals.

At the same time, we also understand that weight loss, weight gain, and aging can change the way your breasts look after the procedure. We will keep in touch with you long after the procedure to help you with any issues that may arise. Should you feel dissatisfied with how your breasts look, we are always ready to listen, evaluate and perform corrective surgeries to keep you feeling great about yourself.

Would you like to learn more about the procedure? Call today to schedule a one-on-one consultation with Dr. Effie Politis. For more information on breast augmentation, visit the Politis Plastic Surgery website.

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“Breast in a Day” Surgical Technique

 
 
 
 
 
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Another ‘Breast in a Day’ case, but executed differently since she has much larger ptotic breasts (sagging breasts). ⁣

She basically had a mastectomy performed through a Wise pattern skin mastopexy and I kept the nipples on an inferiorly based adipodermal flap. ⁣

I reduced her mastectomy envelope, reduced and repositioned her nipple areolar complexed, and placed a cohesive Natrelle Inspira SCF 520cc implant in the prepectoral position with anterior Galaflex sheet. ⁣

“Wise pattern or inverted-T mastopexy has traditionally been used in patients with severe excess of skin relative to breast parenchyma (tissues of the breast essential for functioning) in a patient with severe ptosis. Incisions are made around the areola with extensions for the vertical limbs as in a vertical mastopexy.” (Qureshi, Myckatyn, & Tenenbaum, 2018)⁣

“The Wise-pattern incision addresses any redundant mastectomy skin envelope and avoids excessive and unsightly scarring on the “social” aspect of the breast mound.” (Newman, 2016)⁣

“The pattern allows removal of skin in both vertical and horizontal dimensions allowing for lifting and coning of the breast into a less ptotic shape.” (Todd, 2016)⁣

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What is Breast Augmentation?

 

Sagging breasts can be disappointing and conspicuously small breasts can feel inadequate. Clothes that fit neatly at the shoulders and waist but appear too large at the bust line can be awkward. But you don’t have to be self-conscious when you wear swimsuits or form-fitting tops. You can achieve your desired breast size through the medical procedure known as breast augmentation

Read more about Breast Augmentation

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“Breast in a day” direct-to-implant breast reconstruction

 
 
 
 
 
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Surgical Technique

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Type of Recon: Single Stage Direct to Implant Breast Reconstruction after Mastectomy⁣⁣⁣, Galaflex Ravioli construct⁣⁣⁣⁣⁣
Type of Mastectomy: Nipple Sparing or Nipple Preserving⁣⁣⁣ through inframammary approach⁣⁣⁣⁣⁣
Implants: Natrelle Inspiration Cohesive SCF 295⁣⁣⁣⁣⁣
SPY Elite Imaging⁣⁣⁣⁣
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“Breast in a day” direct-to-implant breast reconstruction represents an emerging technique in the field of postmastectomy reconstruction and holds appeal, as it shortens the reconstructive process, eliminates the expansion period, and avoids a second operation.
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This case was performed with bilateral nipple sparing mastectomy and single stage reconstruction with cohesive implant and Galaflex ravioli construct placed in prepectoral position.⁣⁣⁣⁣⁣
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The advantage of this technique is that it is performed at time of mastectomy whereas traditionally, we place tissue expanders partially under the muscle and expand the patient and then perform a second procedure in 3-6 months where we exchange the expanders for permanent implants. ⁣⁣⁣⁣⁣
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Therefore, instead of a staged process, we can achieve stable and long term results with a single stage or direct to implant reconstruction. This requires collaboration with the surgical oncologist, meticulous dissection, scaffold material (Galaflex to stabilize and secure implant in mastectomy pocket ), and cohesive implants, we are able to perform implant based reconstruction in a single stage. ⁣⁣⁣⁣⁣
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Also, the implants are typically placed over the muscle, which decreases pain, animation deformity, preserves shoulder/arm strength, and creates a more natural result. ⁣⁣⁣⁣⁣
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Please note: These are my individual patients who have provided written photo consent. These photos and posts do not constitute medical advice. Results may vary. See a board certified plastic surgeon for evaluation.⁣⁣⁣⁣
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What is Breast Augmentation with Mastopexy

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Breast Augmentation with Mastopexy (or breast lift) by Dr Effie Politis. – For consultations, please call the office at (813) 542 – 2587.
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Breast Augmentation With 24-hour Rapid Recovery Method

Here’s a before and after of a primary breast augmentation with 24-hour rapid recovery method. When I was training in my residency at USF, Dr. Tebbetts and Dr. Adams, who pioneered the method, lectured and performed hands-on training demonstrating this method. The 24-hour rapid recovery breast augmentation is a procedure that relies on process oriented steps that maximizes planning, minimizes tissue damage and allows patients to get back on their feet in as little as a few hours after waking up from anesthesia. The recovery time is minimal because the procedure involves no bleeding, minimal tissue damage, and is very gentle and precise. It allows the patient to continue with regular life by that very same evening or the next day. Heavy exercise and intense work should be avoided initially; however, patients are encouraged to get moving right away. Patients who have undergone the 24-hour breast augmentation procedure can manage any lingering pain with over-the-counter painkillers. Will be talking more about this on another Instagram live talk soon. Stay tuned for the annoucement! Have a great week ahead!.
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