What Factors Influence the Process of Implant-Based Reconstruction Surgery for Breast Cancer Patients?

KEY TAKEAWAYS:

  1. Factors such as skin envelope, breast size, and body habitus influence the process of implant-based reconstruction surgery.
  2. A multidisciplinary approach involving collaboration with oncologists, breast surgeons, and radiologists is essential for achieving the best results.
  3. Proper support and sizing of the implant are crucial for creating a natural, aesthetically pleasing reconstructed breast.

Introduction

Implant-based reconstruction surgery is a common option for breast cancer patients who have undergone mastectomy or lumpectomy. This procedure helps restore the appearance of the breast and can greatly improve patients’ self-esteem and confidence. Dr. Effie Politis, a plastic surgeon in Tampa, FL, explains the various factors that influence the process of implant-based reconstruction surgery and the importance of a multidisciplinary approach to achieve the best possible results.

Evaluating Skin Envelope, Breast Size, and Body Habitus

The first step in the implant-based reconstruction process is to evaluate the patient’s skin envelope, breast size, and body habitus. These factors play a crucial role in determining the most suitable reconstruction technique and implant size for each patient. By taking these factors into consideration, the plastic surgeon can create a personalized treatment plan that addresses the patient’s unique needs and goals.

Working in a Multidisciplinary Approach

Dr. Effie Politis emphasizes the importance of working in a multidisciplinary approach when performing implant-based reconstruction surgery. This involves collaborating with other specialists such as oncologists, breast surgeons, and radiologists to ensure a comprehensive understanding of the patient’s condition and treatment needs. By working together, the team can develop a cohesive and effective plan for the patient’s breast reconstruction surgery.

Reconstructing Natural Anatomic Landmarks

Once the breast surgeon has removed the breast tissue, ligaments, and tail of the breast, it is the plastic surgeon’s responsibility to reconstruct the natural anatomic landmarks. Dr. Effie Politis explains that this involves creating a mound using an implant and a supportive scaffold or structure. This ensures that the reconstructed breast has the appropriate shape, size, and position.

Supporting and Sizing the Implant

The implant used in breast reconstruction surgery cannot be placed directly under the skin; it must be properly supported by re-establishing the lateral anatomy, folds, and cleavage area. Furthermore, it is essential to size the patient for the correct implant to be used during surgery. This ensures that the reconstructed breast is proportionate to the patient’s body and provides a natural, aesthetically pleasing result.

Politis Plastic Surgery: Expert Care for Breast Reconstruction Patients

If you are a breast cancer patient considering implant-based reconstruction surgery, trust the expertise and compassionate care of Dr. Effie Politis and her team at Politis Plastic Surgery in Tampa, FL. With a multidisciplinary approach and personalized treatment plans, Politis Plastic Surgery is dedicated to helping patients achieve the best possible outcomes in their breast reconstruction journey.

TRANSCRIPTION:

Hi, my name is Dr. Effie Politis with Politis Plastic Surgery.

Implant-based reconstruction, again, applies to the majority of our patients. So what we do is we evaluate their skin envelope, their breast size, body habitus, and we formulate a plan in conjunction with our breast surgeon. We work in a multidisciplinary approach. That means we work with their oncologists, their breast surgeons, their imaging specialists or radiologists.

We make sure we understand whether the placement of the tumor and how we can place our incisions to remove the breast. The breast surgeon removes the breast, but when that happens, they obliterate or they basically remove all the ligaments, the breast tissue, all the ligaments, the tail of the breast.

So my job is to go in and reconstruct the natural anatomic landmarks and then reconstruct a mound. Again, I typically use an implant to make the mound with a scaffold or supportive structure. So you can’t just put an implant under skin. You have to, again, re-support all the lateral anatomy, the folds, the cleavage area, and then you have to size the patient for the correct implant to be used in surgery.

REFERENCES:

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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