Can Enhanced Recovery Protocols Reduce Pain After Breast Reconstruction

KEY TAKEAWAYS:

  1. Enhanced recovery protocols can significantly reduce pain and discomfort after breast reconstruction surgery.
  2. These protocols involve a multimodal approach, including anesthesia, nerve blocks, and supportive scaffolding for the implant.
  3. Dr. Effie Politis and her team at Politis Plastic Surgery in Tampa, FL, are dedicated to providing the highest level of care for breast reconstruction patients, including long-term monitoring and support.

Introduction

Breast reconstruction surgery is an essential procedure for many women who have undergone mastectomy or lumpectomy due to breast cancer. However, postoperative pain management is a significant concern for patients undergoing this surgery. Dr. Effie Politis, a plastic surgeon in Tampa, FL, has been using enhanced recovery protocols after surgery to help her patients recover with minimal pain and discomfort. In this article, we will explore how these protocols can benefit patients undergoing breast reconstruction surgery.

Enhanced Recovery Protocols in Breast Reconstruction

Enhanced recovery protocols involve a multimodal approach to pain management and recovery, including the use of anesthesia, nerve blocks, and supportive scaffolding for the implant. By working closely with anesthesiologists and breast surgeons, Dr. Politis is able to provide her patients with a comprehensive recovery plan that minimizes pain and maximizes comfort.

Short Hospital Stays and Minimal Pain Medication

Patients who undergo breast reconstruction surgery with enhanced recovery protocols typically stay in the hospital for only one night, and some may even go home the same day. Most patients require minimal pain medication, with many opting for over-the-counter pain relievers such as Advil and Tylenol. This is a testament to the effectiveness of the enhanced recovery protocols in managing postoperative pain.

Supportive Scaffolding for Long-Term Stability

Dr. Effie Politis uses advanced supportive scaffolding materials to ensure the long-term stability of the breast implant. These materials, which can be synthetic or organic, eventually disappear and are replaced by the patient’s own type 1 collagen. Fat grafting may also be used to address any palpable abnormalities, further improving the overall aesthetic result.

Long-Term Care and Monitoring

At Politis Plastic Surgery in Tampa, FL, Dr. Effie Politis and her team are dedicated to providing long-term care and monitoring for their breast reconstruction patients. By following patients long-term, they can address any issues or changes that may arise due to factors such as weight gain, pregnancy, or aging.

Politis Plastic Surgery: Expert Care for Breast Reconstruction Patients

At Politis Plastic Surgery in Tampa, FL, Dr. Effie Politis and her team are committed to providing the highest level of care for breast reconstruction patients. With a focus on personalized treatment plans and the use of enhanced recovery protocols, Politis Plastic Surgery ensures that every individual receives the best possible outcome in their breast reconstruction journey, with minimal pain and discomfort.

TRANSCRIPTION:

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

So my patients have been recovering great, again using enhanced recovery protocols after

surgery.

The first surgery is always the toughest.

They undergo the bilateral mastectomies, but because I work with the anesthesiologist and

I do my own blocks, the breast surgeons do blocks, it’s a multimodal approach.

They stay in the hospital typically one night or some of them go home.

This is all assessed prior and usually I only write for three pain pills and some of them

don’t take any of that.

They just are able to tolerate Advil and Tylenol, minimal nausea and vomiting and again the

pain is more of a soreness or working out pain, not excruciatingly painful.

Again we have great supportive scaffolding that can be placed to hold that implant in

place long term.

So these are synthetic materials, but they’re organic in the sense that they disappear and

are replaced by the patient’s own type 1 collagen.

We also can use cadaveric dermis.

We have options of fat grafting for any palpable abnormalities and I kind of go through this

with the patient at the initial consultation, but there are patients that we follow long

term.

So we certainly readdress any issues and again they’re with us long term.

We offer the patient that service because as we know with implants, there certainly

are going to be changes in the patient’s body, perhaps weight gain, weight gain.

Some of these patients still have children, they’re in childbearing age, so we do like

to follow our patients long term.

REFERENCES:

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:

Advances in Breast Reconstruction Surgery

Key Takeaways:

  1. Breast reconstruction is a vital component of breast cancer treatment and advances in technology and medical treatments provide patients with more options.
  2. Dr. Politis’ approach to breast reconstruction provides her patients with a more natural-looking breast that is safe and oncologically sound.
  3. The prepectoral reconstruction technique and the use of nipple-sparing techniques in most cases allow for a more comfortable recovery process and help patients retain the natural appearance of their breasts.

Breast cancer is one of the most prevalent cancers among women. Advances in technology and medical treatments have increased the success rate of treating breast cancer. However, the treatment often requires surgery, and one of the most important concerns for women is breast reconstruction. Dr. Effie Politis of Politis Plastic Surgery in Tampa, Florida, discusses the latest advances in breast reconstruction.

Dr. Politis talks about two types of breast reconstruction that she offers to her patients: direct to implant reconstruction and prepectoral reconstruction. In direct to implant reconstruction, the breast implant is placed over the chest muscle instead of under it. This approach is beneficial as placing the implant under the muscle causes several deformities, pain, animation deformities over time, and implant displacement. The muscle pushes the implant down and out, which results in an unnatural appearance of the breast. By placing the implant over the chest muscle, Dr. Politis can avoid these issues and provide her patients with a more natural-looking breast.

Prepectoral reconstruction is another breast reconstruction technique that Dr. Politis offers. In this approach, the implant is placed over the pectoral muscle, which makes the recovery process easier for patients. In prepectoral reconstruction, the nipple sparing technique is also used in the majority of cases. Dr. Politis found that keeping the nipple-areolar complex is just as safe and oncologically safe as removing it. Additionally, unless the position of the nipple-areolar complex does not allow it, or the patient has extremely large breasts, Dr. Politis can salvage it and provide her patients with the best possible outcome.

Breast reconstruction surgery can be emotionally and physically taxing for patients. Patients have to go through multiple surgeries, which can take a toll on their mental health. By using these techniques, Dr. Politis provides her patients with a more comfortable and natural-looking breast without compromising their physical or mental well-being. These techniques not only provide patients with better outcomes but also help them to have a faster and smoother recovery process.

Breast reconstruction surgery is a vital aspect of breast cancer treatment, and with advances in technology and medical treatments, patients have more options to choose from. Dr. Politis’ approach to breast reconstruction provides her patients with a more natural-looking breast that is safe and oncologically sound. The prepectoral reconstruction technique allows for a more comfortable recovery process, which is important for patients’ mental well-being. The use of nipple-sparing techniques in most cases ensures that patients retain the natural appearance of their breasts.

In conclusion, breast reconstruction is a critical component of breast cancer treatment. Dr. Politis’ approach to breast reconstruction provides her patients with the best possible outcome. The direct to implant and prepectoral reconstruction techniques are beneficial as they provide patients with a more natural-looking breast while ensuring an easier and more comfortable recovery process. The use of nipple-sparing techniques in most cases also ensures that patients retain the natural appearance of their breasts. These advances in breast reconstruction techniques offer a ray of hope for women undergoing breast cancer treatment and help them to regain their confidence and quality of life.

TRANSCRIPTION:

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

One of the advances in breast reconstruction which I offer and I think are well suited

to my patient population here in Tampa is what’s called direct to implant reconstruction

and prepectoral reconstruction.

So we have found that placing the breast tissue is not under the muscle, it’s over the muscle.

So placing the device or the implant under the muscle is not necessary anymore.

It causes some deformities, it causes pain, animation deformities over time, it also causes

implant displacement because there’s no longer any breast tissue camouflaging the implant.

All you see is the muscle kind of pushing the implant down and out.

So in the right candidates, and I would say the majority of ours because these breast

cancers are caught a little bit earlier, they’re screened appropriately.

We offer them pre-pectral, which again ensures an easier recovery, so prepectoral reconstruction

and most of them are nipple sparing again in the right candidates.

We found that keeping that nipple areolar complex is just as safe, oncologically safe.

And again, unless it’s at a position that does not allow or unless they have extremely

large breasts, we are able to salvage that and give them really the best possible outcome

because they have their whole skin envelope, their nipple areolar complex, and we just

need to make sure it’s positioned over the apex of the breast mount.

References:

Bioengineered Breast: Hybrid Breast Reconstruction

 
 
 
 
 
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A post shared by Effie Politis, MD, FACS (@dreffiepolitis)

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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Dr. Effie Politis Instagram
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How to fix a displaced fold (inferior fold displacement after breast reconstruction)?

This lovely lady had the unfortunate diagnosis of breast cancer found on her annual screening mammogram. ⁣
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She underwent bilateral nipple-sparing mastectomies through an inframammary approach. She then underwent bilateral immediate breast reconstruction with silicone implants and acellular dermal matrix. ⁣

Because of the elastic properties of the acellular dermal matrix (its ability to stretch over time just like skin), she suffered from an inferior displacement of her fold (descent of her native inframammary fold) resulting in device malposition. This descent of her right inframammary fold created an increased lower pole breast skin out of proportion to her upper pole. ⁣
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I always tell my patients that during the mastectomy, the primary role of the breast surgeon performing the mastectomy is to act as an oncologic surgeon and safely remove all of the breast tissue to increase disease-free survival. ⁣
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During the mastectomy, all the natural landmarks and ligaments of the breast are removed with the actual breast tissue and this includes obliteration of the inframammary folds as well as the medial and lateral borders of the breast. ⁣
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It is our job as plastic surgeons to reconstruct these with suture techniques and also with adjunct materials that inherently have properties to support the missing ligamentous structures. ⁣
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The soft tissues are variable in every patient according to their age, weight, and subcutaneous tissues as well as fascial tissues. ⁣
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She was brought back to surgery for revision and stabilization of the fold with GalaShape. Again, this material provides a scaffolding and support to counteract increased downward pressure from the implant in a patient with low body weight and minimal subcutaneous fat.⁣

View the Before/After Gallery

“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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