The Breast Reconstruction Guidebook 4th Edition: Issues and Answers from Research to Recovery PDF
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If you’re facing mastectomy to treat or prevent breast cancer, you have a lot of decisions before you. Will you keep a flat chest after surgery, wear temporary breast prostheses, or have your breasts reconstructed? If you do want to have breast reconstruction, is your priority to have the shortest procedure with the quickest recovery or to pursue a method that will give you the most natural breasts possible? Does keeping your own nipples and areolae appeal to you? Do you have quite a bit of excess fat that you’d like to be rid of in the process? Plastic surgeons have been recreating breasts for decades. Technological innovation and surgical improvements in the 15 years since The Breast Reconstruction Guidebook was first published now make reconstructive results with breast implants or your own tissue better than ever. If you’re interested in breast implants, you might choose cohesive silicone gel “gummy bears” that retain their shape and feel more like breast tissue. If you’d like to avoid the traditional method of tissue expansion that creates a space to hold your implant, you might be a candidate for nipple-sparing mastectomy with a direct-to-implant procedure, which completes in a single visit to the operating room what reconstruction with tissue expanders takes months to accomplish. (Solid data show that nipple-sparing mastectomy, considered to be unwise just a few years ago, is safe for most women, even many who are treated for breast cancer.)
If your reconstruction is done with tissue expanders, perhaps you’ll prefer to control the speed of your expansion at home, avoiding routine office visits and shortening the overall reconstruction process. “Flaps” of your own excess fat can also be sculpted into new breasts. Plastic surgeons continue to push the reconstructive envelope, developing better flap techniques and procedures that provide more predictable results and shorten recovery. Some tissue flaps use muscle along with skin and fat to rebuild the breast, but other more sophisticated options spare the muscle, preserving function and making for less intense recovery. These microsurgical tissue flaps, including DIEP (deep inferior epigastric perforator), GAP (gluteal artery perforator), TUG (transverse upper gracilis), and others, are no longer considered weird or experimental, and options for rebuilding your breasts with excess fat from your abdomen, back, buttocks, thighs, or hips are numerous. And flap reconstruction comes with a bonus: new breasts and a slimmer donor area. Methods of nipple reconstruction have also improved. Or like a growing number of women, you may prefer to have three-dimensional nipples tattooed onto your reconstructed breast, giving a lifelike illusion of having nipples where there aren’t any. One of the most exciting reconstructive innovations is fat grafting—liposuctioning your own excess fat and carefully injecting small amounts into your reconstructed breast. Although fat grafting has been used for many years, recent improvements make it far more practical and successful, ensuring that more fat stays in the breast. Adding fat to the new breast can refine shape, increase volume, and improve contour with minimal downtime, making a good reconstruction even better. Perhaps the most important change is the increasing number of plastic surgeons who now routinely offer breast reconstruction, translating to more accessible experience, skill, and choice.