This new procedure preserves the nipple, areola and surrounding skin by using a vertical mastectomy incision, a dermal flap for coverage, and a definitive adjustable smooth saline implant.
Hilton Becker, M.D., a local plastic and reconstructive surgeon and an affiliate professor in FAU's Charles E. Schmidt College of Medicine, studied and developed this procedure as an alternative to radical mastectomy. His findings were published in the Plastic and Reconstructive Surgery Journal, co-authored by Jeffrey Lind II, M.D.
According to Dr. Becker,
There are numerous advantages to using a vertical incision over a horizontal incision. From the surgical perspective, it allows for ease of access, and from an aesthetic perspective this incision leads to a better cosmetic result with a scar that resembles that of a breast lift procedure. The procedure is minimally invasive as no new tissue planes are opened after the general surgeon has completed the mastectomy.
Procedures that spare the nipple and skin have been shown to be oncologically safe and allow for much more flexibility in implant-based breast reconstruction. Single-stage breast reconstruction will become more important as there continues to be increasing financial strains on our healthcare system.
Elizabeth Hopkins is an aspiring physician and pre-med student who has been mentored by Dr. Becker. She is also a patient of his and shared her personal feedback after undergoing this new procedure.
This blessing in disguise introduced me to a brilliant surgeon whose unique procedure enabled me to have a skin and nipple sparing mastectomy free from animation deformity, which happens when implants are placed beneath the pectoral muscle – mine were placed over the muscle. Being his patient and working side-by-side with Dr. Becker has changed my life and will hopefully change the lives of many others.”
During the preliminary stage of the study, 31 patients with a median age of 51 underwent the single-stage breast reconstruction procedure. They were followed over the course of four and a half years.
Both a low complication rate and implant loss were shown and reported as part of the results of the procedure. Other benefits according to the authors of the study include: elimination of animation deformities or movement of the implants, elimination of asymmetry, less postoperative pain and discomfort, and a faster recovery.
In addition, the natural position of the implant above the muscle leads to a more natural feel.
Currently, both a one-stage and a two-stage reconstruction are available for patients.
In an immediate breast reconstruction, the plastic surgeon places the implant beneath the muscle of the patient's chest after the removal of the breast tissue. A special type of graft or an absorbable mesh is used to hold the implant in place, much like a hammock or sling.
In a two-stage reconstruction (also called delayed-immediate reconstruction), a short-term tissue expander is used wherein a saline-water solution is injected by the surgeon over a period of 2 to 3 months. When the skin over the breast has stretched enough, a permanent implant will be surgically done to replace the expander. This kind of reconstruction allows time for other treatment options such as radiation therapy to be done when it is needed by the patients.
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