Dr. Rosen answers: How Has Breast Reconstruction Evolved to Improve Overall Outcomes?

When I began practice in 1989, the only type of surgery performed to treat breast cancer was a modified radical mastectomy and the only option we had to treat it was by using a small selection of round tissue expanders. So much has changed since then! This predated Facebook, Google and the iPhone so please understand information traveled slowly back then. Very few companies were producing implants and in 1990 when the implant crisis over Dow Corning’s silicone devices hit the media, the circus that followed set back the industry still further.

Today we have a plethora of options due to better techniques and technologies, but they fall into distinct categories. Synthetic devices to fill up the lost breast or use of the body’s own natural tissue.

The really huge leap in the evolution of breast reconstruction was the recognition that the breast gland could be removed from the body without sacrificing the breast skin or nipple and keeping incisions to a minimum (nipple sparing mastectomy). So now as surgeons we were able to focus on making more anatomically accurate looking implants to fill up the void after the gland was scooped out or use the body’s own natural tissues to do so. We did both!

Today, tissue can be taken from many places on the body (Belly, Back, Butt, Thigh) and transferred with microsurgery to the breast area where it is reattached. It feels exactly like a native breast which is mainly composed of fatty tissue.

Expanders and implants now are manufactured by many companies throughout the world and they come in every shape and size that anyone could ever need or want. New sutures and biologic materials now allow us to perform these procedures faster and with more predictable results. They even improved the silicone substance within implants that prevent it from extruding. Older implants before 2006 were filled with a liquid substance with the consistency of honey. These could leak from the implant and travel to adjacent breast tissues. They did not find this to cause any diseases but it did cause inflammation and lumps in the breast. Implants today are made of a cohesive substance with the consistency of, but softer than, a Gummy Bear candy. Hence the popularity of the moniker, Gummy Bear Implant. (No actual implant has this name, but maybe they should!) They also have a very low failure rate and are easily replaced. The manufacturers actually warranty them for a lifetime.

Today, since the MRI and digital mammograms are so accurate, breast cancer is detected very early. The breast skin and nipple can be saved in most cases and filling the void up with a modern properly shaped implant or natural fatty tissue from another part of the body where it is not needed, yields a breast that looks almost identical to the original. We actually perform our mastectomy and expander reconstructions as outpatients in our surgery center and tissue transfers only require a few days in the hospital.

Many patients now find their cancers so early that they don’t need mastectomy at all and opt for  lumpectomy. My hope would be no one would ever need a mastectomy again and reconstruction would be obsolete. Until that day comes, we are going to continue our pursuit of improving upon breast reconstruction, and returning patients to “wholeness” again.

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