Breast reconstruction: new support for the immediate approach

Techniques for breast reconstruction after mastectomy have dramatically changed in the past decade, and two recent studies support the idea of immediate reconstruction, that is under the same anesthesia as the mastectomy. The benefits of this are obvious, but in the past it has been problematic and not as widely used as it should be. For this and other reasons, recent statistics from the American Society of Plastic Surgeons reveal that 70% of women having a mastectomy for breast cancer aren’t even told about their reconstructive options. These new studies aim to change that by documenting the safety and benefits of reconstruction in fewer operations and with quick recovery time.
Alternatives for treatment of early stage breast cancer traditionally fall into two categories: lumpectomy and radiation or mastectomy, with or without reconstruction. The former option is typically presented as breast-conserving, a highly appealing proposition when compared to surgery. But radiation after removal of a lump in the breast can result in deformity, while mastectomy techniques have evolved. There is a major trend to what is called skin-sparing mastectomy, which facilitates better reconstruction without compromising cancer treatment. Along with that is the use of Alloderm, a material know as an “acellular dermal matrix” or ADM to make an internal bra to support the implant.
It is these combined factors that enable the reconstruction to be done on an immediate basis, even in a single stage; one surgery, cancer gone, new breast in place. This is the model reported on in these new studies, one from UCLA and the other from New York Medical College. The New York study, led by Dr. Andrew Salzberg, reported good outcomes on a series of 260 patients over 8 years who had “direct to implant” immediate reconstruction with the use of Alloderm. Complications were low, none long-term, and aesthetic outcomes were reports to be good. The UCLA study, reported this month in the journal Plastic & Reconstructive Surgery, had similar results.
These studies are just in time for the second annual Northwest Breast symposium, of which I am faculty moderator. We were fortunate last year to have Dr. Chris Crisera, whose work was the basis for the UCLA study. A topic we are going to explore this year with plastic surgeons and breast surgeons is how to bring these newer approaches into wider clinical use. We are fast approaching the point where blasting the breast with radiation for 8 weeks is starting to look more like the radical approach.