Reconstructive Breast Surgery: New Options

by Joseph D. Alkon, M.D.
Chief, Division of Plastic & Reconstructive Surgery
Trinitas Hospital, Elizabeth, NJ

A woman diagnosed with breast cancer may have an immediate flood of decisions to make regarding her medical care. One of those choices is the option of breast reconstruction if she chooses to undergo a mastectomy, or breast removal. Breast reconstruction, if chosen, may be performed at the time of mastectomy – termed an immediate reconstruction, or alternatively at a later date – termed a delayed reconstruction. From an oncologic, or cancer standpoint, both options are safe and effective, yet this, too, is something that should be discussed between a patient, her breast cancer physicians, and her plastic surgeon.

Data from the American Society of Plastic Surgeons reveals a 113% increase in the frequency of breast reconstruction from 1992-2004. In 2004, nearly 63,000 women chose to undergo breast reconstruction. Mirroring this increase in reconstructive frequency are the refinements and advances in techniques to perform these operations. Currently, breast reconstruction may be performed by using a patient's own tissues, taken from her abdomen in what is called a 'TRAM Flap,' or by using an implanted prosthetic device.

If a patient chooses to undergo a TRAM flap operation, skin and underlying tissue is removed from her lower abdomen. This is the same place tissue would be removed from in a tummy-tuck procedure. The tissue is relocated to underneath her chest to reconstruct her removed breast. This may not be feasible in someone who is very thin, or perhaps someone who has had multiple prior abdominal operations (or even a prior tummy-tuck). In this setting, a patient who desires a reconstructed breast using her own tissues would consider alternate body regions to serve as the donor-site.

Other women may opt for a reconstructed breast to be created with an implant device. If, however, a mastectomy has been previously performed (such as in the delayed reconstruction) or if the cancer surgeon needs to remove a significant amount of overlying skin, the area may be too tight a space to have an implant immediately placed within. In this scenario, a 'tissue expander', which looks like a deflated or unfilled implant, may be used. This device may then be sequentially inflated in the office with saline or salt water. Between short weekly or biweekly filling sessions lasting only a few minutes, the overlying tissues have a chance to gradually stretch and grow. Ultimately, when the desired volume has been added and the desired breast size achieved, the expander device may be replaced for a permanent implant. Each of these options has their advantages and disadvantages, which must be discussed during the plastic surgical consultation.

The Division of Plastic & Reconstructive Surgery at Trinitas
The Division of Plastic and Reconstructive Surgery at Trinitas Hospital is generating a lot of excitement, particularly as a complement to its recently developed Comprehensive Cancer Center. The division will offer breast reconstruction as another jewel in its crown of patient care. For those considering cosmetic or post-oncological breast surgery, the division offers an opportunity for quality care and topnotch surgical expertise right here at home.

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About Joseph D. Alkon, MD:
Joseph D. Alkon, MD, is the Chief of the newly created Division of Plastic and Reconstructive Surgery at Trinitas. A graduate of Brandeis University and the Boston University School of Medicine, Dr. Alkon is a member of Alpha Omega Alpha, the National Medical Honor Society. While completing his training in plastic surgery at Strong Memorial Hospital/The University of Rochester Medical Center, Dr. Alkon served as Chief Resident in Plastic and Reconstructive Surgery. He has been published in several peer-reviewed publications, including Plastic and Reconstructive Surgery, Annals of Vascular Surgery, Journal of Cardiac Surgery and Annals of Thoracic Surgery. He has been invited to lecture nationally on Plastic and Reconstructive Surgery. As part of his practice, Dr. Alkon offers a full range of surgical procedures for women including reconstructive surgery, body contouring, breast surgery and facial aesthetics.


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