Good Reconstruction Outcomes after Nipple-Sparing Mastectomy

Nipple-sparing procedures are an increasingly popular alternative for women undergoing mastectomy. Using this technique, the surgeon preserves the nipple and surrounding tissues for use in immediate breast reconstruction. In patients being treated for breast cancer, nipple-sparing mastectomy can be performed only if the nipple and surrounding tissues are completely free of cancer.

Between 2007 and 2012, Dr. Colwell and colleagues performed a total of 500 nipple-sparing mastectomies in 285 women, average age 46 years.  Fifty-four percent of the women underwent "risk-reducing" mastectomy because of high genetic risk of breast cancer.

Nearly all of the women underwent immediate breast reconstruction, usually with implants. In about 60 percent of patients, breast reconstruction with implants was completed at the same time as mastectomy.  Most of the remaining women underwent two-stage reconstruction, including tissue expansion to increase the amount of skin available for implant-based reconstruction.

The overall complication rate was about 12 percent.  The most common complications were tissue death (necrosis) of part of the nipple or skin used for reconstruction. Cancer involving the nipple area was discovered in another four percent of women. Even including these cases, the natural nipple was retained in the final reconstruction in more than 90 percent of cases.

Smoking, Radiation and Incision Type Affect Complication Rate

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The study identified several important risk factors for complications. The complication rate was more than three times higher for women who smoked. Women who had received radiation therapy were also at increased risk.

Complications were also more common when the incision was placed around the nipple (periareolar incision).  In contrast, the more commonly used incision under the breast fold (inframammary incision) was associated with a lower complication rate.  

Nipple-sparing mastectomy has been "gaining traction as a preferred surgical option" for breast cancer treatment and for preventive mastectomy in women at high risk of breast cancer. It offers effective control of breast cancer risk while preserving the patient's natural tissues for breast reconstruction. The new study is one of the first to detail the outcomes of breast reconstruction after nipple-sparing mastectomy.

With current techniques, the risk of complications appears lower than in initial reports of nipple-sparing mastectomy. At Massachusetts General Hospital, cancer surgeons and plastic surgeons follow a team approach to effectively control breast cancer risk while maximizing reconstruction outcomes.

"We are performing an increasing number of nipple-sparing mastectomy procedures as more breast oncology surgeons become comfortable with the procedure and with expansion of our indications for nipple-sparing surgery," Dr. Colwell and coauthors write. They increasingly use the inframammary incision based on patient preference, as well as the lower complication rate. The researchers add that they now perform single-stage reconstruction in more than two-thirds of women undergoing nipple-sparing mastectomy.

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

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5 Reasons Breast Augmentation is The Most Popular Plastic Surgery Procedure

For the past seven years, breast augmentation has dominated the charts as the number one cosmetic procedure since 2006 and has averaged around 300,000 patients each year. How does the procedure continue to be this popular each and every year?

Reason #1 Breast Augmentation Satisfaction Ratings Are Through the Roof

The American Society of Plastic Surgeons recently published a study in which 98% of women surveyed had said that their augmentation results met or exceeded their expectations. Another 90% of the women surveyed also reported an increase in their self-esteem. This trend has been consistent with other surveys as breast augmentation continues to achieve high patient reviews. The procedure has even been linked to other benefits including an improved sex life. All of these positive results and reviews continue to spark new interest in other women.

Reason #2 The Procedure Does Not Take Long or Require a Lengthy Recovery

A breast augmentation usually takes just a couple hours and does not require an overnight stay at the hospital. There is little interference with daily life and depending on their occupation, most women return to work after just a few days spent recovering.

Reason #3 The Implants Have Been FDA Approved For Safety

Both saline and silicone gel implants have been approved by the FDA for breast augmentation after extensive studies on each. Because saline implants are filled with a sterile saltwater solution, they are safe in case an implant ruptures. The new silicone gel implants have been created to not leak into the body if there is a rupture. Neither silicone nor saline implants have been tied to any major disease or breast cancer.

Reason #4 Breast Augmentation Results Last Long

Though implants are not intended to be lifelong, the results last for decades. There is typically no need to replace or adjust the implants at regular intervals and the implants have proven extremely durable.

Reason #5 A Woman Can Achieve the Results She Desires

With the wide variety of implants available, and now the addition of the new MemoryShape silicone gel implants, women are better able to achieve the personalized results that she desires. There are currently seven implants and three manufacturers that have been approved for use in the United States. Each implant then breaks down into several different sizes, shapes, and profiles. The diverse group of implants allows women to better customize the look that they want.

Male Pec Implants - Plastic Surgery For Men

Women aren't the only ones enjoying the benefits of body implants, men are also joining the club. One of the most popular implants are implants for the pectoral muscles.

Men have become increasingly interested in male chest enhancement. Some men are unable to achieve a defined chest area through exercise. Some men may have underdeveloped chest muscles due to a growth defect or injury. Therefore, they may decide to receive male pec implants as a way to achieve a defined contour.

Not only do male pec implants result in a defined shape, but they also result in increased self-esteem and confidence for men who may have, at one time, been embarrassed by their appearance.

During the initial consultation, you and your surgeon will discuss your expectations and desired outcome. Your surgeon may also take photographs and give you specific instructions for the day of the surgery. He or she may also show you the different shapes and sizes of the implants. Your surgeon will help you pick out a shape and size that will fit naturally with your body shape. It is important for you to make your doctor aware of any past surgeries or procedures you've had or any current medical conditions you have. Your doctor will also want a list of current medications you are taking as he or she may alter or discontinue these before surgery. Your surgeon may also require you to stop smoking if you are a smoker since smoking can cause complications during and after surgery.

The surgery involves making an incision in the armpit. Through this incision, your surgeon will place the implant under the pectoral muscle. The incision is the closed. The implants are held in place by the chest muscles or by sutures that are visible through the skin. The surgery takes one to two hours to complete and is performed under general anesthesia. The surgery can take place in a hospital or outpatient surgery center and will depend on your doctor's personal preference.

Your doctor may prescribe pain medication to reduce discomfort after surgery. You will need to wear an elastic bandage to reduce swelling after surgery. You should expect to experience soreness and bruising which will subside within a week. While results of surgery are immediately visible, it can take up to six weeks to see full results as it can take this long for the swelling and bruising to completely disappear. You will need to avoid strenuous activity the first few weeks after surgery. You should be able to resume normal activity after a month.