Elite Plastic Surgery
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Breast Reconstruction Surgery – Phoenix and Scottsdale, AZ
HISTORY OF BREAST RECONSTRUCTION
WILLIAM STEWART HALSTED
GOALS OF BREAST RECONSTRUCTION
SKIN AND SOFT TISSUE
At Elite Plastic Surgery, we understand the difficulties when you are notified of breast cancer diagnosis or a genetic predilection of developing breast cancer. There are multiple new stressors physically and emotionally. Meeting multiple physicians and health care professionals all while trying to understand an overabundance of new information can be overwhelming. We strive to provide a service in this time of uncertainty to ease your burden and improve your experience. As your reconstructive team, we take seriously the task of returning your self-identity and pride ourselves in bridging the gap from cancer treatment to the phase of true recovery and a return to normalcy. This is not only your battle but a journey that you will be able to share with fulfillment.
We focus on the individual and utilize our knowledge and experience with all available reconstructive procedures, in order to customize our treatment plan for each patient. We are not only experienced with performing the most complex breast reconstruction procedures, we have also published numerous peer reviewed journal articles to better understand and advance breast reconstruction. Our published peer reviewed articles have covered multiple aspects of breast surgery including the most modern options for breast reconstruction, improving recovery following mastectomy, describing narcotic medication prescription patterns, and assessing risk for complications following breast reconstruction. We also believe that the most informed patients are the most satisfied with their reconstructive results. This is due to the shared decision making between patients and physicians which allows for the most ideal outcomes
Advancements in breast reconstruction have coincided with advancement in breast oncological (cancer) care. The goals of oncological care are to remove cancer, prolong life and decrease recurrence. Prior to modern research and advancements in surgical and medical care, more drastic procedures were believed to be required to “cure” a patient of cancer. As we have better understood and managed breast cancer, we have been able to transition to less invasive methods while achieving the same goals. Radical mastectomies involved removal of breast tissue, overlying skin and subcutaneous tissue, underlying chest muscle and lymph nodes. There has been a gradual yet significant change in this approach where patients, when suitable, are offered procedures such as skin or nipple sparing mastectomies (these options are discussed with your breast oncologic surgeons). This has allowed reconstructive surgeons to offer options to better match a natural result.
Meanwhile breast reconstruction has also evolved. Pedicled muscle flaps (local muscle flaps with overlying skin and soft tissue) such as latissimus dorsi and rectus abdominus flaps helped provided natural options earlier in the evolution of breast reconstruction. A better understanding of skin and soft tissue anatomy combined with progressive surgical techniques to include microsurgical procedures has introduced perforator based free flap options as a completely natural and reliable option for breast reconstruction using your own tissue. Perforator based free flap options (see below) offer reconstructive options using your own tissue while minimizing the risks to the donor site (sites where tissue is taken from). The donor sites also can serve to provide an improvement in body contouring of the site they are taken from (see perforator flap options).
Breast implants and surgical approaches have also improved for improvements in safety and reconstructive results. In addition to these advancements, Fat grafting techniques have now been well described and serve as a reliable option to improve outcomes in conjunction with other techniques.
The breast is a specialized gland in the soft tissue. Breasts serve to provide lactation to provide for offspring. The overlying skin, nipple an areolar complex have a well described blood supply and nerve supply (sensation of the area). The breast receives most of the blood supply from medial sources, and a contribution from lateral and superior sources. This provides the nutrition to the tissue and this provides a simplified guideline for blood supply that can be used in microsurgical breast reconstruction
The skin and soft tissue in your body is supplied by small vessels called perforators. Perforator vessels generally branch off of a source vessel before penetrating through fascia and/or muscle to provide blood supply to the soft tissue. Perforator locations and sizes vary from person to person, but there are well described locations. Each perforator feeds an island of skin and soft tissue superficial to the deep fascia. This has allowed description and use of various perforator free flaps (see below). The free flaps can also include sensory nerves which can be preserved and connected to nerves in the chest to possibly provide sensation.
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