Why the “One and Done” Approach to Breast Reconstruction Can Be Misleading

breast-reconstructionRecently, a news article circulated with information regarding a new “one and done” approach to breast reconstruction being available and providing promising results. Sounds great right? While the procedure has been available for some time and it can be a great option for some women, calling it “one and done” can be misleading as over 30% of women will need further surgery. For this reason, many surgeons refer to the procedure as “direct-to-implant” instead. Your plastic and reconstructive surgeon can guide you regarding details, and whether you are a candidate for this procedure.

For patients undergoing a mastectomy due to cancer, there are some things to consider before choosing the “one and done” surgery. The final cosmetic results after implant breast reconstruction depend heavily on the thickness of tissue covering the implant. Often after mastectomy, the tissues over the implant aren’t thick enough to camouflage the implant completely, even if the implant is under the pectoralis major muscle. Many patients experience visible implant “rippling” because of this and more surgery is required (usually fat grafting) to add more tissue over the implant(s) to decrease the visible rippling. This is the most common reason for needing further surgery after a “one and done” procedure.

The possibility of post-mastectomy radiation also needs to be considered. Radiation certainly doesn’t preclude breast reconstruction, but it does increase the risk of complications and can impact the final cosmetic results. Radiation can cause damage to the breast skin and soft tissue. If this tissue becomes too thin as a result, problems can result.   Patients undergoing radiation therapy after breast reconstruction often need more surgery for the best results.

One more factor to consider is the impact of nipple-sparing mastectomy (NSM). Preserving the nipple-areola may improve the cosmetic results after breast reconstruction, particularly reconstruction with implants. Talk to your surgeons, whether you may be a candidate.

For patients seeking flap-based reconstruction a single-step approach can be performed, but consistently superior results are achieved with a staged approach. Procedures such as the DIEP flap are often performed at the same time as the mastectomy (“immediate reconstruction”) allowing patients to wake up with breasts and avoiding the trauma of a missing breast. However, the newly reconstructed breast is not considered a finished product.A second surgery—or revision surgery— is typically needed a few months later to “fine tune” the reconstructed breast(s) for the best cosmetic results. This second-stage outpatient surgery often includes further breast shaping, fat grafting, scar revision, and nipple reconstruction. Once again, Radiation Therapy can affect a Flap-based reconstruction, possibly resulting in additional procedures or a misshapen breast reconstruction.

Although the idea of having everything taken care of in one surgery sounds great, unfortunately this will not always be in your best interests. Please discuss your expectations thoroughly with your Board-Certified Plastic and Reconstructive surgeon prior to proceeding with breast reconstruction.

Here Original Article Available at ASPS