Posted on: April 29, 2014
Empowering Results of New Research on Esthetic Outcomes of Breast Reconstruction
By Dr. Michael H. Rosenberg, FACS, Chief of Plastic Surgery, Vice-President for Physician Surgical Services and Associate Medical Director at Northern Westchester Hospital
My colleagues at Northern Westchester Hospital and I recently published research findings on breast reconstruction outcomes that have the potential to dramatically improve quality of life after breast surgery as well as to save women’s lives. Published in The American Journal of Cosmetic Surgery, our article was titled “Breast Reconstruction With or Without Human Acellular Dermal Matrices:
A Single-Clinic Review of Esthetic Outcomes and Risk Factors for Complications,” and co-authored by David A. Palaia, MD; Anthony C. Cahan, MD; Karen S. Arthur, MD; Danielle M. DeLuca-Pytell, MD; and Philip C. Bonanno, MD.
What makes our findings such good news for women – possibly for you, or someone you love? To understand their impact, let’s look at the context of the study for a moment:
Breast reconstruction has become increasingly important in the total treatment of women with breast cancer. Of course, the priority is to cure the cancer. However, re-establishing quality of life and making survivorship, the post-cancer portion of life, as normal as possible, is really the modern goal of cancer treatment. When the focus is on the woman with cancer – rather than the cancer – breast reconstruction becomes critically important.
Empowering effects of breast reconstruction.
We know that the availability of breast reconstruction empowers women to seek treatment. It also causes more women with a genetic predisposition or increased risk for breast cancer, to consider mastectomy as an option, often proactively, for peace of mind. And we know that the increase in early detection leads to more cures and prevention.
Breast implants are the most common choice for women facing reconstruction. Our ability to achieve ever-better esthetic results is contributing to their popularity.
Two of the most important advances in breast reconstruction are (1) the development of better and safer silicone-gel implants; and (2) the use of allograft in breast reconstruction – human tissue not from the woman herself, used to form a kind of internal bra or sling that helps shape the reconstructed breast; when used with implants, allograft also helps keep the implant in place.
We currently use an allograft called human acellular dermal matrix (HADM). Dermal matrix is the undersurface of human skin, which provides a very natural sling. Acellular means all cells are removed from the dermal substance, leaving only its matrix, or lattice-like structure. Without cells, there is no potential for the entry of foreign organisms, such as a virus, or the stimulation of an immune response.
Those two advances let us get pretty incredible esthetic results using implants.
Questions our study asked.
(1) How safe is HADM? (2) Can we objectively (statistically) prove we get better esthetic results with HADM? (3) What is the best type of HADM? (4) Which patient risk factors point to reconstruction without an implant?
Our study looked at 881 breast reconstructions, one of the largest groups ever, examining data over a five-year period. Because all research was conducted at one place – Northern Westchester Hospital – we could control for variables, giving our findings far more “power,” or validity.
Exciting and empowering results for women.
Our results clearly demonstrate that women get a better esthetic result with the use of allograft in conjunction with implants. By “esthetic,” I mean a more natural-looking, symmetrical breast. This confirms observations made in the course of our practice.
Risk factors identified.
As surgeons, our goal is to mitigate risk to the extent possible. The study helped confirm and identify risk factors for a subset of women who are better off with a method other than HADM. Major risk factors are smoking, high BMI, previous radiation treatment for lumpectomy, and the need for larger implants.
Positive impact for women.
If this study helps provide women with the knowledge and reassurance that breast reconstruction is readily available, affordable, effective and helps them return to a normal and wonderful life after cancer, and as a result, more women seek out a diagnosis and aren’t afraid to get tests… we will have achieved something wonderful.