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Discussing trends in breast reconstruction choices

Women are choosing silicone implants twice as often for breast reconstruction after mastectomy than using their own natural tissue for the reconstruction, a Stanford plastic surgeon says. Both methods have their advantages and drawbacks, Gordon Lee, MD, told an audience at a Stanford Health Library lecture last week.

Implant surgery is simpler, shorter and produces good results, but the implants "don't last forever," said Lee, an assistant professor and director of microsurgery in the Division of Plastic and Reconstruction Surgery. Tissue surgery takes longer and requires more recovery time, but it can provide natural-touch breasts that last long-term, with the "two-for-one" benefit of a tummy tuck for some women as well, he said.

Given the 1-in-8 chance that a woman in the U.S. will get breast cancer, reconstruction is an important topic to many

Given the 1-in-8 chance that a woman in the U.S. will get breast cancer, reconstruction is an important topic to many. "Patients should get a choice," said Lee, who does both kinds of surgery.

Tissue surgery has been refined and improved for more than 30 years, with multiple options available to women now, Lee said. The most recent improvements enable surgeons to build new breasts using fat and skin tissue removed from the belly while leaving most or all of the belly muscles in place. Refined microsurgery techniques have also let surgeons connect arteries to the transplanted tissue with more precision, improving results.

Still, about two-thirds of U.S. women have decided to get implants in recent years, while one-third have had reconstruction using their own body tissues.

Many women choose implants because the procedure is simpler, they can recover in 1 to 2 weeks and get good-looking results sooner. Implants are made with a filler of either silicone or saline. About 95 percent of Lee's patients who get implants choose silicone because they have a more natural feel and don't flatten if the implant shell breaks.

Manufacturers estimate that implants last 10 years, on average, before rupturing, whether they are silicone or saline, Lee said. For any one woman, though, the rupture can occur much earlier or later - as soon one year or as long as 15 years after reconstruction, for example. Even if an implant shell ruptures, a woman may not notice it,  Lee said, because the silicone filler is likely to stay in place given that it is a cohesive material.

None of the procedures are perfect or risk-free, Lee said. Tissue reconstruction is a complex procedure that requires more surgical skill to transfer fat and skin from other body sites, whether from the abdomen, buttocks, hips or thighs. There is a risk of complications if the procedure doesn't restore blood supply to the new breast tissue, for example.

Most insurance plans and Medicare cover most of the patient's cost for either implant or tissue reconstruction. However, Lee said surgeons are reimbursed only slightly more for tissue reconstruction even though it requires much more time and skill. A lot of surgeons lean toward using implants rather than natural tissue reconstruction because of that, Lee said. They also favor implants because the surgery is much easier to do and recovery time is quicker.

He recommended that a woman choose a surgeon who has a lot of experience in all the methods so she can get first-hand information on multiple options. It's also important to find a surgeon accredited by the American Board of Plastic Surgery.

Lee's lecture was part of a series presented by the Stanford Health Library for the general public. Their website offers information and a complete listing of the series.

Donna Alvarado is a Bay Area-based writer and editor who volunteers at the Stanford Health Library and finds inspiration in medical and health topics.

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