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Choices in Breast Reconstruction.  What you should know to move forward with confidence.
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Breast Reconstruction to Help You Move Forward
Over 180,000 women in the US each year are diagnosed with breast cancer. You are not alone. Like you, many women have the option of Breast Reconstruction after their mastectomy. There is a growing acceptance and popularity for breast reconstructive surgery among mastectomy patients and in the medical community. Be sure to ask your breast surgeon or general surgeon about your Breast Reconstruction options early on in your treatment plan.

While not everyone chooses to have Breast Reconstruction, women with Breast Reconstruction have reported an increase in self-confidence, gained emotional well-being, renewed body image and an increased sense of femininity and sexuality.

While you're considering your treatment options, empower yourself and make an informed decision about Breast Reconstruction. This is a personal choice that your breast surgeon (or general surgeon) and plastic surgeon are ready to discuss with you, and plan for, right at the onset of your treatment for breast cancer.

Fully exploring your options will help you make the best choice for your body and your life after cancer. And research has shown that the more informed you are about Breast Reconstruction upfront, the better your plan will be. This look at Breast Reconstruction provides insight for a knowledgeable decision.

While Breast Reconstruction can be performed at the time of your mastectomy or delayed months or even years, knowing your options now can reduce your fear and strengthen your decision. Once
you have read this information, be sure to consult with your breast or general surgeon and plastic surgeon to determine what option is right for you.

 
Tutorial
“I didn't want to be a ‘cancer victim,’ and getting my breasts back helped me to feel attractive and empowered. The truth is that after I was diagnosed with cancer, I felt that my body had let me down. Breast Reconstruction helped me become friends with my body again.”

Alex, age 49, underwent breast implant surgery following a double mastectomy

 
 
     
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  You Have Options
There are different types of Breast Reconstruction surgeries available. Although the options your plastic surgeon can offer you will not look or
feel exactly like your natural breasts, the field of Breast Reconstruction has made great strides in recent years to create a more aesthetic breast
shape that looks and feels more like real breasts.
   
 
  The Women's Health and Cancer Rights Act (WHCRA) requires group health plans and health insurers that provide medical benefits covering mastectomy to also cover the cost of breast reconstructive surgery for women who have undergone mastectomy. Coverage must also include all stages of reconstructive surgery of the diseased breast, procedure to restore and achieve symmetry on the opposite breast, and the cost of prostheses and complications of mastectomy. For more detailed information about WHCRA, please refer to the Department of Labor's "Your Rights After Mastectomy" website at www.dol.gov/ebsa/Publications/whcra.html.  
   
 

A Look at the Most Commonly Performed Breast Reconstruction Procedures
Your plastic surgeon may offer the following Breast Reconstruction procedures. At the end of the overview
you will find a summary chart for these surgical options.

Two-Stage Reconstruction with Breast Implants

   
  Two-stage reconstruction
    Two-Stage Breast Reconstruction procedures use tissue expanders to create pockets for the placement of breast implants.       This process creates a new breast shaped pocket in preparation for your next stage of reconstruction: placement of the implant.  
               
               
  Stage One - A tissue expander is a silicone shell that is filled slowly over time with saltwater to stretch the skin and make room for your implant.
The expander is placed under your chest skin at the site of your planned reconstructed breast. A small needle is used to fill the expander with
sterile saline. The needle is inserted through the skin to a "fill port" located inside the expander. Gradually over time, the overlying tissues
expand, much like a woman's abdomen during pregnancy.
   
  Stage Two - The placement of your breast implant is the second part of the Two-Stage Breast Reconstruction process. After your tissue expander has reached an ideal pocket size, your plastic surgeon will perform surgery to remove the tissue expander and place your saline or silicone gel-filled breast implant. This is a routine procedure that usually takes 1 to 2 hours and may require a brief hospital stay or be done on an outpatient basis. It is possible to fully recover from the procedure in 2 to 3 weeks and be able to resume your normal activities.
   
 
pre/post op photos
  Before nipple-sparing
mastectomy
  Stage1 with Natrelle®
Tissue Expander
  Stage 2 with Natrelle®
Style 20 500cc gel-filled
Breast Implant
   
 
pre/post op photos
  Before total
mastectomy
  Stage1 with Natrelle®
Tissue Expander
  Stage 2 with Natrelle® Style 20 400cc gel-filled Breast Implant, and
Nipple Reconsruction
   
   
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  Your Breast Reconstruction Choices with Breast Implants
 
  Volume Options: The Natrelle® Collection features a full variety of widths and volumes. The size and volume that's right for you is based on existing breast tissue, your body type and frame. The question of size is NOT just about picking a specific volume of breast implant. Your plastic surgeon will help you pick a diameter and projection of implant that fits your needs. For example, Natrelle® gel-filled breast implants come in four different profiles, or projections: Moderate, Moderate-Plus, High, and Extra-High. Only Natrelle® breast implants are available with an Extra-High profile option. The Natrelle® Style 20 implant is the most common implant used in Breast Reconstruction because usually some or all of the breast tissue has been removed. The profile of the implant is an important factor in how far out your breasts will “project” after your reconstruction. And each choice has a different volume. See the Natrelle® gel-filled breast implant examples below and notice how each one can deliver a distinctly different profile:

Natrelle volume options

Natrelle® Style 10
Moderate Profile

Diameter
(cm)

Projection

(cm)

Volume

(cc)

12.2

3.3

270

Natrelle® Style 15
Moderate-Plus Profile

Diameter
(cm)

Projection

(cm)

Volume

(cc)

11.9

4.0

304

Natrelle® Style 20
High Profile

Diameter
(cm)

Projection

(cm)

Volume

(cc)

12.0

5.2

425

Natrelle® Style 45
Extra-High Profile

Diameter
(cm)

Projection

(cm)

Volume

(cc)

11.9

5.7

500


 
Shell Options: There are two shell options available, textured or smooth. Your plastic surgeon can determine which option is best for you based on their technique and the shape of the breast implant that best fits your personal profile goal.
  Filler Options: Women in the United States currently have two distinct filler options approved by the FDA. The FDA has approved both saline and silicone gel-filled breast implants after determining that each are safe and effective options for women undergoing breast aesthetic surgery, breast reconstructive surgery or revision surgery. Ultimately, it is up to you, along with your plastic surgeon, to decide what breast implant option will provide the look and outcome you desire from surgery.

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  Silicone Gel vs. Saline
gel vs saline
gel vs saline
Silicone - Gel Breast Implants
 
Natrelle® silicone gel-filled breast implants have experienced acceptance for more than 25 years in over 60 countries.
They were approved by the Food and Drug Administration (FDA) for use in the US in November 2006.
A Gel-filled breast implant has an elastic silicone rubber shell and is filled with cohesive silicone gel.
The safety of Natrelle® silicone gel-filled breast implants meet one of the most rigorous standards of all medical devices.
gel vs saline
Saline Breast Implants
 
Saline-filled breast implants were approved by the FDA in May 2000.
A Saline-filled breast implant has an elastic silicone rubber shell and is filled with sterile saline (saltwater).
During the breast implant stage of your reconstruction, empty implants are placed in the newly formed pockets under your breast tissue and then filled with saline fluid to the size you and your plastic surgeon agreed upon.
gel vs saline
gel vs saline
   
   
 
A further look at the Safety of Silicone Gel-Filled Implants
Like many other medical devices on the market today, silicone gel-filled breast implants have evolved substantially over the
last two decades. Today's Natrelle® silicone gel-filled breast implants have an advanced technology and enhanced safety profile
thanks to several refinements in product design and manufacturing. The most significant advancements available today include a
more cohesive silicone gel and a thicker, yet supple shell with an additional barrier layer that is distinct from earlier breast
implant devices.
   
 
  Low long-term rupture rates: To assess the long-term safety of Natrelle® breast implants, Allergan conducted extensive clinical studies both in the United States and in Europe. These studies show that silicone gel-filled implants have low long-term rupture rates. In fact, the results of the European research found that after 11 years, 92 percent of implants were still intact.*

*Data on file
 

“The reason was simple: my breasts had been with me for the first 50 years of my life and I wanted them there, in place, for the next 50 years as well. It was my way of dealing with the trauma I, along with many other women, had suffered and prevent my disease from leaving a permanent imprint on my body.”

Dr. Christine Rodgers, cancer survivor and plastic surgeon

 
     
  Rigorous testing: Today's breast implants in the Natrelle® Collection undergo thorough testing and meet the very high standards of Allergan quality. They are backed by an unsurpassed warranty that reflects the Allergan commitment to quality.
     
  Ongoing research: Through ongoing research Allergan is constantly assessing the impressive long-term safety record of our full line of elegant silicone gel-filled breast implants.
     
   

Natrelle® silicone gel-filled breast implants are one of the most studied FDA approved medical devices in existence.* There have been hundreds of peer-reviewed studies and published reports involving silicone gel-filled breast implants, including robust epidemiological studies supporting their use. The Institute of Medicine of the National Academies (IOM), concluded in its landmark report (IOM, 1999) that "a review of the toxicology studies of silicones and other substances known to be in breast implants does not provide a basis for health concerns." More information about the safety of silicone gel-filled implants can be found in the IOM report at www.iom.edu/CMS/3793/5638.aspx.

For safety data on implants go to www.fda.gov/cdrh/breastimplants and please
read the complete patient information at www.natrelle.com/safety_info.aspx.

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Tissue Flap Breast Reconstruction Options
Breasts can also be reconstructed by surgically moving a section of skin, fat and muscle from one area of your body to your chest, this is referred to as an Autologous Reconstruction.

In Autologous Reconstruction, tissue is taken from your abdomen, upper back, upper hip or buttocks. Depending on your plastic surgeon's surgical plan, the tissue flap may be left attached to the blood supply and moved to the breast area through a tunnel under the skin called a Pedicle Flap, or it can be removed completely and reattached to the breast area by a microsurgical technique called a Free Flap.

The advantage of flap surgery is the replacement of chest area tissue. This is an important consideration if:

 

“A plastic surgeon specializing in Breast Reconstruction, worked in tandem with my surgical team so that I came out of the mastectomy with ‘expanders’ where my breasts had been, which would make room for my permanent silicone implants. I chose Natrelle® silicone gel-filled breast implants because I felt that they were the most natural appearing option.”

Alex, age 49, Denver, CO,
underwent breast implant surgery
following her double mastectomy

 

 
     
  Your chest tissue has been damaged and is not suitable for tissue expansion
  Extra tissue is needed to recreate a large breast without a breast implant
  Extra tissue coverage is needed over a breast implant
     

Unlike Two-Stage Breast Reconstruction with breast implants, Flap Reconstruction is a major surgery. It requires a hospital stay and longer recovery time.

Flap surgery also creates scars at the site where your flap was taken and additional scars are possible at the site of your reconstructed breast.

It is important to reinforce that tissue flap surgery, particularly the TRAM and DIEP flaps, are major surgeries, more extensive than your mastectomy. They require good general health and strong emotional motivation.

If you are very overweight, smoke, have had previous surgery in the area the flap would be taken, or have any circulatory problems, you may
not be a good candidate for a tissue flap procedure. If you are very thin, you may not have enough tissue in your abdomen or back to create a breast using this method.

   
 

The Three Most Frequent Types of Flap Surgery
TRAM
Transverse Rectus Abdominus Myocutaneous Flap

 

TRAM surgery involves moving fat, skin and muscle from the lower abdomen (C) to create a new breast mound (A).

The surgery is approximately 3 to 6 hours long, requires a hospital stay of 2 to 5 days and 6 to 8 weeks to resume normal daily activity.

Some women refer to this as the "tummy tuck" procedure, because a flatter stomach is often part of your result. Obtaining the flap for your new breast will leave a scar on your abdomen.

TRAM
   
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DIEP
Deep Inferior Epigastric Perforator
In simple terms, DIEP is a TRAM surgery without using the muscle from your abdomen; just the skin and the fat. This
procedure uses microsurgery to reattach the blood supply to the flap once it is placed on your chest. And like a TRAM
flap, DIEP surgery is approximately 3 to 6 hours, requires a hospital stay of 2 to 5 days and 6 to 8 weeks to resume
normal activity. The scarring concerns are the same as with the TRAM procedure.

   
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Latissimus Dorsi Flap
Sometimes called the Latiss Flap, this procedure involves taking the latissimus muscle from your back and rotating it around to your front to create, or help create a breast mound. Sometimes an implant is used when the muscle isn't large enough to produce the desired size. This will leave a scar on your back.

The surgery is approximately 2 to 4 hours, requires a hospital stay of about 2 to 3 days and 2 to 3 weeks before you can resume normal activity.

 

TRAM
   

“Breast reconstructive surgery was an essential part of my recovery process and I’m so happy reconstructive surgery was an option for me.”

Bliss, age 58, Long Beach, CA,
Underwent Two-Stage Breast Reconstruction surgery



  Summary Chart of Surgical Options
   
  Summary chart of surgical options
   
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  Additional Breast Reconstruction Considerations
Whether you have breast implants placed following a tissue expander or a tissue flap reconstruction, the following surgical procedures are
options your plastic surgeon may consider to complete your Breast Reconstruction. For some women it is important to leave the unaffected breast
entirely as it is. You should discuss this with your plastic surgeon to ensure the right Breast Reconstruction method is presented to meet your
goals.
   
 
Improving Symmetry
If you have a unilateral mastectomy, it may be difficult for the plastic surgeon to exactly match the remaining breast, particularly if you have large breasts or if your breasts have sagged with age or from bearing children. In order to help improve symmetry between your natural and reconstructed breasts, your plastic surgeon may recommend:

“I didn’t realize how closely connected my breasts were to my sense of self until I was faced with the idea of losing them. I wasn’t going to let cancer take away my spirit or my curves.”

Margaret, age 44,
Golden, CO

  Mastopexy: A breast lift
  Mammoplasty: A breast reduction
  Augmentation Mammoplasty: A breast enlargement
 
All of these are quite common plastic surgeon considerations.
 
Nipple and Areola Reconstruction
If the nipple is removed with the breast tissue during a mastectomy, there are
nipple reconstruction solutions. Your nipple can be reconstructed using a small skin
graft or by taking part of the nipple from your opposite breast. And your areola may be reconstructed with a skin graft, or by tattooing the area to enhance the color to
match your opposite breast.
   
  Your nipple and areola reconstruction may be performed at the time of your implant placement or as a separate outpatient procedure after the
initial reconstruction surgery is complete.

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Questions Your Plastic Surgeon Can Answer
If you are considering Breast Reconstruction, a plastic surgeon can provide you with information that fully explains the risks and complications associated with breast implants, tissue flaps and with Breast Reconstruction surgery itself. You can find a board certified plastic surgeon in your area by using
the
Find a Surgeon directory on Natrelle.com.

It is recommended that you read all of the information provided before scheduling your surgery, so that you have plenty of time to ask questions
and evaluate all of your options.

 
   


“My breast cancer diagnosis was traumatic enough, and just when I felt at my lowest, suddenly there were so many decisions to make. I was grateful for the many treatment options, but when faced with a life-threatening illness, the information can be really overwhelming. Finding a doctor that took the time to answer all of my questions made all the difference.”

Bliss, age 58, Long Beach, CA. Cancer survivor and Two-Stage Breast Reconstruction patient

  What are all my options for Breast Reconstruction?
  What are the risks and complications of each type of Breast Reconstruction
surgery and how common are they?
  What if my cancer recurs or occurs in my other breast?
  Will reconstruction interfere with my cancer treatment?
  How many steps are there in each procedure, and what are they?
  How long will it take to complete my reconstruction?
  How much experience do you have with each procedure?
  Do you have before and after photos I can look at for each procedure?
  What results are reasonable for me?
  What will my scars look like?
  What kind of changes in my reconstructed breast can I expect over time?
  Can I talk with other patients about their experiences?
  What is the estimated total cost of each procedure? How much is my
insurance expected to cover?
  How much pain or discomfort will I feel, and for how long?
  How long will I be in the hospital?
  Will I need blood transfusions, and can I donate my own blood?
  When will I be able to resume normal activity (or sexual activity or
athletic activity)?
  Where can I get more information?
  Is there a warranty that covers my implant(s)?
       
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This information gives you an understanding of Breast Reconstruction and should help you make an informed decision. It is not meant to replace a thorough consultation with a plastic surgeon. Your general surgeon and plastic surgeon should work together to plan your mastectomy and reconstruction procedures.

 

Additional Resources
1. Cancer Care: www.cancercare.org
2. Susan G. Komen for the Cure: www.komen.org
3. Y-ME, Breast Cancer Organization: www.networkofstrength.org
4. Share: www.sharecancersupport.org
5. American Cancer Society: www.cancer.org
6. Cancer Connection: www.cityofhope.org
7. American Society of Plastic Surgeons: www.plasticsurgery.org
8. Breastimplants.org: http://www.breastimplants.org



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*Inamed Corporation's PMA P020056: Silicone Gel-Filled Breast Implants, FDA Presentation from April 12, 2005, slide 11, http://www.fda.gov/ohrms/dockets/ac/05/slides/2005-4101s1_Inamed-P020056.pdf. Only round gel-filled implants are included. Style 153, anatomical, dual lumen implants are excluded.

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