When it comes to breast reconstruction after surgery from breast cancer, the biggest myth is that there are few options available.
“What I want to make clear is that there are many options for women,” says Dr. James Watson, a UCLA academic plastic surgeon and a clinician with his own cosmetic clinic who has 23 years of clinical experience in cosmetic surgery.
“I usually give women eight to 10 options—not all work for everyone, but we can find three or four options for every patient who comes in who is diagnosed with breast cancer,” he says.
The majority of breast cancer today can be treated with a lumpectomy and radiation, “and we don’t recommend any reconstruction surgery. The majority of the time they do fine and don’t need any reconstruction.”
However, a few patients end up with breast asymmetry, “in other words, the breast that had cancer ends up being smaller than the other side. So the good news is there are several things that can be done.”
After a patient like this waits about two years, “we can either do a lift for the opposite breast; we can do a reduction on the opposite breast; or in some cases, we can do fat grafting to that breast that has the lumpectomy to take care of the asymmetry,” explains Dr. Watson, further adding that as many as 80% of patients today who are diagnosed with breast cancer can get by with a lumpectomy and don’t need a mastectomy.
The fat grafting technique involves liposuction with a syringe from other parts of the body.
“We wash the fat and inject the fat into the breast that had the lumpectomy to take care of a deformity from that,” says Dr. Watson, who has been the recipient of over $1.25 million in grant funding for research in liposuction, fat grafting, stem cells and tissue engineering.
There are also options available for those who undergo a mastectomy.
“If the surgeon can save the skin of the breast and the nipple, many times we can go directly to a breast implant,” Dr. Watson says.
Another option is called direct-to-flap.
“That means we take tissue from somewhere else on the body and transfer it to the breast to make a new breast,” he explains. “The idea of direct-to-implant or direct-to-flap is that they go to sleep with a breast and wake up with a breast.”
In the past, the direct-to-flap surgery option was quite painful—especially when the fat was taken from the abdomen. As a result, these patients would require IV narcotics to manage their pain.
“There’s a new way that we’ve developed for pain control that reduces the pain by 90% for the abdominal flap option. This eliminates the need for IV narcotics and ICU stay while in the hospital. Now patients only take mild pain pills and don’t need any IV narcotics after surgery,” Dr. Watson says.
“In the last four patients I’ve done with the direct-to-flap option, they didn’t require any IV narcotics and they didn’t have to go to the ICU,” he continues. “They will have to stay in the hospital for usually three days after surgery, but most of them say the pain is no more than they would have from having their gall bladder removed or having a mild procedure on their knee.”
If a patient goes directly to an implant, they have three choices: implants filled with saline, implants filled with silicone gel, or implants filled with cohesive gel.
“We use saline-filled implants with people who are concerned about the risk of silicone implants,” Dr. Watson explains. “A silicone gel implant is as soft as normal breast tissue, but over time, usually around 10 years, that implant leaks and the gel can get into your surrounding tissue.”
With a cohesive gel implant, “it’s made with silicone; but the gel sticks to itself so if the shell ruptures, it doesn’t leak out,” says Dr. Watson, noting that this option is also known as the gummy bear implant.
A “tissue expander” is another option that involves the use of a balloon-like device with a valve that’s inserted.
“We can inflate it through the valve and fill it with salt water—saline,” Dr. Watson explains. “Most commonly, we do this for somebody who loses some of the skin of the breast with the mastectomy. We’d have to stretch things out to compensate for missing skin.”
He notes that the most common skin removed is the nipple, “because it’s not always possible to save it. The most common patients who lose the nipple include those with very large breasts—double D—or those with a lot of drooping.”
With a tissue expander, after the skin is stretched over approximately six weeks, “we remove the expander and then we put in the implant of their choice,” says Dr. Watson, further noting that another option involves the expander balloon followed by a flap.
Those who elect this option can have their fat removed from areas of the body including the back, buttocks, love handles and inner thigh. “All require a stay in the hospital,” he says.
For patients who want a simple, outpatient option without any hospitalization, they can choose a procedure that involves fat grafting.
“We do liposuction; then we wash the fat and transfer it to the breast,” Dr. Watson explains. What’s nice about this option is that “you get rid of fat in all the areas you don’t want—the love handles, on your arms, the inner and outer thighs. Anywhere you have extra fat, you can harvest it with liposuction, then wash and prepare that fat and inject it to make a new breast.”
As far as future options are concerned, Dr. Watson is currently immersed in what’s considered “cutting edge.”
“We’re developing techniques to restore sensation to the breast so they can regain sensation after a mastectomy,” he says. “I’m doing research on this right now, and I’m extremely excited about it.”
Meanwhile, “what I tell people is to look at all of these options as being good news,” Dr. Watson adds. “Nowadays, it’s like visiting a restaurant with a menu with many items. We can find an option that can make each person happy.”
Dr. Watson can be reached at the Shonan Beauty Clinic located at 425 Haaland Dr., Suite 102 in Thousand Oaks. For more information call 805.723.8008.
