Evolution of breast reconstruction (or a trip down mammary lane?)

As we gear up for our Breast Reconstruction Awareness day event on Oct 17, I have been reflecting on how much our approach to reconstruction and treatment of breast cancer has changed over the years. When I was in general surgery training in the 1980’s, most women with breast cancer received a “modified radical mastectomy” (MRM), which though less radical than its predecessor, still left women with a significant scar and often swelling in the  arm from removal of the lymph nodes. Breast reconstruction was still in its infancy, though new techniques such as the TRAM flap were being introduced. Nevertheless, it was clear (at least to me) that there was room for improvement.
At about the same time studies reported equal results in terms of survival and cancer recurrence with lumpectomy – removing only the tumor – and radiation therapy. This quickly became the preferred option for many women, and it came to be called “breast-conserving” treatment.  (The first presentation I made at a formal medical conference, as a first-year resident, was on breast-conserving treatment!)


Many cases were still better treated with mastectomy however, and so methods for mastectomy and reconstruction continued to evolve. About a decade ago, several factors began to converge: the MRM became replaced with a skin-sparing mastectomy, which leaves less scar and makes for a better breast reconstruction; breast implants for reconstruction improved and became better accepted as large clinical studies affirmed their safety; the idea of combining the mastectomy and reconstruction in one surgical session began to take hold; and the use of a material called Alloderm to make an internal bra for implant support and coverage made it all work better.


This is where I have a small claim to fame, as I published the first  proving the use of Alloderm for revision breast reconstruction with implants.  Alloderm is what is known as an “acellular dermal matrix” or ADM, which is a biologic material made from skin with the cells removed. When implanted, it is gradually transformed into living tissue, so I call it the living internal bra. It is bow a routine method of primary breast reconstruction. Essentially, the advantages are that there is better control over the shape and size of the breast, and when combined with a skin-sparing mastectomy it can often produce results that are better than with so-called breast conserving treatment. (Consider that removing a piece of the breast then giving radiation treatment over several weeks can result in significant changes.)


No doubt things will continue to improve. Research in the areas of fat grafting, stem cells, and regenerative medicine may yield even more dramatic changes in how we treat breast cancer, but the challenge for now is still getting the information out. Our BRA day event will do just that while having some fun and good entertainment. Facebook it here.

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