National Breast Reconstruction Awareness Day

October is Breast Cancer Awareness Month, a  campaign to  educate women  about this all too common disease. Though the disease is common, the treatment can vary widely  and decisions for therapy need to be individualized. For the second year in a row, the American Society of Plastic Surgeons has sponsored Breast Reconstruction Awareness Day, or BRA DAY as part of the October campaign.  

This year’s spoke’s person for BRA Day is singer/songwriter Jewel, who has composed a song The song is entitle “Flower” and can be downloaded on I Tunes to benefit breast reconstruction patients.

Here are a few facts about public awareness of breast reconstructive options:

1. Only 19% of women understand that the timing of their treatment for breast cancer and the timing of their decision to undergo reconstruction greatly impacts their options and results.
2. Only 23% of women know that there are a range of options available for breast reconstruction.
3. Only 22% are familiar with the quality of outcomes that are possible.
4. 89% of women express the desire to know more about results of breast reconstruction prior to undergoing treatment for breast cancer.

The American Society of Plastic Surgeons urges women to make sure a plastic surgeon is part of their treatment team as they select options for treatment.  Here are a few online resources for breast reconstruction information.

American Society of Plastic Surgery

plasticsurgery.org/choices

BRAdayUSA.org

American Cancer Society

A recent survey of board certified Plastic Surgeons confirms that plastic surgeons are using fat transfer with increasing frequency and success.
80% reported using fat in parts of the body other than breast.
70 % actively perform fat grafting to the breast.
62% used fat transfer as a good choice for improving breast shape and
contour in reconstructive breast surgeries.
28% of the surveyed surgeons employ this technique for cosmetic purposes.

Here are some of the ways this valuable technique is being used:

1. Breast implants in thin women can show wrinkling or visible borders. Fat can provide a thicker soft tissue cover to hide implant characteristics.
2. Fat grafts can cover prominent ribs or an irregular chest wall.
3. Congenital breast problems, such as tubular breasts or lack of growth of one breast can be reshaped with fat transfer as part of the procedure.
4. In breast reconstruction after mastectomy, fat can help camouflage the borders of an implant, or fill in a deficit in a flap contour or after a lumpectomy defect. Fat can treat irradiated tissue and seems to improve skin quality. 

There were nearly 72,000 fat grafting procedures reported by US board certified surgeons for 2012, according to the American Society for Aesthetic Surgery. 

For more detail visit the July 2013 issue if Plastic and Reconstructive Surgery, www.PRSJournal.com.

What’s ideal? What’s normal? Women’s breasts vary so widely that there really is no way to define the “normal.” Each person’s experience, cultural background and preferences create  their personal “ideal” and there is remarkable difference of opinion. So what do plastic surgeons consider when trying to get the very best appearance for each woman choosing breast surgery? In order to communicate aesthetic ideas with their patients, plastic surgeons analyze basic characteristics of the breast and try to describe what features are possible to change and how to create the best surgical strategy for improvement. After your surgeon has listened well to your preferences, these are a few of the features that your surgeon may want to analyze with you.

1. Where is the breast located on the chest wall?  The base of the breast (breast disc or footprint) should meet the chest wall in a way that is the foundation for the overlying three dimensional structure of the breast. This footprint is constant throughout life. An abnormal location of the footprint or an irregular chest wall can interfere with the aesthetics of the breast. Is your breast fold too high or too low?  Is your spine straight?  Does one side of the chest project more than the other?  Are your ribs crooked? 
2. What is the shape or “conus” of the breast? Breast shape varies widely among women and quite a bit over a given woman’s lifetime. In adolescence the breast is cone shaped. Over time there should be a progressive transition with a greater portion of its volume resting in the lower outer quadrant. The nipple should be at the area of maximum breast projection, roughly at the apex of the cone shape. 
3. What is the quality and quantity of the breast skin? Too much skin leads to a drop in the breast position on the chest wall. The skin provides the major support for the breast gland. If elasticity is poor, the skin envelope cannot contain the gland in a suitable shape.
4. Is the areola size a good match for the volume of the breast? Is the nipple position correctly located on the projecting portion of the breast and in the middle or slightly lateral to the middle of the breast?
5. Do the two breasts look alike? Most women’s breasts are more like sisters than identical twins, but symmetry is one feature of the hoped for end result.
6. Is the volume appropriate for the rest of the body’s proportions? You should express your size concerns to your surgeon and have a careful discussion about any possible downsides to your choice. 

Tubular Breasts

The term “TUBULAR” refers to SHAPE for a tubular breast. It is used to describe a breast shape that is long and narrow, rather than being broad at the base with a gradual decrease in width up to the top, like a cone or pyramid. Women that have tubular breasts often have a very high fold at the base of their breast, and they have puffiness in the nipple-areolar region where the breast seems to bunch out of the top. A mild tubular breast shape is quite common. Extreme tubular breast deformity can be very troubling  to have, and women often want the shape improved.

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