Women undergoing a mastectomy, either preventive or after a cancer diagnosis, can benefit when the plastic surgeon and mastectomy surgeon collaborate on breast reconstruction, says Harrisburg physician Dr. John P. Stratis.
Harrisburg, Pennsylvania (May 2013) — A lot of lessons can be gleaned from the coverage of actress Angelina Jolie's announcement earlier this month that she underwent a preventive double mastectomy. One lesson women should focus on is that coordinated planning for her breast reconstruction began early on, says Harrisburg plastic surgeon Dr. John P. Stratis (www.focusedforyou.com).
"It's clear when you read Ms. Jolie's article and the blog post written by her doctor that there was early collaboration with the plastic surgeon," Stratis says. "It works out to everyone's advantage when both physicians work together." According to Stratis, making decisions about the mastectomy and breast reconstruction as a team can ultimately enhance the process and the final results.
"When women are diagnosed with breast cancer," the Pennsylvania plastic surgeon says, "reconstruction is sometimes an afterthought. These patients are often busy with fighting the disease and probably not thinking too much about breast reconstruction." Jolie's experience, though, demonstrated the importance of a team approach to the mastectomy and reconstruction so the woman is aware of all surgical options from the outset.
Many women, unfortunately, aren't told of their choices. In fact, according to the American Society of Plastic Surgeons (ASPS), nearly 70% of women eligible for breast reconstruction are not told about all of their options. Stratis says it's up to plastic surgeons who perform breast reconstruction to build relationships with nearby cancer doctors.
"I've developed close working relationships with oncologists and general surgeons throughout the region, including Hershey, Reading, and Lancaster," says Stratis, whose plastic surgery practice is in Harrisburg.
Working together, general and plastic surgeons can achieve remarkable results in many cases, thanks to recent surgical advances in breast reconstruction. Stratis, who focuses on breast and body procedures at Stratis Gayner Plastic Surgery, says microsurgical techniques and improvements in tissue expanders — such as those used in Jolie's case — enable plastic surgeons to create results that look and feel natural.
Breast reconstruction options fall into two broad categories: implants and flaps. If a woman chooses to have implants inserted, she can opt to either undergo a direct-to-implant procedure, which involves inserting the permanent implants at the same time as the mastectomy surgery. Patients can also use tissue expanders, as Jolie did, which are placed when the mastectomy is done.
Those expanders are temporary, balloon-like implants that are gradually filled with more saline solution, creating a pocket for the permanent implants by stretching the tissue and skin. Permanent implants are inserted about 10 to 12 weeks after the mastectomy.
The other method involves autologous flap techniques, says Stratis, which use tissue from elsewhere on a patient's body, such as the abdomen or upper back, to create a new breast mound. Another choice that should be planned from the start: A woman can also have nipple-sparing surgery, Stratis says.
"The conversations started by Angelina Jolie's decision to publicize her own experience will ultimately benefit many, many women who face similar choices every day," Stratis says. "I applaud her courage for using her status to bring the topic into the spotlight."