In honor of Breast Cancer Awareness Month, we'll be spotlighting breast cancer-related news from around Penn Medicine on our News blog every Wednesday in October. First up, we delve into Penn Medicine research providing personalized breast reconstruction options for women of all shapes and sizes.
For years, breast reconstruction options have been limited for women depending on their size. Too thin? No form-fitting implants for you. BMI too high? Free flap breast reconstruction was out. Or so was thought.
Now, thanks to research from the team of breast surgeons and plastic surgery breast reconstruction experts at Penn, there are options for women of all sizes.
"Breast reconstruction can have a profoundly positive effect on both the physical and psychological well being of women who have had mastectomy," according to Joseph Serletti, MD, FACS, chief of Plastic Surgery in the Perelman School of Medicine at the University of Pennsylvania and director of the Penn Center for Reconstructive Microsurgery. "Women deserve to have breast reconstruction options tailored to their needs, so we've done research to define what options work best, on an individual basis."
For obese women (BMI over 30), surgeons usually recommend implants , yet a Penn Medicine study released this summer had unexpected results: free tissue transfer from the abdomen is safe and effective for obese women, too. In the study, a team of Penn plastic surgeons investigated whether obese women with a BMI over 40 could withstand the free flap surgery. The vast majority of morbidly obese patients in the study had a successful reconstruction using tissue from their own abdomen without manageable complications. The cosmetic outcome is superior to what could be offered with implant reconstruction, and could last a lifetime (implants typically last 15-20 years).
For thinner, smaller patients who may not have enough spare tissue for a free flap surgery, Penn has done a lot of research on "gummy bear" implants, which use a thicker silicone gel than regular implants and have a teardrop shape that makes them look more like a natural breast. We're one of the sites selected to work with the FDA to provide safety data for the implants. These form-stable anatomically correct implants have become a good option for smaller, thinner women.
Penn has done more than 2000 free flap surgeries in 6 years (that's almost one a day!), and is one of the busiest breast reconstruction centers in the country. Free-flap surgeries involve completely detaching skin, fat and blood vessels from one part of the body, moving them to the mastectomy site and reattaching the artery and veins of the flap to the blood supply of the mastectomy pocket, where the skin and fat are shaped into a new breast. In some cases, a piece of abdominal muscle is taken along with the fat. The team produces a lot of research on the topic, including a few notable recent studies:
- Late last year, Penn researchers and colleagues published two very important, extensive studies looking at the impact various kinds of free-flap surgeries have on abdominal muscle function. The team confirmed that patients who had muscle taken during their reconstruction didn't fully recover their muscle strength, and had a greater decline in function than the patients who hadn't had muscle removed during surgery.
- The team recently presented data at the 2011 Annual Meeting of the American Association of Plastic Surgery, which showed that Penn's team approach and surgical protocols helped improve outcome rates and achieve lower failure rates. At Penn, nearly 99 percent of free flap cases were successful.
For women who are comparing options and deciding what suits them best, our breast reconstruction team sat down and answered some of the most common and important questions about reconstruction. Everything from explaining the different types of surgery, to what to expect (and wear) for surgery. There is so much important information in this guide, it's worth a read.