Doctors are testing a device that would let women do part of their breast construction at home. It’s not only aimed at making treatment more comfortable and convenient, but also giving a sense of control to women who’ve had a breast removed. (Nov. 16) AP


Dr. Babak Mehrara, a plastic and reconstructive surgeon at Memorial Sloan Kettering, has some advice for patients considering breast reconstruction. Here is a Q&A:

What's new? According to Mehrara, the biggest advance is the evolution of microsurgery. "Thirty-five years ago, you had to do a skin graft from the lower belly and rectus muscles; essentially you were taking one of the six-pack muscles. Now, we can take less of those. We use skin and fat and blood vessels, pluck it out and reconnect. With microsurgery, there is less post-operative pain and less recovery time."

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What's the first consideration? "Ask: 'What are my options, implant or my own tissue? When should I do it?' The patient should learn about the impacts of radiation and understand the length of surgery. These are very delicate surgeries. It can can be 4-6 hours for one side, so it has to be done right."

What about pain? "We are more aware that patients have a lot of post operative pain so at MSK, we have an interdisciplinary team to treat pain through recovery pathways, which begins with a long lasting anesthetic in the abdominal area. We have an enhanced recovery team with two attending surgeons, the nursing staff, pain management team; this decreases complications and blood loss."

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One or both breasts? "Symmetry is a big thing. You want both sides to look and feel similar, so again, that's is another reason many opt to have both breasts done. What's new at MSK is that for all surgeries, there are now two breast cancer plastic surgeons attending."

Opting out of reconstruction?  "I don't really see it. Most people do go on to have reconstruction. At MSK, I would say that 75 percent have reconstruction at the time of mastectomy. On that subject, I would say that the biggest trend I am seeing is prophylactic mastectomy.

After a mastectomy or a lumpectomy, many breast cancer patients opt for reconstructive surgery and are opting to do both sides. It's because of social sharing; I think more people are opting to have both done vs. one side, with a fear that cancer could recur in the other. There is also a lot more understanding of genetic disposition when it comes to breast cancer. "



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