What We Can Learn From Angelina Jolie's Breast Reconstruction

By Dr. Wandra K. Miles

Angelina Jolie's recent breast reconstruction opened up a discussion on surgical options. Dr. Wandra K. Miles, a breast reconstruction specialist in Seattle, says advances in surgical techniques allow her to achieve good aesthetic results from a skin-sparing mastectomy and immediate reconstruction.

An ongoing national discussion launched in the wake of Angelina Jolie's revelation that she underwent a preventive double mastectomy has focused primarily on the genetic testing that spawned her decision. But Jolie's announcement also shed some light on surgical advances in breast reconstruction.

At my Seattle practice, many women considering mastectomies aren't aware of the various reconstruction options available. The American Society of Plastic Surgeons estimates only 30 percent of women are made aware of reconstruction options before having a mastectomy. Ideally, the publicity surrounding Jolie's choice will get people talking and increase that number substantially.

As more women undergo genetic testing to determine whether they face increased chances of getting breast cancer, reconstruction techniques are becoming more advanced. A young woman opting for a preventive double mastectomy to avoid getting breast cancer should still have aesthetic breasts after reconstructive plastic surgery. At my Seattle practice, I can achieve good aesthetic results using different techniques, including immediate reconstruction using the patient's own tissue or implants.

In that situation, the doctor performing the mastectomy and I collaborate early in the process to ensure the best possible results are achieved during surgery. A study in the ASPS journal Plastic and Reconstructive Surgery® concluded that immediate breast reconstruction has a low risk of complications. Its advantages also include:

  • Improved cosmetic outcomes
  • A more natural feel than with implants
  • Shorter recovery times
  • Decreased costs
  • The psychological benefit of having new breasts immediately

Autologous flap reconstruction — meaning a patient's tissue is used — can be performed using donor tissue from different areas of the body, including the abdomen, latissimus dorsi, or the buttocks. Although flap reconstruction results in additional scarring, recent advances have minimized the size of scars for many patients.

Other women, such as Angelina Jolie, choose to have staged breast reconstruction using implants. In Jolie's case, she also had what is called a "nipple delay" procedure about two weeks prior to her double mastectomy. A nipple delay is performed when a patient, especially one undergoing a prophylactic mastectomy, wants to spare her nipples. The physician makes a short incision and removes a small amount of tissue from directly behind the nipple to biopsy. If no potential for cancer exists, the patient's nipple or nipples aren't removed. The decision to proceed with this procedure would be determined, if you are an appropriate candidate for this procedure, by your breast surgeon who would be performing the skin sparing or nipple areola sparing mastectomy.

At the time of Jolie's double mastectomy, her plastic surgeon inserted temporary implants called tissue expanders. During the ensuing 10 weeks, a saline solution was progressively injected using ports put in place during the surgery. When the expanders reached the desired size, she underwent a third surgery to insert permanent implants. It should be noted that the lifespan of a permanent implant is approximately 10 years but can be longer.

Whether you are considering preventive mastectomy or you have been diagnosed with breast cancer, it's important to know all of your options for breast reconstruction — including the option of not having reconstruction at all.

Dr. Miles' Alaska, Seattle, Tacoma, Olympia and Bellevue breast reduction patients are consistently pleased with their results. If you're considering breast reduction, request a consultation online or give us a call at 206-215-6221.

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