Presentation on theme: "Advances in Breast Augmentation and Breast Reconstruction Physician-to-Physician Discussion Guide 1."— Presentation transcript:
Advances in Breast Augmentation and Breast Reconstruction Physician-to-Physician Discussion Guide 1
Breast Implant History and Evolution 2 Historical Facts Timeline Silicone Moratorium Implants Today
History and Evolution 100s of years ago Ivory, Bone, Glass, Metal, Bone and Liquid Paraffin were reportedly used In the 1940s women in Japan were injected with Liquid Silicone 1950s saw the introduction of the Ivalon Sponge…found to harden and disfigure the breast 3 Weve come a long way since then……………..
Evolutionary Timeline of Silicone Implants 21st Century Generation 21st Century Generation Form Stable in Clinical Trials 90s Fourth Generation 90s Fourth Generation Refinements Continue 80s Third Generation 80s Third Generation Dry Shells Cohesive Gels Textured Shells 70s Second Generation 70s Second Generation Thin Shells Thin Gels Saline Implants 1962 First Silicone Breast Implant
Silicone Implants removed from U.S. Market U.S. gel implant advancements stall FDA sets guidelines for U.S. trials to study silicone implants European gel implant advancements continue with Form Stable Implants The Institute of Medicine concluded: a review of the studies of silicones and other substances known to be in breast implants does not provide a basis for health concerns FDA finds silicone breast implants to be safe and effective Approve sale of silicone implants outside clinical study to certified surgeons in U.S. Moratorium Timeline
Shapes Round: Most commonly used for augmentation Anatomical Shapes: Helps adjust breast shape Breast Implants Today Options Fills Cohesive Gel: Follows industry standards for cohesivity. Delivers a soft feel closest to breast tissue. Saline: Allows for small incision sizes & fill flexibility Cut implant showing cohesiveness Surface Smooth: Pliable elastomer Textured: Offers greater tissue adhesion for controlled placement
NATRELLE ® Implant Collection Offering more Styles and Sizes than any manufacturer on the market today 8 Style Options8 Style Options 5 Profiles5 Profiles 143 Sizes143 Sizes Gel 7 Style Options7 Style Options 6 Profiles6 Profiles 103 Sizes103 Sizes Saline
The Procedure First recommendation the surgeon will make is the incision site Under the breast in the fold: Inframammary In the armpit: Transaxillary Around the nipple areola: Peri-Areola 10 Breast Augmentation can be performed different ways
Placement of implant Submuscular: Under the Pectoralis (chest) Muscle Subglandular: Under the breast tissue, above the muscle 11 Breast Before & After Implantation The second recommendation the surgeon will make is implant placement Breast after subglandular augmentation Breast after submuscular augmentation Breast before augmentation
Type of Implant Gel implants feel more like breast tissue. Available to women 22 years and older for augmentation Saline implants involve a smaller incision. Available to women 18 years and older for augmentation. 12 The final decision will be the type of implant GelSaline
Breast Reconstruction 13
Breast Reconstruction 14 Statistics A Womens Right Options Two Stage Reconstruction Current Advancements About Silicone Breast Implants Autologous Reconstruction Time Line for Procedures Why?
Breast Cancer Statistics 15 * American Cancer Society, Breast Cancer Facts & Figures : Breast cancer accounts for 1 in every 4 cancers diagnosed in U.S. women* 192,370 women were diagnosed with invasive breast cancer in 2009* Women with BRCA1 gene mutations are 57% likely to develop the cancer by age 70 (49% likely for BRCA2)*
A Womans Right Under WHCRA, group health plans, insurance companies and health maintenance organizations (HMOs) offering mastectomy coverage must also provide coverage for reconstructive surgery…including any adjustments to the opposite breast to get symmetry 17 The Womans Health and Cancer Rights Act of 1998 (WHCRA) A Womans Right that is protected by law!
Why Inform Patients of Breast Reconstruction? 18 *Rowland, Julia H. Psycological Impact of Treatments for Breast Cancer, Surgery of the Breast, 2nd Edition, p. 382, 2006 The Treatment of Breast Cancer consists of 3 parts Pharmacological Physiological Psychosocial 76% of women receiving implants reported that reconstruction was important in helping them cope with cancer.* Breast Reconstruction is a womans right under the law and women should be informed of their options early in the treatment process.
So, A Complete Treatment Plan Includes A Discussion of Reconstruction Options… 19
Reconstruction Options All can be offered as Immediate or Delayed Additional combinations: Expanders/Flaps/Implants All can be offered as Immediate or Delayed Additional combinations: Expanders/Flaps/Implants Alloplastic Procedure Single Stage: Using Expandable Implant or Implant alone Two Stage Reconstruction: Using Expanders and Implants Autologous Procedures TRAM flap: Tummy Tuck benefit DIEP flap: Similar to TRAM, without using Rectus muscle Latissimus Dorsi flap
Alloplastic…Expander and Implant Utilizing a Tissue Expander followed by a Breast Implant Two Stage Reconstruction Image Courtesy of P. Cordeiro and NEJM, October 9, 2008
NATRELLE ® Two-Stage Reconstruction System
The First Stage The expander is filled with saline over a few weeks and allowed to rest for a period of 4-6 months NATRELLE ® Style 133 Series Expanders with patented BIOCELL ® texturing have integral ports and come in 42 different sizes and profiles
The Second Stage For expander to implant exchange the Plastic Surgeon has many options to customize the final result The NATRELLE ® Implant Collection offers over 200 gel and saline implant choices in various shapes and sizes
Operative Result Two Stage Reconstruction Pre-Operative Expansion Complete Post-op with Implant
Recent Advancements in Two Stage This patient had a bilateral Skin and Nipple Sparing Mastectomy followed by bilateral 133V Tissue Expanders. Photo shows immediate post-op result after exchange to breast implants Photo courtesy of G. Patrick Maxwell, M.D., Nashville, TN Skin Sparing/Nipple Sparing Mastectomies can lead to a more natural looking result
The FDA imposes a moratorium on silicone implants while awaiting extensive studies The Institute of Medicine of the National Academies finds that silicone breast implants do not show a basis for health concern After extensive study the FDA finds silicone implants safe and effective and approves use outside of clinical study for women 22 yrs & older in augmentation and women of any age in reconstruction. What about the safety of Silicone Implants?
Latissimus Dorsi Flap: Sometimes used with an expander & or a breast implant TRAM Flap: Transverse Rectus Abdominus Musculocutaneous…. akatummy tuck reconstruction DIEP Flap: Deep Inferior Epigastric Perforator…similar to a TRAM without the muscle TRAM Flap: Transverse Rectus Abdominus Musculocutaneous…. akatummy tuck reconstruction DIEP Flap: Deep Inferior Epigastric Perforator…similar to a TRAM without the muscle Autologous Options 28
The TRAM and DIEP Flap The TRAM Flap…1st performed in 1980 Can be performed as Immediate or Delayed
Latissimus Flap The latissimus flap is used in a variety of ways: 1. With an expander, followed by an implant 2. With an implant 3. As a muscle flap alone
Timeline for Procedures
Additional Reconstruction Procedures Surgery on the Contralateral Breast for symmetry may consist of: Mastopexy to lift the breast Reduction to reduce the breast Augmentation to enhance the breast Nipple and Areola Reconstruction is then performed…first by grafting, then tattooing for color enhancement
Surgeons today have offering women
Brochures and Information Choices in Reconstruction Brochure Informs Patients of autologous and alloplastic reconstruction options Available from your Allergan Surgical Sales Representative Visit the American Society of Plastic Surgeons (ASPS) 34
Important Natrelle ® Safety Information Indications: Breast Augmentation. Breast augmentation includes primary breast augmentation to increase the breast size, as well as revision surgery to correct or improve the result of a primary breast augmentation surgery. Breast Reconstruction. Breast reconstruction includes primary reconstruction to replace breast tissue that has been removed due to cancer or trauma or that has failed to develop properly due to a severe breast abnormality. Breast reconstruction also includes revision surgery to correct or improve the result of a primary breast reconstruction surgery. NOTE: the FDA has determined that patients seeking breast augmentation with silicone-filled implants must be at least 22 years of age. Patients seeking breast augmentation with saline implants must be at least 18 years of age. There is no age restriction for reconstruction patients with either implant type. Contraindications Breast implant surgery should NOT be performed in: Women with active infection anywhere in their body. Women with existing cancer or pre-cancer of their breast who have not received adequate treatment for those conditions. Women who are currently pregnant or nursing. Warnings Every effort should be made to avoid damage to the breast implants during surgery. Care should be taken to avoid the use of excessive force and to minimize handling of the implant during surgical insertion. Care should be taken when using surgical instruments in proximity with the breast implant, including scalpel, sutures, and dissection instrumentation.. 35
Important Natrelle ® Safety Information Continued 36 Use care in subsequent procedures such as open capsulotomy, breast pocket revision, hematoma/seroma aspiration, and biopsy/lumpectomy to avoid damage to the implant Do not contact the implant with disposable, capacitor-type cautery devices. Do not alter the implants or attempt to repair or insert a damaged prosthesis. Do not immerse the implant in Betadine solution. Do not re-use or resterilize any product that has been previously implanted. Breast implants are intended for single use only. Do not place more than one implant per breast pocket. Do not use the periumbilical approach to place the implant. Do not use microwave diathermy in patients with breast implants, as it has been reported to case tissue necrosis, skin erosion, and implant extrusion. Precautions Safety and effectiveness have not been established in patients with the following: Autoimmune diseases (for example, lupus and scleroderma) A weakened immune system (for example, currently taking drugs that weaken the bodys natural resistance to disease) Conditions that interfere with wound healing and blood clotting Reduced blood supply to breast tissue Radiation to the breast following implantation Clinical diagnosis of depression or other mental health disorders, including body dysmorphic disorder and eating disorders. Please discuss any history of mental health disorders with your surgeon prior to surgery. Patients with a diagnosis of depression, or other mental health disorders, should wait for resolution or stabilization of these conditions prior to undergoing breast implantation surgery. Adverse events The most commonly reported adverse events for Natrelle ® Silicone Filled Breast Implants are: reoperation, implant removal with replacement, grade III/IV capsular contracture, implant malposition, and asymmetry, The most commonly reported adverse events for Natrelle ® Saline Filled Breast Implants are: reoperation, grade III/IV capsular contracture, implant removal, and implant deflation. Other potential complications include: rupture, unsatisfactory results, pain, changes in nipple sensation, infection, hematoma/seroma, breastfeeding difficulties, calcium deposits in tissue around the implant, necrosis, delayed wound healing, chest wall deformity, and lymphadenopathy. Important: For full safety information please visit or call Allergan Product Support at www.natrelle.com Caution: Rx only.