June 25th, 2009 Dr. McKane
Some of my patients ask me what will happen to them if they develop a breast cancer after undergoing aesthetic breast surgery. They wonder if they will be a candidate for breast conservation therapy and sentinel lymph node biopsy. As more and more breast surgery is performed, unfortunately, more and more women will be confronted with this problem.
Sentinel lymph node biopsy is used to stage the spread of breast cancer. It is a technique by which the “sentinel” or first lymph node to collect the lymphatic fluid draining from the breast is examined for the presence of metastasis. If breast cancer is present in this lymph node, a formal lymph node dissection is performed as there is a reasonable chance that the cancer has spread to additional lymph nodes in the arm pit or axilla. If no cancer is present here, oncologists can be reasonably certain that the cancer has not spread beyond the local site in the breast and a formal axillary lymph node dissection is avoided.
In patients who have had past breast surgery, the sentinel lymph node biopsy technique was contraindicated due to a hypothesized risk that the breast lymphatics were divided and that this would lead to an inability to accurately identify the sentinel node. Recent studies have suggested that this may not be the case and that the procedure can be appropriately performed. Fernandez et al. evaluated 70 patients who underwent breast augmentation via an inframammary or periareolar approach or a breast reduction that ultimately developed breast cancer. These patients underwent a sentinel lymph node biopsy as part of their cancer staging. The sentinel node was identified in 100% of these patients and none of them went on to develop recurrence of the tumor in their axilla at 19 months of follow up. This article suggests that sentinel lymph node biopsies can safely and appropriately be performed in women who have undergone previous breast augmentation or breast reduction.
Our websites, www.beauty-surgeon.com and www.drmckane.com have additional information and before and after photographs of breast augmentation and breast reduction for review. I invite you to schedule a consultation with me if you would like to learn more about breast augmentation, breast reduction, or breast conservation surgery. Please feel free to contact our office at (713) 661-5255 if you have any questions.
-Brice W. McKane, M.D.
Posted in Breast Augmentation, Breast Cancer, Breast Reduction, Home | No Comments »
April 24th, 2009 Dr. McKane
I review all of the comments that I receive to my blog. Occasionally, one will ask a specific question that I am happy to answer. A few days ago, I received a comment asking “It seems that breast reduction surgery can help women. Would you share more information and experience about this procedure?”
Breast reduction or reduction mammaplasty is a procedure that can be performed for women that experience neck, shoulder, breast, and back pain due to the large size and weight of their breasts. Other problems that a woman with large breasts may experience are shoulder grooving, neurologic symptoms of the hand, and intertrigo. Breast reduction surgery can improve these symptoms. Some insurance companies have benefits for the procedure.
Breast reduction surgery can help with women with large breasts, if you wonder about this, I would point you to a recent article by Woodman et al. that looked at women’s perception of life following breast reduction. This phenomenological study has a limited number of participants but provides valuable insight into the lives of several women that have undergone breast reduction surgery. The advantage of this study is that it looks at experiences from a first person (patient’s) point of view and not from the surgeon’s point of view. Patients often want to know if the surgery will improve their symptoms. The participants in this report noted a reduction or elimination of their pain symptoms, improved body image, increased self esteem, and increased self confidence. This study also found that there were some negative experiences associated with the surgery and its recovery. However, the improvements the women experienced made the surgery worthwhile and would lead them to recommend the surgery to other patients with breast hypertrophy.
Here is an example of a woman that experienced significant neck, shoulder, and back pain due to the large size of her breasts. Without a bra, she even experienced pain in the sides of her breasts. She wanted to undergo a breast reduction to help alleviate her symptoms. This is the preoperative photograph:
She underwent an inferior pedicle wise pattern breast reduction. This is the postoperative result:
The reduction improved her symptoms of neck, shoulder, back, and breast pain and dramatically improved her quality of life. The procedure also provided her with improved self confidence and self esteem. She was pleased that she ultimately decided to undergo surgery after waiting a long time while considering it.
Our websites www.beauty-surgeon.com and www.drmckane.com have additional information and before and after photographs of breast reduction for review. I invite you to schedule a consultation with me if you would like to learn more about breast reduction surgery or the improvements that can be experienced with it. Please feel free to contact our office at (713) 661-5255 if you have any questions.
-Brice W. McKane, M.D.
Posted in Breast Contouring, Breast Reduction, Home | 2 Comments »
July 21st, 2008 Dr. McKane
I received an email today from a young woman who is not happy with the size of her breasts following a breast reduction (reduction mammaplasty) procedure. She writes, “When I was 16 I suffered from very large breasts. I had a lot of neck, shoulder, and back pain which was improved by my reduction. I’ve always felt that I was made too small. Now, I’m 24 and I’m going to be married next summer. Is it possible to have a breast augmentation after a breast reduction in your center in Houston? I really want to look good in my wedding dress. Please help.”
There are over 100,000 breast reductions performed in the United States each year. The literature addresses many of the complications of this procedure but long term outcomes studies have failed to identify patients who are unhappy with their final size. Women may experience immediate dissatisfaction if the breasts are over reduced and little breast tissue remains following the procedure. Other women may become dissatisfied with time as changes occur in the breast due to volume loss following weight changes, pregnancy, or with age.
A recent study by Colwell et al. identified 7 patients who felt that their breasts were too small following their breast reduction surgery. The study shows that breast augmentation can be a useful technique in women with this problem. All of them had an improvement in their body image scores following breast augmentation. 5 out of 6 of them were very satisfied following the procedure.
Here is an example of a patient that underwent a breast augmentation in my practice following a breast reduction by another surgeon. She is a 36 y/o woman who underwent a small breast reduction in 1997. She was pleased with her surgery until recently when she has felt that her breasts have become “deflated” On examination, she had lost upper pole fullness and volume in her breasts. She also has pigmented scars typical of a patient with a prior history of a breast reduction. Here is the preoperative photograph:
During our consultation, she decided that she would like to use a 325 cc implant to help restore her breast volume. Due to her prior history of a breast reduction, I elected to put her implant into the sub pectoral plane. I used a small segment of the breast fold incision that she already had as the approach. Here is the postoperative result:
The operation achieved her goal of a fuller breast following breast reduction surgery. It should be noted that this patient also underwent a tummy tuck (abdominoplasty).
Our websites www.beauty-surgeon.com and www.drmckane.com have additional information about breast augmentation and before and after photographs for review. I invite you to schedule a consultation with me if you would like to learn more about this procedure. Please feel free to contact our office at (713) 661-5255 if you have any questions.
-Brice W. McKane, M.D.
Posted in Breast Augmentation, Breast Reduction, Home | No Comments »
