Cosmetic Breast Surgery

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Cosmetic Breast Surgery

• By Elizabeth T. Weaver B
• BSN, RN

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Purpose of Presentation

• Provide an overview of Cosmetic Breast Surgeries
• Reasons for Cosmetic Breast Surgeries
• Expectations and Complications of Procedures
• F.D.A. Recommendations and current research
• Case Study

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3 Most Common Types of Cosmetic Reconstruction

• Breast Augmentation Mammoplasty, most common
  cosmetic surgery, using various
  techniques/materials, estimated 1.8 million
  American women have silicone implants, (1.2 of
  female population)
• Reduction Mammoplasty, 5th most common cosmetic
  surgery
• Breast Lift Laser Bra

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Breast Augmentation Mammoplasty

• Various Reasons for choosing surgery
• Feelings that breast are too small or sag
• Out of proportion, one smaller that the other
• Loss of volume after pregnancy/weight loss
• Reconstruction after cancer treatment
• Patient desires- ENHANCED APPEARANCE

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Patient Desires Enhanced Appearance
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Restoring a Womans Natural Beauty
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Maintaining Professionalism

• Ethical opinions need to be maintained
• Keeping Bias at bay
• Culturally breast enhancement is starting at an
  earlier age among white women, gt college age
  white women with access to health care and
  socioeconomic status
• Black Women less likely to reconstruct after
  cancer treatment

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Surgical Procedures

• Silicon sacs filled with saline or silicon gel,
  placed under the skin or muscle
• Submuscular most popular with better results
• TRAM Flap Trans Rectus Abdominal Muscle, results
  with a tummy tuck
• Latissimus Dorsi Flap muscle off back slid to
  front, results asymmetry of back area

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What does the F.D.A. say?

• F.D.A. approves silicon gel implants only for
  currently approved F.D.A. Clinical Trails.
  F.D.A. 1-800-532-4440
• Saline implants most commonly used
• New evidence that platinum by be leaking from
  silicon sacs, platinum is an ingredient of
  silicon, data not conclusive

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Follow up Teaching For Screening of Cancer

• Continue SBE, Breast implants separate tissue
  from chest wall, often easier to do exams because
  ribs do not interfere
• Mammograms, same as for women without implants
  except, need facility with experience and
  interpretation
• National Cancer Information Service 1-800-4cancer

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• Breast Feeding is still possible, reports
  indicate more silicone found in cows milk than in
  breast milk
• Improved Self image and confidence
• Scars often will fade
• Best to wait till after pregnancies for best
  results
• Implants do not age well, sagging often results
  (Study)
• Patient Education on Risks, Benefits, and follow
  up care found essential to good outcome

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TRAM Flap Requires Experienced Plastic Surgeon

• Skin, Fat and Muscle tissue is removed from
  Abdomen, transplanted to breast area via
  microscopic surgery, surgery time 2-4 hrs
• May result in tummy tuck
• Long-term satisfaction is greater
• Potential complications longer surgery time,
  larger wounds, rejection, bleeding complications,
  and increased cost

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Post Cancer Treatment Reconstruction

• Expectations need to be discussed
• Often future surgeries to make adjustments to
  reconstruction site or the other breast to match
  shaping and size
• Add nipple
• Tattooing
• Most patients satisfied with the decision to
  reconstruct

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Breast Reduction Mammoplasty

• 5th most common cosmetic surgery
• 2001- 99,428 surgeries done
• Reasons 1 Pain, back, neck, and shoulder
• Developed 50 years ago
• 2-6 hr procedure, extensive scars, nipple
  sensation and breastfeeding ability decreased

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Reduction Mammoplasty

• Anchor incision made near nipple
• Excise and discard glandular, fat, and skin
  tissue
• Relocate nipple
• Risks of blood loss due to vascular tissue
• Infection
• Activity limited for 1-2 months postop

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Newer Approach

• Liposuction technique
• Incision ¼, close to scarless
• Minimum effects on breastfeeding
• No cutting
• Less blood loss
• Less recovery time

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New on the Horizon for Reduction

• Medications
• Dimunex Herb/Chemical, action increase muscle
  tone and decrease fat
• Claims decrease breast tissue by 33 in 3-4
  weeks
• Ingredients St. John Wort, Dandelion Root, Cat
  Claw, Horse Chestnut

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New on the Horizon for Enhancement

• The Stevens Laser Bra, invented in L.A.
• Forms an internal bra from patients own tissue
  using the Co2 Laser
• Laser d-epithelializes the skin to create an
  internal bra with the normally discarded skin
  tissue
• Bra is connected to chest wall to create the
  Lift

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Clinical ResearchWhat are we learning?

• Breast Implants Do Not Age Well
• Researcher reported in Plastic Reconstruction
  Surgery Vol. 107.No. 7 1702-1709, over time
  implants did not hold up as well as the TRAM Flap
• 2 part study, results at 5 yrs, implants
  satisfaction rate 54, compared to TRAM Flap at
  92

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Prophylactic Mastectomy

• Option for those at risk
• Minimum long-term efficacy
• ? How to remove all breast tissue
• Mayo Clinic Study 1960-1993
• Risk assessment based on Gail Model
• Control group sisters
• Results 90 reduction in incidents of breast
  cancer
• APN aware of risks and counseling concerns

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Micheles Story(A case study on reconstruction)

• 1999 38y/o white female G3P3,Used OCP for 10yr,
  breast feed all 3 children, BMI wnl exercise 5
  times a week
• Pt c/o fibrocystic breasts on BSE, mammogram
  neg., sono positvie for two small 5mm lumps on
  right upper quadrant of breast
• Surgeon-hold for 6 months without biopsy,
  decision made to biopsy
• Dg. On needle biopsy Ductal Carcinoma In situ,
  decision made to do skin saving technique radical
  mastectomy
• Modified (without muscle) done with right sided
  removal of lymph nodes, sentinel node not
  perfected at this time.

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The adventure of reconstruction

• Surgery done March 1999 with expanders in place
  with port for saline administering access
  (surgeon and plastic in on case)
• Q6wks injected to fill expanders
• Oct. 1999 ready for real implants and nipple
  plastic surgery (form a purse string bunching)
• Inducted into the FDA McGane Study
• Jan. 2000 tattooing of the nipple

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Adventure continues

• Feb. 2002 implants shift and need replacing due
  pain
• Received a new weighted implant
• Scar under nipple line opposed to axilla
• Dec. 2002 fell while snow skiing and left
  implant ruptured
• Jan 2003 Study site in Colorado replaced implant
• Chest x ray finds two small non-biopsyable small
  legions on right and left lung

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Currently Doing Well

• Q 6 month MRIs to follow legions, diff. dg is
  possible calcium deposits from injury
• Full time RN, Climbed 6, fourteeners in Colorado,
  holds a position with the 3 day events for Komen
• Would you reconstruct again YES
• Theoretical Framework Abraham Maslow

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Maslow Motivation Key

• Individuals have to be active in self care, not
  passive
• Active participant strives for self actualization
• Science should explore individuals who recognize
  their full potential
• Basic needs must be met before the individual can
  progress to next stage of personal growth
• This leads to fullest potential
• Which leads to inner peace
• Each person is at a different level determined by
  ones own on basic needs

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How Maslow can be applied to Nursing

• Allows the nurse to emphasize strengths instead
  of weaknesses
• Focuses on the Human Potential, thus giving HOPE
• Gives a blueprint for prioritizing a clients care
  according to their hierarchy of needs
• Physiological, safety, love and belonging, self
  esteem, self-actualization

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Conclusion

• Aware of our own attitudes respect others choices
  
• Encourage realistic expectations with our
  patients
• Focus on health promotion and illness prevention
  as primary goal

Live Well with Your Illness
Live Well with Your Illness
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References

• www.plasticsurgery.org
• www.cosmedical.com
• www.cancer.org
• www.medicalreporter.health.org
• www.fda.gov
• American Academy of Plastic Surgeons, Home Room
  Press Release. Retrieved September 2, 2004 from
  hhttp//www.plasticsurgery.org/news_room/press_rel
  ease/breast-reduction-surgery-more-