Mastectomy or Lumpectomy?

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Submitted by Twin City Plastic Surgery

There is nothing easy or simple about a cancer diagnosis. From the moment a patient hears the words “you have breast cancer,” she begins an exhausting schedule of medical appointments, treatments, and procedures. While much attention is given to treating the patient’s medical condition, she also needs support in thinking through her options impacting her health and appearance.

The vast majority of breast cancer diagnoses involve some type of surgical treatment with lumpectomies being more common in early-stage cancer situations. According to the American Cancer Society (ACS), 57 percent of women with early stage (Stage I or II) breast cancer have a lumpectomy or partial mastectomy and 36 percent have a full mastectomy, with others electing non-surgical options. Thirteen percent of women with late stage breast cancer (Stage III or IV) have a lumpectomy or partial mastectomy and 60 percent have a mastectomy.

The ACS also tells us 20 to 40 percent of women who undergo mastectomy have breast reconstruction which typically includes an implant, tissue from another part of the body, or a combination of the two.  Some types of reconstruction can begin during the mastecomy surgery itself, so having a reconstruction plan from the beginning of treatment is critical. Of course, some women are not candidates for lumpectomies due to the size or location of the tumor. But for a woman who has options, how does she make the decision to remove part or all of her breast?

Current data shows the type of surgery – lumpectomy or mastectomy – does not appear to impact a patient’s survival rate or possibility of cancer recurrence. Also, these surgical options do not impact the need and/or type of chemotherapy and/or hormone therapy a doctor recommends.

A lumpectomy always:

  • Allows the patient to preserve more of their breast, which can give the patient comfort and an obvious feeling of normalcy.
  • Involves a less extensive surgery in which the patient can go home the same day.
  • Requires radiation as part of the therapy to treat the breast cancer.
  • Does not involve placement of an implant.

Lumpectomy with radiation therapy (XRT) is becoming much more common versus a full mastectomy, and, therefore, mastectomies may be on the decline. From a breast conservation perspective and oncologic perspective, this is good. But there are some downsides to choosing lumpectomy/XRT that are rarely mentioned to the patient.

  • Lumpectomies can result in uneven breasts which may not give the patient the look they hoped for.
  • The defect may still leave a significant cosmetic concern, but any surgery to correct this may be considered cosmetic and be more difficult to get covered by insurance.
  • Radiation treatments can cause adverse cosmetic changes such as darkening of the skin at the treatment site.
  • Any surgery that is ever done on the radiated breast for the rest of that patient’s life, is at a much higher risk for complications due to the radiation, and, therefore, limits the patient’s options for reconstructive surgery in the future.

The decision to have a lumpectomy or mastectomy is as individual and personal as a surgery can be. Each patient should to talk with their plastic surgeon prior to making their final decision so they can be fully informed of the advantages and challenges of each option. As board-certified plastic surgeons, we have the education and experience to provide effective breast reconstruction consultations and provide our patients peace of mind during a stressful time as they reclaim their life and body from this disease.

Scar Revision….Minimizing the Reminder of a Wound or Surgery

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Submitted by Twin City Plastic Surgery

Scars are visible signs that remain after a wound has healed. They are unavoidable results of injury or
surgery, and their development can be unpredictable. Poor healing may contribute to scars that are
obvious, unsightly or disfiguring. Even a wound that heals well can result in a scar that affects your
appearance. Scars may be raised or recessed, different in color or texture from surrounding healthy
tissue or particularly noticeable due to their size, shape or location.

Scar revision is meant to minimize the scar so that it is more consistent with your surrounding skin tone and texture. Although scar revision can provide a more pleasing cosmetic result or improve a scar that has healed poorly, a scar cannot be completely erased.

Is it right for me?
Scar revision is a highly individualized procedure and you should do it for yourself, not to fulfill someone else’s desires or to try to fit any sort of ideal image. Scar revision can be performed on people of any age and is a good option for you if:

You are bothered by a scar anywhere on your body
You are physically healthy
You do not smoke
You have a positive outlook and realistic goals for your scar revision surgery
You do not have active acne or other skin diseases in the area to be treated

The success and safety of your scar revision procedure depends very much on your complete candidness during your consultation. You’ll be asked a number of questions about your health, desires and goals, medical history, and lifestyle habits.

Different types of scars include:
Discoloration, surface irregularities and other more subtle scars can be cosmetically improved by
surgery or other treatments recommended by your plastic surgeon. These types of scars do not impair
function or cause physical discomfort and include acne scars as well as scars resulting from minor injury and prior surgical incisions.

Hypertrophic scars are thick clusters of scar tissue that develop directly at a wound site. They are often
raised, red and/or uncomfortable, and they may become wider over time. They can be hyperpigmented
(darker in color) or hypopigmented (lighter in color).

Keloids are larger than hypertrophic scars. They can be painful or itchy, and may also pucker. They
extend beyond the edges of an original wound or incision. Keloids can occur anywhere on your body, but they develop more commonly where there is little underlying fatty tissue, such as on the face, neck, ears, chest or shoulders.

Contractures are scars that restrict movement due to skin and underlying tissue that pull together during healing. They can occur when there is a large amount of tissue loss, such as after a burn. Contractures also can form where a wound crosses a joint, restricting movement of the fingers, elbows, knees or neck.

The degree of improvement that can be achieved with scar revision will depend on the severity of your
scarring, and the type, size and location of the scar. In some cases, a single technique may provide
significant improvement. However, your plastic surgeon may recommend a combination of scar revision techniques to achieve the best results.

Topical treatments, such as gels, tapes or external compression can help in wound closure and healing,
or to reduce the ability of skin to produce irregular pigment. These products may be used to treat existing surface scars and discoloration, and to aid in healing of scar revision procedures.

Injectable treatments are often used to fill depressed or concave scars. Depending on the injectable
substance used and your particular scar conditions, results may last from three months to several years.
Therapy must be repeated to maintain results.

Surface treatments are most often used for cosmetic improvement of scars. These methods can soften
surface irregularities and reduce uneven pigmentation. Surface treatments are a controlled means of
either mechanically removing the top layers of skin or changing the nature of tissue. These treatment
options include:

Microneedling is a form of collagen induction created by a mechanical force delivered to the
dermis. It also is useful for improving acne pock marks and can weld stretch marks together by
creating collagen bridging.
Dermabrasion is a mechanical polishing of the skin.
Laser or light therapy causes changes to the surface of the skin that allow new, healthy skin to
form at the scar site.
Chemical peel solutions penetrate the skin’s surface to soften irregularities in texture and color.
Skin bleaching agents are medications applied topically to lighten the skin.

Surgery is sometimes necessary for the improvement of scars especially if non-surgical means are not
possible or successful. Often the scar is excised and then closed in layers adjusting the tension or
orientation of the scar. Advanced techniques with flap closure or repositioning of the scar in a natural
crease sometimes makes it less conspicuous. More advanced techniques, such as tissue substitutes/skin
grafting or tissue expansion, may be necessary if the scar is more complex.  Give Dr. Laura Randolph a call at (309) 664-6222 to discover your scar revision options today.

Breast Augmentation … It’s A Personal Choice!

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Submitted by Dr. Laura Randolph

Reasons may vary as to why women elect to have breast augmentation surgery. According to the American Society of Plastic Surgeons, the reason is simple: women get breast augmentation surgery because they are dissatisfied with their breast size. Some women want to improve the balance of their figure and improve self-image, while other women want to restore breast volume after weight loss or child birth. But regardless of the reason why, how many women are really satisfied with their results?

Well, the results are clear:  98% of women undergoing breast augmentation surgery say the results met or exceeded their expectations, according to a study in the May 2016 issue of Plastic and Reconstructive Surgery®.  In the study of 225 consecutive women who returned for interviews at least 1 month after breast augmentation over a 5-year period, women also reported improvements in self-esteem and quality of life after breast augmentation.  In addition, on a 10-point scale, women reported an average pain score during recovery of 5.9. On average, they used prescription pain medication for 5 days and were off work 7 days. Patients felt they were “back to normal” about 25 days after surgery, the new study showed.

Furthermore, 85% of women rated their new breast size “just right.” 13% would have preferred a larger size, and less than 2% wished they had chosen a smaller size. Only 1% expressed dissatisfaction with their scars. Seventy-five percent of women rated their breast firmness “just right.” When asked to rate the result, more than half of the patients gave it a perfect 10 on a scale of 1 to 10. Almost all patients (98%) reported that the results met or exceeded their expectations.  On another note, nearly 40% of the patients surveyed experienced at least temporary nipple numbness after surgery. Persistent numbness was reported by only 2% of patients. The complication rate reported by patients was 10%.

When asked about psychological effects, 92% of women reported improved self-esteem after breast augmentation, and 64% reported an improved quality of life. Before surgery, the majority of women (86%) were self-conscious about their breasts. After surgery, only 13% were self-conscious about them.

Electing to have cosmetic surgery may not be right for everyone, but the choice is personal and the individual outcome is what truly matters.

 

Source:  Plastic Surgery Practice

For more information regarding breast augmentation or other cosmetic surgery procedures contact Dr. Laura Randolph—309-664-6222.

You’ve Lost The Weight … Now What??

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Submitted by Twin City Plastic Surgery

We’ve all heard countless success stories about friends, family members and even total strangers who have lost significant amounts of weight. Maybe it’s even you who has dropped 100 pounds or more, either strictly by diet and exercise or interventional methods such as bariatric surgery. While either of these results in better long-term health, your initial appearance after weight loss may be not quite what you expected.

What happens after massive weight loss?

While you’re carrying those extra pounds, your skin is stretched around areas of your body like the abdomen, arms, legs, breast and face. After significant weight loss, the skin often fails to shrink back, resulting in upper arms that may sag and appear loose or full, flattened breasts, excess abdominal skin that may lay apron-like around your sides and lower back area, and hanging pockets of skin around buttocks, groin and thighs.

Many individuals who have experienced a great weight loss are turning to plastic surgery to improve the shape and tone of underlying tissue that supports fat and skin and removes excess sagging fat and skin. The result gives your new body a more “normal” appearance, with smoother contours.

The skinny on post-weight loss plastic surgery

There are a number of procedures that may be of interest to an individual who has recently lost 100 pounds or more. They include:

Body Contouring

Also called a body lift, this is the most commonly-performed surgery after weight loss. More than 106,000 body-contouring procedures were performed in 2016, up 77 percent over the last five years, according to the American Society of Plastic Surgeons. Massive weight loss patients accounted for nearly 56,000 procedures. Body contouring is the removal of excess, sagging skin around the abdomen and a tightening of skin around the buttocks, abdomen, waist, hips, thighs and arms.

Tummy Tuck

A tummy tuck involves an incision at the bikini line and around the navel. The surgeon then manipulates the skin and tissues and repairs weakened abdominal muscles. In some cases, you may have an additional incision to remove excess skin in the upper abdomen.

Breast Lift

During a breast lift, excess skin and tissue is removed and the nipple is repositioned. Implants can be added as well to improve shape.

Brachioplasty

This procedure removes excess skin from the upper arm area.

Face “Lift”

This  procedure involves removing excess skin around the face and neck.

Are you ready for the final step?

Many consider plastic surgery the “final step” in their weight loss journey. If your weight has stabilized for at least a year and you’re in overall good health, and if you don’t smoke and are committed to good nutrition, fitness and an overall healthy lifestyle, you are likely to get the thumbs up from your doctor as well as your plastic surgeon to make the desired physical tweaks. However, this process is not one to be entered into lightly. The results may be immediate but the healing will take time, your activity will be restricted temporarily, visible scarring will remain, and it will be your job to maintain a stable weight and overall fitness for the remainder of your life.

No matter if your weight loss is due to diet or surgical means, you deserve to have the body you earned for a lifetime to come.

Call Dr. Randolph (309) 664-6222 for a consultation. Contact Us

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