From the first moment my wife discovered
she had breast cancer, there was a deafening silence from the men I know. Even
ones whose wives, mothers or girlfriends had breast cancer seemed to have
received a gag order from some Central Cancer Command and did little more than
mumble about the experience. Not one to shut up for any known reason, I started
this blog…
“It appears that the next event is breast
reconstruction!”
Today will be a bit of history regarding breast
reconstruction and a glimpse into the future.
“Documented cases of breast cancer date back to 6000 BC...George
Washington’s mother, Queen Mary, and Nabby Adams (daughter of John (second
president of the US) and Abigail Adams) succumbed to breast cancer...Breast
cancer surgery was revolutionized by Dr. William Halsted, who popularized the
radical mastectomy as the treatment of choice for any woman with breast
cancer...the latter half of the 20th century [saw] the modified radical
mastectomy...breast conservation therapy...sentinel lymph node biopsy and
radiation was developed...[and] the emergence of breast cancer reconstruction.”
Initial attempts at reconstruction were crude, though as the
years passed, certain of those techniques finally met adequate technology. For
example, in the 1800’s, there were attempts to transplant a lipoma (fat slice)
to a mastectomy site. This lead to techniques that were largely unsatisfactory,
but were clear precursors to the current successful practice of the
microsurgery that allows for TRAM flap reconstruction. As well, initial use of
silicone breast implants, the subsequent frenzy that toppled the Dow Corning
corporate giant, and the FDA’s recanting of its 24-year ban on the same
implants; has led to the use of both saline and silicone implants preceded by
insertion of expandable “bubbles” to stretch tissue in preparation for the
implant, and cadaver-harvested, cell-free matrix that holds the expander in
place.
What exactly does the future hold?
Some possibilities:
“Adipose derived stem cell breast reconstruction...is still
considered experimental...” and involves the removal of fat tissue. One half
remains as it is, but the other half undergoes a process that concentrates stem
cells. This “concentrate” is then mixed with the original fat tissue and
injected into the breast. The stem cells take on the characteristics of the fat
and grow into fat cells. There is however, good evidence that this procedure is
becoming more generally accepted. (http://www.futuremedicine.com/doi/abs/10.2217/17460751.4.1.109)
“skin-sparing and nipple-sparing mastectomy” in which the
surgeon removes cancerous breast tissue through a small incision usually around
the areola area of the nipple.
In New Zealand, “[A new] tissue expansion...technique allows
soft tissue [to be made into a] meshed matrix of connective tissue [where] small
amounts of fat can be injected into separate small tunnels.” The method has
been in use for 30 years, but this is a new and exciting possibility for reconstructing
human breast tissue – with even less invasion of the body than ever before.
The future is not only on its way – it may actually be here!
Resources: http://www.breastreconstruction.org/ReconstructionOverview/breast_cancer_reconstruction_history.html,
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2884724/,
http://www.medpagetoday.com/Blogs/CelebrityDiagnosis/31043,
http://www.breastpreservationfoundation.org/skin-sparing-mastectomy/,
http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11219885&ref=rss
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