ENCORE #135! – The Reconstruction Era Part 13: History and Future!

From the first moment my wife discovered she had breast cancer in March of 2011, there was a deafening silence from the men I knew. 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…That was four years ago – as time passed, people searching for answers stumbled across my blog and checked out what I had to say. The following entry first appeared in June of 2014.

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

Image: https://c2.staticflickr.com/6/5527/10893068965_1d328e8f71_b.jpg