Rebuilding Since 1895
Plastic surgery. Both praised and criticized in the mass media; cosmetic surgical procedures have always been seen as slightly taboo. Shrinking factions of modern-day culture often look down upon the altering of one’s physical features, a criticism admittedly not without merit. While many believe cosmetic surgery is simply a tool used to enhance one’s existing features and increase body positivity, others attack its artificiality; “natural” beauty is to be embraced without alterations, they argue. But one often overlooked portion of the plastic surgery industry, encompassing over a quarter of all procedures, will rarely draw controversy.
Whether through physical trauma or disease, disfigurements to the body are emotionally devastating. And it’s up to a plastic surgeon to restore a patient’s confidence in their own skin. According to the American Society of Plastic Surgeons, over 5.8 million reconstructive procedures were performed in the United States in 2016. Of those (excluding tumor removals), laceration repairs, maxillofacial surgeries, and scar revisions topped the charts.
But the next most common procedure is fairly unique in origin. While lacerations and maxillofacial injuries and scars are often the results of physically traumatic accidents, the disfigurement caused by breast cancer is incomparable in nature.
The removal of cancerous breast tissue can be devastating both physically and mentally to a breast cancer patient. And considering the fact that breast cancer is the most common cancer among women, amounting to about a quarter of all female cancer cases, extensive research has been done into treatment options for those affected. In fact, the oldest evidence of breast cancer treatment comes from the Edwin Smith Papyrus, estimated to have been written about 3600 years ago in Egypt. It describes eight cases of breast tumors which were treated with cauterization of the breast, noting that “there is no treatment” for this disease.
Between ancient Egypt and the 17th century, little advancement towards treatment was made. Medical practitioners occupied themselves with postulating preventative measures rather than responsive treatments. And the treatments that were proposed were often barbaric; prescriptions of poisonous herbs and chemicals, including arsenic, were common due to the danger associated with surgical removal of the affected tissue. Even when it was discovered that excision of the tumor was often necessary for a positive prognosis, little thought was given to recovery after surgery. Early mastectomies from the 6th century and on were brutal and disfiguring, leaving a woman’s chest looking “like a skeleton” in most cases; as time passed, surgeons began to remove more of the affected area, including lymph nodes and underlying muscles. These procedures were later refined and became known as radical mastectomies, a term popularized by American surgeon William Stewart Halsted, who was aided by modern anesthesia and aseptic technique decreasing the risk of pain, trauma, and infection in the late 1800’s.
Still, little consideration was made towards post-surgical physical rehabilitation in the form of reconstruction. Radical and so-called “super radical” mastectomies left little tissue to work with. The first documented attempt at a breast reconstruction did not occur until 1895 when Vincent Czerny, a surgery professor in Heidelberg, transplanted a lipoma from the patient’s flank to her breast. Over the next few decades, rare attempts at reconstruction were made using various tissues from other locations on the body. Early reconstructive attempts were often risky and laden with complications such as necrosis of the tissue and heavy scarring; reconstruction was rarely recommended.
It wasn’t until 1963 with the introduction of the silicone implant that the modern era of breast reconstruction began. From there, research advanced quickly. Implants were generally inserted with a brief delay following mastectomy, but in 1971 it was reported that immediate silicone implants inserted in place of the removed tissue underneath the breast wall proved to be more effective and less traumatic.
Various types of flaps were also designed, using the patient’s own tissue to reconstruct a breast mound. Continued refinements were made to improve surgical procedures and appearance of the reconstructed breast.
Significant research in the 1980’s and 1990’s confirmed that breast reconstruction performed immediately after mastectomy, during the same surgical procedure, did not lead to increased recurrence of breast cancer. This led to the current standard of care of immediate breast reconstruction where an oncologic surgeon performs the mastectomy procedure and a plastic surgeon performs the breast reconstruction immediately afterwards so that when the patient wakes up from anesthesia, she does not have a devastating mastectomy defect, but rather has begun the process of moving forward to become whole again.
Today plastic surgeons work closely with their oncologic surgeons to determine the best surgical plan for treatment of the patient who requires mastectomy for treatment of breast cancer.