The Miami Herald

Silicone implants are not the only way to go in breast reconstruction

My fear of dying was diminishing. In about two weeks the cancerous tumors would be removed. And if it weren’t that my breasts were going to be gone, and I felt pressured to choose a method of immediate reconstruction, I would have thrown a party.

The days when saline implants were the only approved devices for reconstruction are long gone. The options now include cohesive gel-filled implants, the TRAM-flap (transverse rectus abdominis myocutaneous), which uses other muscles to build a breast, and even fat transfer.

To assume that the options come without risks, is to believe in the tooth fairy.

Breast cancer survivor Shirl McNabb, 43, described how she was rushed into choosing silicone implants during her first reconstruction.

“I did a mammogram, a sonogram, then a digital mammogram, then an MRI. The next day they did the lumpectomy, within a week later I was in having a double mastectomy,” said McNabb. “I was in such a rush, because here they are telling you this is a life-or-death situation … I came out with the expanders [saline- filled prosthesis placed under the pectoral muscle with a port used for inflation].”

Breast cancer survivor Diane Purin, who had a unilateral mastectomy and her first reconstruction with saline implants, related to the pressure.

“It all goes too fast. I think that you are so overwhelmed by the emotion of it all,” said Purin, 50. “I mean we are intelligent women and under any other normal crisis you would sit there and you would do the homework and you would figure out what your options are. We didn’t. We didn’t have time.”

Both McNabb and Purin pursued a second reconstruction with the help of Dr. Roger K. Khouri, a Key Biscayne plastic surgeon and pioneer in fat transfer to breast and reconstructive microsurgery.

McNabb’s painful journey worsened after the silicone implants replaced the expanders and she found a cancerous lump growing on her chest wall. Doctors decided to radiate her breast without removing the implant.

“They eventually had to take the implant out. The radiated tissue was like plastic, ” McNabb said. “I felt like I wasn’t a woman, like I wasn’t even a person. I felt less than human. I woke up every morning and I looked in the mirror and I would ask my self, ‘Will I ever be whole again?’ You don’t just grow breasts.”

Khouri, who has performed breast implants and TRAM-flap procedures, disagrees. He uses a dome system named BRAVA that applies tension “to expand the tissue,” so that he can inject fat suctioned off from other parts of the body to “grow breasts.”

“I would say two-thirds of my practice is taking care of silicone implant problems, especially after radiation,” said Khouri. “Implants never have sensation. They always feel foreign. They don’t last and they are more expensive to the system.”

Experts say radiotherapy to the breast area increases the risk of scar tissue and hardening around the breast implant to 40 to 50 percent. The most common side effect with implants is capsular contraction, which happens when the scar tissue contracts against the implant. Some surgeons use textured implants to reduce the risk, and the contracted capsule can be surgically removed.

“Even without complications, it’s very painful to do the expander and get the implant put in,” Purin said. The process of inflating the expander can take three to six months, and thanks to the bravery of about a dozen women, it can be viewed on YouTube.

“The saline implants are not meant for reconstruction. They are meant for augmentation,” said Purin, who was not satisfied with the appearance of the implant. “They are kind of like the top of a hamburger bun. They are very flat.”

Purin and other breast cancer survivors agreed that losing sensation can also be very traumatic.

“I could remember one time I was leaning over and I was closing an under-counter refrigerator and I couldn’t understand why the door wouldn’t close,” said Purin. “My breast was in the way.”

Purin says that after months of fat grafting that is no longer an issue and sensation has returned to her breast. For McNabb, who has yet to complete the reconstruction, this was emotionally painful.

“I felt like [my husband] was getting short changed. It’s not fair. ‘God if you want to punish me that’s one thing, but why are you punishing this beautiful man who loves me so much, and does so much for our family.’ And here he gets this second-rate thing for a wife,” said McNabb. “I don’t like to take my clothes off in front of him, and I can’t wait for that day when I feel full again.”

With the help of Khouri, McNabb believes she is on her path to a “miracle.”

For me, the clock is ticking. The mastectomy is right around the corner. I think I may have crossed the implants off my list, but I am still not sure.




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