Several interesting topics were discussed at the Breast Surgery Symposium in Atlanta, GA at the Southeastern Society of Plastic and Reconstructive Surgeons Meeting.  A panel discussing Oncoplastic Breast Conservation Surgery & Nipple Preserving Mastectomy was extremely interesting.   For decades Plastic Surgeons have provided reconstructive options for women undergoing partial and complete mastectomy which are included but not limited to the permanent silicone gel implant, tissue expanders that are later exchanged for implants, expanders and or implant in addition to a latissimus flap, and the now various forms of flap from the lower abdomen and thighs such as the TUG flap, Free TRAM, Pedicled TRAM, and the increasingly popular DIEP flap. Despite all of the options less than 30 percent of women get a reconstruction.  This leads to finger pointing on both sides.  The plastic surgeons think the general or breast surgeons are not referring or discussing breast reconstruction in their initial consultation with the patients and the general surgeon or breast surgeons feel like they cannot get a plastic surgeon to see the patient.  Sometimes because of location there may not be a plastic surgeon nearby.  This is becoming less the case with the aid of the internet.  Finding physicians and surgeons is becoming easier.  There can be hurdles with insurance after that with respect to the providers.  Fortunately it is a Federal Law that women have the ability to under reconstruction after mastectomy and any symmetry procedures on the opposite breast.

One of the take home points from the panel to me was that great reconstruction outcomes can only  happen with great mastectomies.  That means the general or breast surgeon has to do a great job performing the mastectomy in order for the plastic surgeon to then perform the best reconstruction.  In cases of nipple sparing mastectomy the general or breast surgeon performs the mastecomy and sentinel lymph node biopsy and then performs a biopsy of the tissue behind the nipple to confirm there is not cancer.  At this point the plastic surgeon can perform the reconstruction with a comination of expanders and acellular dermal matrix.  The techniques can very among the plastic surgeons who perform the procedure but the outcomes should be great if the mastectomy was done well.  The final product shold look like a breast augmentatin rather than a breast reconstruction.