Wednesday, December 2, 2009

PUTTING IT ALL TOGETHER: The Socially Constructed Breast: breast implants and the medical construction of need

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1508290/
Abstract: When silicone gel breast implants became the subject of a public health controversy in the early 1990s, the most pressing concern was safety. This paper looks at another, less publicized issue: the need for implants. Using a symbolic interactionist approach, the author explores the social construction of the need for implants by tracing the history of the 3 surgical procedures for which implants were used. Stakeholders in this history constructed need as legitimized individual desire, the form of which shifted with changes in the techonolgical and social context.
(Full article available: complete article)

Starting in the 1800’s with simple and ineffective procedure using fat redistribution to augment breasts, to a dangerous silicone gel in the 1990’s, to now using the fully bio-synthetic implant, breast augmentation has grown into a highly personalized and popular procedure for both aesthetic improvement as well as reconstruction. Advances in the technology have removed many of the major risks involved in the surgery allowing societal pressures to become a factor in determining its growth in popularity. The procedure is almost always out-patient, most related discomfort has been reduced, and recovery time continues to decrease leading to declines in price of the procedure itself as well as post-care expenses. These changes have led to an overall increase in the desirability of the procedure as well as increasing its accessibility for millions of women. Due to this decrease in risk, the debate over breast augmentation has shifted from a focus on safety and efficacy to the discrepancy between desire and need or cosmetic versus necessary. There are many strong arguments for both sides.

Has breast augmentation become a social necessity or just a social construction? The argument for necessity places high priority on the psychological well-being of women in regard to their self image and gender identity. They argue that confidence and self-esteem can be devastated by the size or loss of one’s breasts and that it is completely natural and acceptable for a woman to seek medicinal aid to restore that confidence. Considering the current perceived social norm, the idea is that it is unrealistic to expect women to be satisfied with an aspect of their body that can now so easily, with current technology, meet the perceived societal standard. The battle over insurance coverage and out-of-pocket expenses for these women is the greatest concern and topic for debate regarding current and future US health care policy and reform in regards to this procedure. As of now there are varying degrees of coverage primarily with post-operative complications. Enhancement procedures are generally out-of pocket, while post-mastectomy coverage varies by law among states. According to the paradigm of thinking a patient should be able to correct their perceived physical inadequacies and the health care system should recognize these as ailments with legitamate medical concern and accommodate patients with fully insured procedures.

On the other hand, the contrasting opinion is that given that breast augmentation is completely elective and the procedure cannot improve or restore the function of the organ, it's place our society is purely cosmetic. The belief is that the procedure deals with a non-life threatening situation and is in no way deemed necessary surgery and therefore, is only serving to contribute to social stratification, and the social construction of gender normativity and identity. In terms of insurance coverage, this position lobbies against any and all insurance coverage including procedure, post-operative care and post-operative complications. This camp of thought emphasizes patient personal responsibility as the most important factor in elective surgery and promotes the belief that health care funding should be allocated to life-saving procedures and health insurance for the 47 million people who are uninsured and should not be drained by unnecessary, non-life threatening procedures. The aim is to stop the medicalization of self image and self esteem issues that are likely to not even be curable by a surgical procedure and to promote social change for acceptance without the need for cosmetic surgical procedures, particulary breast augmentation.


We recognize that grey areas exist between these arguments, particularly in regard to post-mastectomy reconstruction. Some view this as non-cosmetic or less elective because it is not an enhancement of their natural breasts but rather replacing them and restoring original appearance. Our opinion still lies toward the no coverage side of the spectrum based primarily on our belief in minimalizing medicalization of societal and social pressures. Vast amounts of money are already being spent on essential health issues and this is non-essential surgery. Basically, money could be better spent on saving lives as opposed to subjectively improving appearance. We also have the concern that if we support breast augmentation in new coverage decisions, what other procedures will it open the door for? Will men soon be covered to reverse their baldness because it also hurts their self esteem? Botox? Calf, pectoral or butt implants? Tummy tucks? By including some cosmetic procedures and not others it makes it increasingly difficult to draw the line between the necessary and desired procedures. In light of imminent health care reform and the fact the the US already spents among the most in the world for health care per capita, the public as well as US policy makers need to re-evaluate the true purpose of the medical system and what direction is most beneficial both medically and financially for the American people.

Sunday, November 22, 2009

Health Insurance Coverage for Reconstruction Following Mastectomy

http://www.insure.com/articles/healthinsurance/mastectomy.html

Women have right to health insurance coverage for breast reconstruction surgery after mastectomy

By Insure.com
Last updated May 22, 2009

The Women's Health and Cancer Rights Act (WHCRA) of 1998 is a federal law that requires health insurance companies and self-insured group health plans that cover mastectomies to also provide benefits for mastectomy-related services, including breast reconstruction surgery. If you're receiving health insurance benefits in connection with a mastectomy and you elect breast reconstruction surgery, WHCRA states that the insurer also must cover:

WHCRA is also known as Janet's Law, named after Janet Franquet, who was denied reconstructive surgery after a mastectomy in 1997.
  • Reconstruction of the breast on which the mastectomy was performed.
  • Surgery and reconstruction of the other breast to create a symmetrical appearance.
  • Prostheses (breast implants).
  • Treatment for physical complications of the mastectomy, including lymph edema (swelling caused by an accumulation of lymph fluid in the arm).

Janet's Law

WHCRA is also known as Janet's Law, named after Janet Franquet, who was denied reconstructive surgery after a mastectomy. The Long Island, N.Y., woman was diagnosed with an aggressive form of breast cancer in 1997. Her insurer denied her breast reconstruction because it considered the surgery cosmetic rather than medically necessary. During a lengthy appeals process, which Franquet eventually won, her doctor performed the surgery for free.

Meanwhile, Franquet's plight drew the support of former New York Sen. Alfonse M. D'Amato, who had targeted more than $900 million in federal money for breast cancer research between 1982 and 1998. D'Amato sponsored WHCRA in Congress and helped pushed through the legislation, which was signed into law on Oct. 21, 1998.

WHCRA applies to three types of insurance, according to the Department of Health and Human Services:

  • Self-funded group plans
  • Fully insured group plans
  • Individual health insurance plans

How WHCRA works

WHCRA amended the Public Health Service Act and the Employee Retirement Income Security Act of 1974 (ERISA). It is administered by the U.S. Department of Health and Human Services and the U.S. Department of Labor (DOL). It does not require group health plans and individual insurers to cover mastectomies. Instead, it requires those plans and insurers that already provide coverage for mastectomies to also pay for breast reconstruction surgery in connection with a mastectomy

WHCRA does not prohibit plans and insurers from imposing deductibles or co-payments for benefits relating to breast reconstruction surgery following a mastectomy. However, these deductibles or co-payments must be consistent with those charged for other benefits under the health plan.

It's against federal law for a health insurance company to deny you a policy or fail to renew your health insurance coverage solely for the purpose of avoiding WHCRA's requirements. In addition, insurers must not penalize your doctor for complying with WHCRA or provide financial incentives to induce your doctor to furnish care that is not consistent with WHCRA rules.

Although WHCRA covers most women with group health plans and individual insurance, the law does not apply to everyone, according to the DOL. If your employer is a church or state or local school district, and the plan is self-insured, your employer is exempt from WHCRA. It does not apply to state high-risk pools either. Although these plans may indeed cover mastectomies, they do not have to cover breast reconstruction or implants.

State breast reconstruction laws sometimes apply

Some states require the same coverage for breast reconstruction that is legislated by WHCRA and also mandate minimum hospital stays in connection with a mastectomy.

If you obtained your group health coverage through your employer and your coverage is fully insured, you're entitled to the minimum hospital stay required by state law. However, if your group health plan is self-insured (meaning your employer rather than an insurance company or HMO assumes the group's risk), then state law does not apply. In this case, only WHCRA applies and it does not require minimum hospital stays. To find out if your group health coverage is fully insured or self-insured, check your Summary Plan Description or contact your plan administrator at work.

Also, keep in mind that some state laws provide more protections than WHCRA. To learn more, contact your state's insurance department.

WHCRA requires insurance companies to notify plan members regarding coverage under the law. This notification is required upon enrollment and annually thereafter.

The Henry J. Kaiser Family Foundation provides the below list of states that require broader coverage than the requirements under WHCRA.

StateMandates?Details:

Reconstructive surgery includes augmentation mammoplasty, reduction mammoplasty and mastopexy

AlabamaNoN/A
AlaskaYesWHCRA coverage applies to any policy that covers mastectomies
ArizonaYesAny policy that covers mastectomy must cover reconstruction
ArkansasYesWHCRA coverage applies to any policy that covers mastectomies
CaliforniaYesAny policy that covers mastectomy must cover reconstruction
ColoradoNoN/A
ConnecticutYesAny policy that covers mastectomy must cover reconstruction
DelawareYesAny policy that covers mastectomy must cover reconstruction
District of ColumbiaYesAny policy that covers mastectomy must cover reconstruction
FloridaYesAny policy that covers mastectomy must cover reconstruction
GeorgiaNoN/A
HawaiiNoN/A
IdahoNoN/A
IllinoisYesIf no malignancy found, reconstruction must be performed within two years
IndianaYesAny policy that covers mastectomy must cover reconstruction
IowaNoN/A
KansasYesAny policy that covers mastectomy must cover reconstruction
KentuckyYesWHCRA
LouisianaYesAny policy that covers mastectomy must cover reconstruction
MaineYesAny policy that covers mastectomy must cover reconstruction
MarylandYesAny policy that covers mastectomy must cover reconstruction
MassachusettsNoN/A
MichiganYesAny policy that covers mastectomy must cover reconstruction
MinnesotaYesAny policy that covers mastectomy must cover reconstruction
MississippiNoN/A
MissouriYesAny policy that covers mastectomy must cover reconstruction
MontanaYesAny policy that covers mastectomy must cover reconstruction
NebraskaYesAny policy that covers mastectomy must cover reconstruction
NevadaYesAny policy that covers mastectomy must cover reconstruction
New HampshireYesAny policy that covers mastectomy must cover reconstruction
New JerseyYesAny policy that covers mastectomy must cover reconstruction
New MexicoNoN/A
New YorkYesAny policy that covers mastectomy must cover reconstruction
North CarolinaYesAny policy that covers mastectomy must cover reconstruction
North DakotaYesWomen's Health and Cancer Rights Act coverage requirements apply to any policy that covers mastectomies
OhioNoN/A
OklahomaYesAny policy that covers mastectomy must cover reconstruction
OregonYesAny policy that covers mastectomy must cover reconstruction
PennsylvaniaYesAny policy that covers mastectomy must cover reconstruction
Rhode IslandYesAny policy that covers mastectomy must cover reconstruction
South CarolinaYesAny policy that covers mastectomy must cover reconstruction
South DakotaNoN/A
TennesseeNoN/A
TexasYesAny policy that covers mastectomy must cover reconstruction
UtahYesAny policy that covers mastectomy must cover reconstruction
VermontNoAny policy that covers mastectomy must cover reconstruction
VirginiaYesAny policy that covers mastectomy must cover reconstruction
WashingtonNoN/A
West VirginiaYesAny policy that covers mastectomy must cover reconstruction
WisconsinYesAny policy that covers mastectomy must cover reconstruction
WyomingNoN/A

Source: Kaiser State Health Facts, State Mandated Benefits, Reconstructive Surgery after Mastectomy, 2008, and Health Policy Tracking Service, Thomson West

The law appears to aim at restoring the part of a woman that is lost from a masectomy. But at what point does it become cosmetic? Should insurance cover the cost of a woman seeking to enlarge her natural breast size after a masectomy?And what about other forms of reconstructive breast surgery (beside silicon or saline breast implants)? A good family friend of mine received a reconstruction using her natural fat after surviving breast cancer.In the end, an insurance company is trying to run a business, not a charity. What should they really be responsible for?

Health Insurance Options for Breast Augmentation




http://www.plasticsurgerypractice.com/issues/articles/2008-05_05.asp

INPRACTICE
Is It Covered?

by Patricia McGuire, MD
It is time to get educated about insurance reimbursements for breast procedures

I think that it is necessary for an individual insurance company to cover breast augmentation following a mastectomy or for any other medical reason for breast augmentation. For these purposes I see it in the same light as any other prosthetic. One would not deny someone who needed a prosthetic hand due to amputation from cancer or otherwise, so why should a breast be any different. In this article they do not focus on breast reduction at all. In my opinion that form of breast reconstruction should also be covered when done for medical reasons i.e. back problems. On the other hand, I do agree with some insurance companies that "[t]he insurance company's stand is that if the patient chooses to pay for aesthetic breast augmentation, all costs related to the surgery are the patient's responsibility." If the procedure is purely cosmetic the patient is fully aware of the risk and future costs, and it is completely elective. If cosmetic breast reconstruction coverage begins where will the line on coverage be drawn? That being said, if the patient has a defective implant, leak or an unsuccessful surgery I believe the cost should be place on either the surgeon or the supplier of the implants to ensure quality.

Government Funding for Breast Reconstruction?



http://www.medicalnewstoday.com/articles/169219.php



$2.95 Million Government Breast Reconstruction Funding Gives New Benefit To Breast Cancer Survivors, Australia

Main Category: Breast Cancer
Article Date: 30 Oct 2009 - 1:00 PDT



It appears someone in the Australian government understands what a mastectomy really means to the woman undergoing the procedure. As if months of sickness, hair loss and in having to accept that you may not survive are not hard enough on a female breast cancer victim, often she must suffer the loss of one or even both breasts. For those of us who still have ours it probably seems like a small price to pay for survival. But our breasts are more than just fatty tissue and glands. They represents femininity and beauty.Women with a smaller set often feel insecure about their body, but it can't be worse than the feeling of having yours taken away from you. No different than our hands, breasts are part of who we are.As long as the Australian governement restricts the funding to masectomy recipients there's only good being done by the program.

We found this article really interesting because of the information it provided us regarding a truly innovate biotechnology: a customized biodegradable chamber contoured to match a women’s natural breast shape. What is even more remarkable is that this technology can foster the growth of the permanent fat that is found in breasts. The article also mentions that if there is insufficient fat following the mastectomy that researches intend to develop a muscle tissue that induces fat tissue production called Myogel. These new biotechnologies will enable patients to seek alternatives to silicon implants for their reconstructive breast surgery. The work of these Australian researchers is admirable and their dedication to the cause is something that should definitely be mirrored by researchers in other countries. We feel as though the results in patients that receive breast reconstruction with materials that are the most similar to those found in the human body will be revolutionary and very beneficial to their overall well being and assurance. It is also very promising to see government funding being used for the development of essential biotechnology such as a biodegradable chamber and other essential devices as mentioned in the article.

Friday, November 20, 2009

Celebrity Obsession with Breast Augmentation




http://www.thesun.co.uk/sol/homepage/woman/301630/Why-do-stars-love-boob-jobs.html
Why do stars love boob jobs?
By BELLA BATTLE
Published: 08 Oct 2007




CHEST how many boobs ops does one girl need?

There are countless articles such as this one that detail celebrities’ obsession with breast augmentation and more general cosmetic surgical procedures. Although it is unfortunate that so many stories exist concerning celebrities’ addiction to plastic surgery, the articles provide extensive information about why some people are more likely to suffer from such a costly and body altering addiction. Essentially, this article is intended to open doors to further research surrounding why celebrities with so much disposable income chose to spend their hard-earned money on seemingly unnecessary and risky surgical procedures. According to this article, many celebrities feel as though they need to undergo breast augmentation surgery in order to feel as though they are deserving of such high profile attention. Since they are constantly in the spotlight, the article suggests that they begin to feel like commodities. In this sense, celebrities must ultimately sell themselves to the public in order to continue to advance in their careers. Truth is, there are plenty of very successful celebrities that have avoided cosmetic breast implantation and the public scrutiny that subsequently follows such dramatic procedures. The question that pervades is why do some celebrities feel they need to undergo such procedures when others can continue on a successful path without the aid of breast augmentation. Current research suggests that some people are simply predisposed to surgical procedures as a way to improve the way they perceive their body and ultimately themselves. Many celebrities suffer from body dysmorphic disorder in which they become dissatisfied and eventually obsessed with a certain body part that they feel is inadequate. This can certainly explain the growing rates of breast augmentation surgery amongst young celebrity women. As a result of the constant attention and commentary on their body types, many female celebrities feel as though breast augmentation is a quick fix to all of their problems and since they can afford the procedure it is much more attainable.

Thursday, November 19, 2009

Essential Questions Regarding Breast Augmentation

http://www.plasticsurgery.org/Patients_and_Consumers/Procedures/Cosmetic_Procedures/Breast_Augmentation.html

Questions to ask your Breast Augmentation Surgeon

American Society of Plastic Surgeons

All Materials 2009 ASPS/PSEF

  • It is important to be an active participant in the process, so we've developed the following
  • list of questions to ask about breast augmentation during your consultation:
  • Are you certified by the American Board of Plastic Surgery?
  • Were you trained specifically in the field of plastic surgery?
  • How many years of plastic surgery training have you had?
  • Do you have hospital privileges to perform this procedure?
  • Is the office-based surgical facility accredited by a nationally-or state-recognized accrediting agency, or is it state-licensed or Medicare-certified?
  • Am I a good candidate for breast enhancement or breast enlargement?
  • What will be expected of me to get the best results?
  • Where and how will you perform my breast augmentation surgery?
  • What shape, size, surface texturing, incision site and placement site are recommended for me?
  • How long of a recovery period can I expect, and what kind of help will I need during my recovery?
  • What are the risks and complications associated with my procedure?
  • How many additional implant-related operations can I expect over my lifetime?
  • How will my ability to breastfeed be affected?
  • How can I expect my implanted breasts to look over time?
  • What are my options if I am dissatisfied with the cosmetic outcome of my implanted breasts?
  • How will my breasts look if I choose to have the implants removed in the future without replacement?
  • Do you have breast augmentation before-and-after photos I can look at for this procedure and what results are reasonable for me?
  • If so, at which hospitals?
  • How are complications handled?
  • After pregnancy? After breastfeeding?

Regarding the American Society of Plastic Surgeons list of suggested questions, the first 7 questions are kind unnerving. The idea that when looking into breast augmentation you need to ask those kind of questions regarding the ability of the surgeon really makes one wonder about the safety and efficacy of this kind of surgery. It also leads to the question about how prevalent the black market or unlicensed undertaking of this procedure is. As well as how easy it is to find yourself in that situation without even knowing about it. A lot of the other questions on the list would be very helpful if considering breast augmentation. The particularly necessary and I think under recognized ones are those regarding post surgery necessities and issues regarding unwanted results. That would be very helpful in the decision process.

http://www.feminizationsurgery.com/services/breast_augment.htm

Ask Dr. Beck

Feminization Surgery

© 2008 Bay Area Aesthetic Surgery. All Rights Reserved

Q:I have heard that people’s implants get hard over time. Is that true?
A:You are referring to a condition called “capsular contracture.” This is a contraction of the natural internal scar tissue that surrounds the implant. It is a small risk, but one that must be considered. Should capsular contracture occur and bring discomfort or distortion to the breast(s), a surgical procedure can be performed to correct the situation. In rare cases, the implants must be replaced or removed altogether. Saline implants have a lower incidence of capsular contracture. Following pre and post operative instructions can also help reduce your risk.

Q:What is the link between autoimmune diseases, cancer and breast implants?
A:Despite all the publicity, the “FDA Breast Implant Consumer Handbook 2004” dispels any possible links between illness and silicone or saline implants.

Q:Will a breast implant lift my breasts up?
A:An implant will expand the size and alter the shape of a breast. The shape of some implants can mediate mild breast sag, but will not change the position of the nipple or counteract significant droop.

Q:Can I choose if I want my implant above or below the muscle?
A:Not always. It depends on your anatomy and options should be discussed with Dr. Beck or Dr. Brink.

Q:Are there any guarantees that my implant won’t break or leak?
A:There are no guarantees, but there are warranties available. Implants are engineered to withstand considerable pressure or impact; however they are not lifetime devices. Following your procedure we will give you a serial number and warranty card from the implant manufacturer. You can elect to purchase an extended warranty.

The Q and A from "Dr Beck" would be very helpful. Upon researching this topic, finding the answers to frequently ask questions was relatively scarce. This is likely due to the highly individual nature and motivations for the surgery. I found it very interesting to see a doctor’s answers to frequent patient concerns. I would have also liked to have seen some answers from an objective researcher as I got the impression that this information was being given by a plastic surgeon with somewhat of a biased perspective.

Monday, November 16, 2009

National Cancer Institute's Study of Breast Implant Risk

http://www.cancer.gov/cancertopics/factsheet/risk/silicone-implant

Breast Implant Study

In March 2000, the National Cancer Institute (NCI) published their findings from a study conducted in response to the FDA's 1992 ban of silicone gel implants.The study included 13,500 participants who had surgery for cosmetic implants in both breasts before 1989. And for comparison, the study looked at 4,000 other patients similar in age who had other types of cosmetic surgery. The study was based of collected medical records or death certificates (no examinations were performed on the participants by the NCI). About 80% of participants were successfully tracked, and 70% of those provided updated information.It is one of the longest studies into the relationship between breast augmentation and cancer development. Additionally, no other study has taken into account patient lifestyles or compared its findings with other cosmetic surgery recipients. Additionally, the study distinguishes between the affects of silicone and saline breast implants.The NCI found that there is no risk correlation between breast implants and the subsequent development of breast cancer. Breast cancer risk was also not associated with any certain type of implant. There was also no significant difference in breast cancer mortality between the implant and comparison patients.

Saturday, November 14, 2009

Racial/Cultural Determinants of Breast Reconstruction (2)

http://www.mentalhelp.net/poc/view_doc.php?type=news&id=122654&cn=176


This segment from Women's Health on MentalHelp.net provides a recent study published in the 'Journal of Clinical Oncology' that show a cultural discrepancy. It was found that Latinas that retained their original cultural beliefs were significantly less likely to opt for breast reconstruction than Caucasians as well as lees likely to talk to a plastic surgeon before their mastectomy. However they are more likely to seek out more information about the procedure. This proves to be an interesting study in why a cultural group would be want to be the most informed about breast reconstruction and remain the least likely to have the procedure preformed.



http://breastcanceraware.net/2009/10/breast-reconstruction-varies-by-race.html

The second link we posted is a more intensive review of the same study in the 'Journal of Oncology'. This review provides a list of all categories of women studies, the percentages of all categories that received reconstruction. It also included a quote from the lead study author. She commented on reconstruction as an improvement on quality of life. This review also better explains the results by stating that less-accultured Latinas reported that their surgeon did not explain reconstruction and were less likely to be referred to a plastic surgeon, but they would have liked to receive the information. Through the results the study suggests that better efforts be made to present reconstruction as an option for all patients. The comparisons of these two site reviews shows that even when discussing the same study information can still be better conveyed by some sites than others. Some information can be confusing and incorrect inferences can be made from that information.

Socioeconomic Determinants of Breast Reconstruction

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448910/

The article demonstrates a general correlation between socioeconimc status and the decision to undergo breast reconstruction post. Women who are less educated (high school diploma or less) showed a significant less percentage in reconstruction. Additionally, minority groups and patients who were unemployed showed a low percentage in the choice to undergo reconstruction.

The numbers show that reconstructive surgery is more a luxury for the elite. Femininity is often associated with the female breast, which begs the question: Should all women who undergo masectomy have the right to reconstruction? It seems unfair that surgery that can have such an impact on a woman's emotional state and quality of life should in fact be an achievable technology. In order to tip this scale, either governement funds or insurance need to begin absorbing some of the cost. Women should have the right to choose.





Friday, November 13, 2009

Types of Surgery- Incision types and Basic Procedures

http://www.mentorcorp.com/breastsurgery/augmentation/cs_ba_aa_quest05.htm




What better way to learn about breast implants than to research the procedure as if you are going to have it? We stumbled upon this website which is meant to inform prospective breast augmentation patients about their options. There are many different sites that give similar information but this one was one of the easier ones to find as well as to follow. This page offers simple explanations of current placement types and incision types. There is even more information that is easily accessed through the links on either side of the article.

Breast augmentation has become a very personalized procedure with many different options that can suit the different needs of different patients. For example, there are many different sizes of implants as well as different shapes. There are
also different procedures offering more or less recovery time, more or less accessibility to the implant and even a choice of how natural the patient wants the breast implant to look and feel. Most importantly this website has links that give a good review of the major risk factors involved in breast augmentation surgeries. The information presented in this site is very helpful for patients who just want a general understanding of the pros and cons of different types of breast augmentation and is a testament to the most current advancements in medical technology within the field of cosmetic surgery.


Monday, November 9, 2009

Types of Breast Reconstruction Following Mastectomy

http://www.cancer.org/docroot/cri/content/cri_2_6x_Breast_Reconstruction_After_Mastectomy_5.asp




This link provides information for someone seeking information about post-mastectomy breast reconstruction. It goes over what breast reconstruction is, why one might choose to have it and what it entails in simple, easy to understand language. It discusses the difference between immediate reconstruction (directly following the mastectomy) and delayed reconstruction (following father chest radiation or other delay factors) and flap gives personal factors that would weigh in on ones decision. It also provides a list of other considerations for this type of procedure. It gives a detailed description of two types of reconstruction; implant procedures and tissue flap procedures. There is also optional nipple and areola reconstruction for aesthetic purposes. They provide a helpful list of questions to ask your physician and well as a list of pros, cons and possible risks regarding the reconstruction. They talk about the pre and post reconstruction issues. It is nice see that the website states that this procedure may boost self-esteem and self-image but it also may not. Some people may not be satisfied with their reconstructed breasts.

http://www.clarian.org/ADAM/doc/HealthIllustratedEncyclopedia/3/100156.htm

The link above provides a simplified step by step procedure of post-mastectomy breast reconstruction. Detailed images are provided to take the reader through a guided description of one type of procedure.

Reasons for Cosmetic Surgery

http://www.surgery.org/consumers/procedures/breast/breast-augmentation

"Breast augmentation plastic surgery is one of the most common procedures performed annually by members of the American Society for Aesthetic Plastic Surgery. Women may choose to under go breast enlargement surgery for various reasons. These personal reasons may center around breasts that are perceived to be under developed, or because of differences in the sizes of the breasts or from changes after pregnancy or breast feeding. Some women may be happy with their breasts but just want them made fuller. Often after weight loss, aging or childbirth a woman's breast volume and shape may change. This too can lead to a woman to seek a breast augmentation. Breast implant surgery performed by cosmetic plastic surgeons is the most popular way to improve breast shape and size. Breast enhancement using breast implants can give a woman more proportional shape and may improve self esteem."

This article on Breast Augmentation from The American Society for Aesthetic Plastic Surgery walks through the basics of candidacy, what to expect with the surgery, potential benefits and risk factors. Written as a purely informative piece, it begins by describing reasons that women seek breast implantation. These include masectomy, changes after pregnancy, or simply dissatisfaction with their natural breasts. The article preps readers with the basic knowledge of what to expect before, during and after surgery. It describes a timeline of the healing process, including figures like how many days it will be before you can shower or do normal activity. They also discuss the benefits of a saline implant (smaller incision, adjustible size and no toxic risk) vs. those of silicone (more structured). The overall message conveyed in the article is that anyone seriously considering breast augmentation should be fully aware of both the benefits and risks associated with the surgery.

Breast Augmentation Video Demonstration

http://www.youtube.com/watch?v=RXBrD5vXyJM


Dr. Loftus Performs and Narrates a breast augmentation surgery and demonstrates both saline and silicone breast implantation

As we continue our research and learn about the basics of breast augmentation we felt that the best way to really understand the procedure and the risks associated with it is to watch a real live surgery. This surgery shows one of the most common of breast augmentation procedures and shows both types of implant (saline and silicone) inserted into the chest underneath the pectoral muscle using an inframammary incision. Most surgeries in the U.S. are of this type where the patient is unhappy with the size and/or shape of their breasts and wants to surgically enhance them to fit their own personal perception of beauty. This video is a quick ten minute look into the procedure, showing basic technique and execution of a routine breast augmentation.

We as a group see ourselves as general medical technology enthusiasts and while we are by no means avid surgery watchers we were impressed to see how this procedure has evolved to become relatively simple as well as minimally invasive. Although the idea of having someone create a pocket inside a person’s chest with nothing more than their forefinger is a bit odd, maybe even a little unsettling for more squeamish viewers, the ease with which the surgeon carries out the procedure shows that when done correctly there should be very little risk for complications. Prospective patients should see that the expertise of the surgeon is a very important factor while researching their options particularly in this type of surgery seeing as it is pretty much always an elective surgery. It is also impressive to note the techniques for minimal scarring that are employed in the video. Medical advancements have made this type of procedure very low risk and in time technique and technology only stand to get better creating even less recovery time and even better results.

Sunday, November 8, 2009

Patient Characteristics

http://suicide.suite101.com/article.cfm/depression_and_body_image

Depression Disorder & Body Image

Women With Breast Implants More Likely to Commit Suicide

"In July of 2007, Sarwer et al. published a review article in The American Journal of Psychiatry investigating recent research linking breast augmentation and suicide. The studies revealed that the suicide rate of women who recieved cosmetic breast implants is approximately twice the expected rate based on estimates of the general population."

Several studies have been published concerning the disproportionate relationship between cosmetic surgery, specifically breast augmentation, and increased suicide rates among postoperative patients. In July of 2007, Sarwer et al. published a detailed review in The American Journal of Psychiatry, which revealed that women who received cosmetic breast implants were twice as likely to commit suicide when compared to the general population.

In choosing this article, which focuses specifically on cosmetic breast implantation, our group hopes to investigate the patient characteristics that predispose these patients to increased rates of suicide. The article describes this correlation in terms of specific patient qualities, motivations and expectations of patients who seek breast implants as a way of improving their social interaction and the way they feel about their bodies post surgery. When these expectations are not necessarily fulfilled, psychopathology results. Characteristics in prospective patients include more frequent alcohol and tobacco use, more sexual partners, higher use of oral contraceptives, having an abortion, eating disorders, and previous psychiatric hospitalizations. The highest risk factors are identified as having been hospitalized, alcohol consumption and tobacco use, and eating disorders.

The article references a study performed by Sarwer in 2004 that seems contradict many other studies that have been performed. Although this researcher found that patients report dissatisfaction with their body image, the studies mention that this dissatisfaction improves postoperatively. No actual statistics are provided which leads us to believe that the studies could be invalid, especially because the article goes on to mention a study by Cerand in 2005 which states that 90% of patients experienced either no change of a worsening of body dysmorphic disorder following breast augmentation surgery. A supporting study by Honigman in 2004 notes that there is no evidence that patients’ interpersonal relationships improve after surgery and that these unrealistic expectations and motivations are associated with poor postoperative outcomes.

It seems logical to think that postoperative dissatisfaction can potentially lead to depression, a disorder that is correlated with increased rates of suicide. Since these patients already exhibit suicidal risk factors prior to surgery, it appears as though many of these studies are logical. When we consider the unrealistic expectations, high cost of breast augmentation surgery and subsequent dissatisfaction with the procedure, it seems very realistic that emotionally unstable patients will exhibit higher suicide ideation rates.

It is interesting when we connect the facts and figures of this article within the realm of the pharmaceutical industry, specifically the market for antidepressants. Women are two times more likely than men to experience depression and it is estimated that nearly 7 million women suffer from some form of diagnosable depression in the United States. When you consider that number of these patients that are on antidepressant drugs, you can imagine the amount of revenue the pharmaceutical industry is generating. According to an analysis of the antidepressant drug market,
http://www.wikinvest.com/concept/Antidepressant_Drug_Market,
the market reached sales of nearly 11 billion dollars in 2008. When we consider the side effects that result from such a high consumption of these synthetic drugs it sheds light on to how multidimensional and complex this problem truly is.

Read more: http://suicide.suite101.com/article.cfm/depression_and_body_image#ixzz0X2mpvGP8

History of Breast Augmentation

http://www.breast-augmentation-resource.com/html/history.html

To begin our research we all agreed that the first logical step was to research the history of breast augmentation. This article is a very brief history of the procedure and the current techniques that are being used today. As with any procedure, the beginning consisted of a lot of trial and error. Breast augmentation started as far back as 1895 but the results were shaky at best, often resulting in awful scarring or a complete mastectomy. As time went on and technology advanced, the procedure evolved to become much safer as well as more desirable due to the high potential for aesthetically pleasing results. New materials were developed as well as new techniques offering more opportunity for patients to personalize their results particularly regarding size, placement and incision type. Currently, breast augmentation is one of the most popular cosmetic surgery procedures performed in the United States and with the increasing efficiency and efficacy of medical techniques this procedure only stands to gain more popularity as well as more profitability.


We also found it interesting that this article focused specifically on the history of cosmetic breast implantation and breast augmentation which dates farther back than breast reconstruction. We searched extensively for an article pertaining to the history of breast reconstruction options following a mastectomy for research purposes and encountered this article which dates reconstruction back to the late 1970s. In the late 1970s, the latissimus flap was the most popular form of autogenous tissue breast reconstruction. Superior gluteal free flap surgery was performed by Fujino in 1976. In 1978, LeQuang performed the first breast reconstruction with an inferior gluteal free flap.

http://emedicine.medscape.com/article/1274236-overview

Although reconstruction with prosthetic implants remains the most common method of breast reconstruction today, proponents of autogenous reconstruction argue that the natural "feel" and durability of a flap exceeds that of an implant.