One key technique in this approach is the local advancement flap, long used during breast reduction surgery. With this technique, the surgeon removes the cancer, then rotates the remaining tissue to reconstruct the breast. This gives the woman an optimal appearance and leaves no indentations or defects. Oncoplastic techniques can give more women the option of lumpectomy with immediate local reconstruction, rather than mastectomy. In some cases, the surgeon may also reduce the size or alter the shape of the opposite breast in order to maintain a balanced appearance.
Women with DCIS (ductal carcinoma in situ), a noninvasive cancer, can also benefit from oncoplastic techniques. Because DCIS is distributed through the breast's ductal system, sometimes it can be difficult to excise. Removal of DCIS may require removal of a substantial amount of breast tissue, and some patients have traditionally had to undergo mastectomy. Now, the creative use of oncoplastic methods is allowing many women with DCIS to keep their breasts intact and with excellent results.
We also offer skin-sparing mastectomies which allow the surgeons to remove the breast while maintaining the overlying skin. This procedure, when combined with immediate breast reconstruction, gives patients a more satisfying cosmetic result after mastectomy.
Tissue AIR Expansion System for Breast Reconstruction
After mastectomy, breast cancer patients who wish to have reconstructive surgery often undergo a process by which a space to accommodate a breast implant is created under the patient's remaining skin. The standard process entails injections of saline every few weeks to gradually expand the skin and muscle in the chest to allow placement of a permanent implant. Some women find that not only are the injections painful, but frequent visits to the hospital for 4 to 6 months or more may present a significant time burden.
NewYork-Presbyterian/Columbia is the first center in the U.S. to conduct a trial of a needle-free tissue expansion technique, which eliminates the need for frequent saline injections and hospital visits. This investigational method first requires implantation of a small expander device. Once at home, the patient uses a remote-control device to release small amounts of compressed carbon-dioxide from a valve in the expander. Daily expansion may result in creation of a pocket in an average of 15 days, a significant advantage over several months of saline injections. Patients can use the new needle-free technology while at home, at their own pace and comfort level.
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