Cosmetic Breast Surgery by fanzhongqing


									Cosmetic Breast Surgery

  By: Elizabeth T. Weaver B
           BSN, RN
     Purpose of Presentation
• Provide an overview of Cosmetic Breast
• Reasons for Cosmetic Breast Surgeries
• Expectations and Complications of
• F.D.A. Recommendations and current
• Case Study
      3 Most Common Types of
      Cosmetic Reconstruction
• Breast Augmentation Mammoplasty, most
  common cosmetic surgery, using various
  techniques/materials, estimated 1.8 million
  American women have silicone implants,
  (1.2% of female population)
• Reduction Mammoplasty, 5th most
  common cosmetic surgery
• Breast Lift= Laser Bra
         Breast Augmentation
• Various Reasons for choosing surgery
• Feelings that breast are too small or sag
• Out of proportion, one smaller that the
• Loss of volume after pregnancy/weight
• Reconstruction after cancer treatment
• Patient desires- ENHANCED
Patient Desires Enhanced
Restoring a Woman’s Natural
   Maintaining Professionalism
• Ethical opinions need to be maintained
• Keeping Bias at bay
• Culturally breast enhancement is starting
  at an earlier age among white women, >
  college age white women with access to
  health care and socioeconomic status
• Black Women less likely to reconstruct
  after cancer treatment
         Surgical Procedures

• Silicon sacs filled with saline or silicon gel,
  placed under the skin or muscle
• Submuscular most popular with better results
• TRAM Flap= Trans Rectus Abdominal Muscle,
  results with a tummy tuck
• Latissimus Dorsi Flap= muscle off back slid to
  front, results= asymmetry of back area
   What does the F.D.A. say?
• F.D.A. approves silicon gel implants only
  for currently approved F.D.A. Clinical
  Trails. F.D.A. # 1-800-532-4440
• Saline implants most commonly used
• New evidence that platinum by be leaking
  from silicon sacs, platinum is an ingredient
  of silicon, data not conclusive
Follow up Teaching For Screening
           of Cancer
• Continue SBE, Breast implants separate
  tissue from chest wall, often easier to do
  exams because ribs do not interfere
• Mammograms, same as for women
  without implants except, need facility with
  experience and interpretation
• National Cancer Information Service 1-
• Breast Feeding is still
  possible, reports indicate
  more silicone found in
  cows milk than in breast
• Improved Self image and
• Scars often will fade
• Best to wait till after
  pregnancies for best
• Implants do not age well,
  sagging often results
• Patient Education on
  Risks, Benefits, and
  follow up care found
  essential to good
TRAM Flap Requires *Experienced
        Plastic Surgeon
• Skin, Fat and Muscle tissue is removed
  from Abdomen, transplanted to breast
  area via microscopic surgery, surgery time
  2-4 hrs
• May result in tummy tuck
• Long-term satisfaction is greater
• Potential complications; longer surgery
  time, larger wounds, rejection, bleeding
  complications, and increased cost
        Post Cancer Treatment
• Expectations need to be discussed
• Often future surgeries to make
  adjustments to reconstruction site or the
  other breast to match shaping and size
• Add nipple
• Tattooing
• Most patients satisfied with the decision to
Breast Reduction Mammoplasty
• 5th most common cosmetic surgery
• 2001- 99,428 surgeries done
• Reasons= #1 Pain, back, neck, and
• Developed 50 years ago
• 2-6 hr procedure, extensive scars, nipple
  sensation and breastfeeding ability
     Reduction Mammoplasty
• Anchor incision made near nipple
• Excise and discard glandular, fat, and skin
• Relocate nipple
• Risks of blood loss due to vascular tissue
• Infection
• Activity limited for 1-2 months postop
            Newer Approach
•   Liposuction technique
•   Incision ¼”, close to scarless
•   Minimum effects on breastfeeding
•   No cutting
•   Less blood loss
•   Less recovery time
 New on the Horizon for Reduction
• Medications
• Dimunex= Herb/Chemical, action increase
  muscle tone and decrease fat
• Claims= decrease breast tissue by 33% in
  3-4 weeks
• Ingredients= St. John Wort, Dandelion
  Root, Cat Claw, Horse Chestnut
        New on the Horizon for
• The Stevens Laser Bra, invented in L.A.
• Forms an internal bra from patient’s own
  tissue using the Co2 Laser
• Laser d-epithelializes the skin to create an
  internal bra with the normally discarded
  skin tissue
• Bra is connected to chest wall to create
  the “Lift”
         Clinical Research
        What are we learning?
• Breast Implants Do Not Age Well
• Researcher reported in Plastic &
  Reconstruction Surgery Vol. 107.No. 7:
  1702-1709, over time implants did not hold
  up as well as the TRAM Flap
• 2 part study, results at 5 yrs, implants
  satisfaction rate = 54%, compared to
  TRAM Flap at 92%
     Prophylactic Mastectomy
• Option for those at risk
• Minimum long-term efficacy
• ? How to remove all breast tissue
• Mayo Clinic Study 1960-1993
• Risk assessment based on Gail Model
• Control group = sisters
• Results = 90% reduction in incidents of breast
• APN aware of risks and counseling concerns
          Michele’s Story
  (A case study on reconstruction)
• 1999 38y/o white female G3P3,Used OCP for 10yr,
  breast feed all 3 children, BMI wnl exercise 5 times a
• Pt c/o fibrocystic breasts on BSE, mammogram neg.,
  sono positvie for two small 5mm lumps on right upper
  quadrant of breast
• Surgeon-hold for 6 months without biopsy, decision
  made to biopsy
• Dg. On needle biopsy = Ductal Carcinoma In situ,
  decision made to do skin saving technique radical
• Modified (without muscle) done with right sided removal
  of lymph nodes, sentinel node not perfected at this time.
The adventure of reconstruction
• Surgery done March 1999 with expanders
  in place with port for saline administering
  access (surgeon and plastic in on case)
• Q6wks injected to fill expanders
• Oct. 1999 ready for real implants and
  nipple plastic surgery (form a purse string
• Inducted into the FDA McGane Study
• Jan. 2000 tattooing of the nipple
         Adventure continues
• Feb. 2002 implants shift and need replacing due
• Received a new weighted implant
• Scar under nipple line opposed to axilla
• Dec. 2002 fell while snow skiing and left implant
• Jan 2003 Study site in Colorado replaced
• Chest x ray finds two small non-biopsyable
  small legions on right and left lung
        Currently Doing Well
• Q 6 month MRI’s to follow legions, diff. dg
  is possible calcium deposits from injury
• Full time RN, Climbed 6, fourteeners in
  Colorado, holds a position with the 3 day
  events for Komen
• Would you reconstruct again “YES”
• Theoretical Framework = Abraham
     Maslow = Motivation Key
• Individuals have to be active in self care, not
• Active participant strives for self actualization
• Science should explore individuals who
  recognize their full potential
• Basic needs must be met before the individual
  can progress to next stage of personal growth
• This leads to fullest potential
• Which leads to inner peace
• Each person is at a different level determined by
  one’s own on basic needs
   How Maslow can be applied to
• Allows the nurse to emphasize strengths
  instead of weaknesses
• Focuses on the Human Potential, thus
  giving HOPE
• Gives a blueprint for prioritizing a clients
  care according to their hierarchy of needs
• Physiological, safety, love and belonging,
  self esteem, self-actualization
• Aware of our own attitudes respect others
• Encourage realistic expectations with our
               Live Well with Your Illness
• Focus on health promotion and illness
  prevention as primary goal
•   American Academy of Plastic Surgeons, Home
    Room Press Release. Retrieved September 2,
    2004 from

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