Dr. Isak Aaron Goodwin, MD

There are a few different methods used to create the round shape of the breast on the chest. A flap of fat, skin, and muscle can be taken from the side, abdomen or buttock and implanted on the chest to create a breast from the patient's own tissue. Alternatively, the skin over the chest may be gradually stretched to allow for the placement of an implant. Stretching of the skin is done using expanders, which are similar to breast implants, except they increase in size when saltwater solution is injected into them. Many women also choose to combine the flap procedure with implant placement to achieve their desired result. Once the new breast shape is formed, a nipple can be created and even tattooed to match the other side.

Reconstruction may be done in a single surgery or broken up into multiple procedures:

• Immediate reconstruction rebuilds the breast right after mastectomy. This method is not recommended if additional chemotherapy or radiation is needed after surgery.
• Delayed reconstruction occurs after chemotherapy or radiation has been given. These treatments may decrease the volume or alter the color of the reconstructed breast, so they should be completed before the breast is rebuilt. This type of reconstruction may happen weeks, months, or even years after mastectomy.
• Staged reconstruction splits the reconstructive process into two parts. The first part inserts temporary expanders to stretch the skin and is done immediately after breast removal surgery. The second part replaces the expanders with implants after chemotherapy or radiation treatments have been given.

Breast reconstruction is not perfect. The two breasts may not always look exactly identical, although they will be close. There may be small scars, and a loss of sensation in the reconstructed breast. A reconstructed breast will not produce milk, so patients may have trouble breastfeeding. Still, reconstruction is a great option for women who want that part of their appearance back.

The patient and surgeon will discuss the patient's needs, preferences, and limitations to determine the type of implant and incision to use.

Using one's own fat for breast enlargement starts with a procedure called liposuction, which is the removal of excess fat from other parts of the body. After the fat is collected, it is rid of impurities and then injected into the breast. This option suits those who do not wish to have foreign materials placed inside their bodies.

Deformities such as tubular breasts may also be corrected using breast augmentation. Tubular breasts are characterized by small, droopy breasts and a narrow base. Aside from placement of an implant, the surgeon cuts the breast tissue to release the tightness and make the base wider.

Breast implants are not lifelong devices. They may rupture or may develop capsular contracture, which is the hardening of scar tissue around the implant. If these complications occur, another surgery may be required to replace or remove the implants.

While a breast augmentation enlarges the breast, a breast lift, also called mastopexy, raises the breast by repositioning the nipple and removing excess skin. Breast lifts can be done using three techniques. If there is only a small amount of sagging, removal of excess skin around the outline of the areola may accomplish the desired result. This technique is called a doughnut lift. If the nipples are just at or slightly below the level of the breast fold, a surgeon may recommend a lollipop lift. This type of lift involves a doughnut lift and a vertical incision from the bottom edge of the areola to the crease. If there is a lot of excess skin, a surgeon may recommend an anchor lift. This technique is similar to the lollipop lift, but it also involves a crescent-shaped incision along the breast fold to be able to remove more excess skin. Sometimes loss of breast volume accompanies sagging. If this is the case, an augmentation can be performed in combination with the lift procedure.

Because nerves around the nipple are cut during surgery and need time to heal, temporary loss of sensation in this area is common after having a breast lift. Sensation is usually regained after several weeks to a few months. Although uncommon, loss of sensation may also be permanent, especially if a significant amount of tissue around the nipple was removed.

Both breast augmentation and breast lift are typically done in an outpatient facility and do not require a hospital stay. Following surgery, patients should apply a cold compress over their breasts for the first 24 hours and keep their upper body elevated -- even during sleep -- for the first few days. Patients are also given a special type of bra to wear while recovering. Using cold compresses, staying elevated, and wearing the special bra help to minimize swelling and pain. Strenuous activities like running and working out should be avoided for four to six weeks, but light exercise may be started about one week after a breast augmentation procedure.

There are two main types of stroke: ischemic stroke and hemorrhagic stroke. Ischemic stroke occurs more commonly and is when a blood vessel in the brain becomes blocked. Blockages are caused by blood clots and built-up plaque (deposits of fat and cholesterol), which leads to atherosclerosis, a condition where the blood vessels narrow and harden. The resultant restricted blood flow may lead to an ischemic stroke by blocking essential oxygen to the brain, causing the heart to exert more effort to pump blood.

Hemorrhagic stroke occurs when a blood vessel in or around the brain ruptures. The burst vessel leaks blood into surrounding brain tissue, causing irreparable brain damage.

Hemorrhagic strokes are less common and may occur from head injuries, brain aneurysms, brain tumors, and bleeding disorders, amongst other conditions.

Both ischemic and hemorrhagic strokes require immediate medical treatment. Medical intervention can prevent severe and life-threatening brain damage. Signs of stroke include:

-Disorientation or confusion

-Difficulty speaking

-Difficulty walking

-Impaired vision

-Weakness in the face, legs, or arms

-Severe headaches

When someone suspected of having a stroke reaches the hospital, the patient will usually receive a CT or other scan that provides an image of the brain. The scan results can reveal clotted or leaking blood in the brain. Physical exams, neurological exams, and blood tests may also be used to check for blood clotting and sugar. Treatment begins generally immediately if a stroke is detected.

Medical treatment for ischemic strokes includes a thrombolytic medicine which breaks up and disperses blood clots. This medicine can greatly improve stroke recovery and long-term health. However, the thrombolytic medicine must be administered as soon as possible to achieve these results. Other treatments for ischemic strokes are blood thinners and thrombectomy, a surgical procedure to remove a blood clot in the brain. Thrombectomy is performed by inserting a catheter (thin needle) into the artery to reach the blood clot and mechanically remove it. With the clot removed, normal blood flow to the brain resumes. Thrombectomy is typically performed at most six hours after a patient shows signs of a stroke.

Hemorrhagic strokes are treated with blood-saving medication and surgery. For a hemorrhagic stroke caused by the rupture of an aneurysm (blood vessel bulges), surgery to stem the bleeding aneurysm and vessel may be used. One surgical technique is stent-assisted coiling, which adds a stent (small wire-meshed tube) into the blood vessel to block the leaking opening of the aneurysm. A non-surgical procedure is endovascular coiling, where a catheter (thin, hollow needle) places a platinum wire coil at the spot of the aneurysm. The coil blocks bleeding and prevents the aneurysm from continuing to leak blood. These procedures are usually combined with blood-thickening medications. Blood transfusions may be administered if substantial blood loss has occurred.

Since stroke patients may have lost some essential functions while the blood flow to their brains was obstructed, both ischemic stroke and hemorrhage stroke patients may receive post-stroke rehabilitation to rebuild their physical and mental abilities. Some restorative treatments include occupational, physical, and speech therapy. Patients may also receive care from neurologists, who can assist patients in recovering certain brain functions and cognitive abilities, and rehabilitation psychologists, who may help patients with their emotional, behavioral, and cognitive recovery. Some stroke patients require lengthy rehabilitation and may never fully regain function, while others may recover more quickly. While the fastest recovery improvements are usually seen in the first three or four months, stroke rehabilitation can last for years.

If someone begins to show signs of stroke, contact emergency services and call 9-1-1 immediately since blood flow must be restored as soon as possible to help avoid significant brain damage. If an ambulance takes the person to the hospital, paramedics can initiate stroke treatment as soon as the patient enters the ambulance, allowing for more prompt medical intervention and care.