Dr. Allison Welte Lorenzen, 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.

• Two or more cancerous regions in the same breast
• Inability to receive chemotherapy or radiation therapy
• High likelihood of recurring breast cancer
• Large tumor that is bigger than two inches across
• Pregnancy that prohibits radiation therapy
• Preexisting conditions like lupus or scleroderma

Notably, some patients may elect to undergo mastectomy without a breast cancer diagnosis. Preventative (prophylactic) mastectomy is performed on those with a high risk of breast cancer, such as having a family history of the disease or carrying the breast cancer BRCA1 or BRCA2 gene. Preventative mastectomy substantially reduces one's chances of developing breast cancer in the future, but it cannot wholly prevent it.

Surgical oncologists perform several types of mastectomies, depending upon the severity of the breast cancer (including factors such as its location and spread), as well as the patients' own aesthetic and personal choices. The six main types of mastectomy include:

• Total mastectomy, where the surgical oncologist removes an entire breast, including parts like the pectoral chest muscle, skin, and nipple.
• Radical mastectomy, where the surgical oncologist removes the entire breast, underarm lymph nodes, pectoral chest muscles, and outer skin and nipple. One of the most invasive forms of mastectomy, radical mastectomy is infrequently performed.
• Modified radical mastectomy, where the surgical oncologist completes a total mastectomy and also removes the underarm lymph nodes. This procedure is slightly less invasive than radical mastectomy.
• Skin-sparing mastectomy, where the surgical oncologist removes cancerous breast tissue and nipple, but leaves most of breast skin. This method is used in conjunction with breast reconstruction, as implants can be added below the skin. Skin-sparing mastectomy often requires a treatment team with a surgical oncologist and a plastic surgeon experienced in breast procedures.
• Nipple-sparing mastectomy, where the surgical oncologist removes cancerous breast tissue and leaves the nipple and most of the breast skin. This method is only available to patients in the early stages of breast cancer. Similar to skin-sparing mastectomy, this procedure is frequently performed with breast reconstruction.

Any of these procedures can be done on both breasts, in which case the procedure would be known as a double mastectomy. For example, a surgical oncologist might perform a total or nipple-sparing mastectomy on both breasts. Double mastectomies are often used as a preventive surgery for those who are at risk of developing breast cancer later on in life.

Patients have one or two days of hospital stay before returning home from their mastectomy procedures. Full recovery can take several months, but some patients find they are able to resume normal activity within one month of their mastectomy. Patients are advised to limit arm and chest movements whenever possible.

After surgery, patients must also adjust to changes in their appearance. While some patients choose to receive breast reconstruction, other patients may decide to wear prosthetic breasts or will simply embrace their new chest.

Mastectomies permit patients to conquer cancer and lead healthy, thriving lives as breast cancer survivors.

Professional cosmetic skin treatments exist to treat wrinkles, scars, dark spots, remove excess hair, tone and tighten skin, and otherwise improve the appearance of the skin. They may use lasers, light therapy, chemical peels, microdermabrasion, or many other forms of skin treatment.

Acne occurs when hair follicles become clogged with oil and dead skin cells, most commonly on the face or back. The clogged follicles can then become infected and inflamed. Treatments include antibiotics, anti-inflammatories, and retinoid creams.

Eczema is dry, sensitive skin that causes an itchy red rash, often in response to specific triggers. It is common in childhood but can sometimes last into adulthood. The main treatment involves keeping skin well moisturized.

Dermatitis is the medical name for any kind of skin inflammation or rash. Rashes can happen because of an allergy or contact with an irritating substance. They may be red, itchy, or even painful. They are often treated with antihistamines or moisturizing creams containing cortisone.

Psoriasis is patches of thick, red skin that is covered in silvery scales. It is often itchy and sore. Psoriasis is thought to be caused by an immune disorder, and it runs in families. Psoriasis is not contagious. There is no cure, but there are medicated creams available to treat the symptoms.

Skin growths, including warts and moles, are usually not serious. However, some skin growths should be examined by a doctor to make sure they don't cause problems in the future. Warts are harmless, rough, bumpy growths caused by a viral infection. They occur most often on the hands and feet. Because they are caused by a virus, they are contagious. Moles are brown or black spots that are sometimes raised slightly from the surface of the skin. They happen when clumps of pigment cells form in a cluster instead of spread out. Moles are harmless except that they are more vulnerable to cancer than other parts of the skin. Skin cancer is the most common form of cancer in the United States, and its risk increases with sun exposure and fair skin tone.

Skin issues can be embarrassing or irritating, but most are minor and can be treated without serious problems. Some, however, can be a sign of a more significant issue, so it is important to see a doctor for anything out of the ordinary.