Orlando Cosmetic Surgery believes many of you might have seen a recent breast reconstruction story
It referred to a popular option for breast reconstruction surgery.
The combination surgery has been commonly named the “One and Done” approach.
The name, One and Done, refers to a breast surgery which combines two procedures:
First– The cancer patient undergoes a nipple-sparing mastectomy, which we recently explained in our blog. In this procedure, the surgeon removes breast tissue, sparing the nipple.
Second– Without waking the patient, a plastic surgeon then steps in and immediately completes the surgery with breast reconstruction and breast implants.
“Aesthetic refinements include nipple-sparing mastectomy, use of acellular dermal matrix, shaped implants and fat grafting,” stated the authors of recently published studies in the Journal of the American Society of Plastic Surgeons.
Previously, the reconstruction surgery would be delayed, probably for months, until after the mastectomy. It is only in the within the last five years that the One and Done techniques have been perfected and popularized.
One of the major advantages of having breast cancer surgery done “One and Done” style means the patient will not be forced to cope with the mutilated body image usually associated with mastectomy.
In his article on the subject, ASPS (American Society of Plastic Surgery) Member, Dr. Mark A. Codner of Emory University, Atlanta, stated optimistically, “Breast reconstruction after mastectomy has evolved toward less invasive, single-stage procedures.”
High Praise for the Procedure
Likewise, as was reported by the CBS news article, “Dr. Mehra Golshan, Chair of Surgical Oncology at the Dana-Farber Cancer Institute in Boston, said the benefits are huge.
He explained the advantage directly from the viewpoint of the patient, “Right after surgery you wake up and take a look down, you get to see the skin, the nipple, the size is the same as when you went to sleep and this is something we couldn’t offer a few years ago.”
Special Alert: One and Done Could Be a Misnomer
The American Society of Plastic Surgeons as well as Orlando Cosmetic Surgery, feel like this One and Done idea should possibly be renamed since “over 30% of women will need further surgery.”
It is for this reason that you will also hear surgeons call this type of surgery “direct to implant,” which is a name that appropriately describes the procedure without making generalized promises.
The Single Procedure: Not Always the Best Option
There are many factors involved before the decision to do a mastectomy and a reconstruction at the same time should be made. Let’s look at some of them:
1. This double procedure surgery has been highly successful for patients who elect prophylactic mastectomy in the case of genetic factors. You will undoubtedly recall Angelina Jolie’s case.
2. The rules change when diagnosed cancer is involved.
You should understand that “The final cosmetic results after implant breast reconstruction depend heavily on the thickness of tissue covering the implant.
Often after mastectomy, the tissues over the implant aren’t thick enough to camouflage the implant completely, even if the implant is under the pec muscle.”
Thus many patients require additional surgery with fat grafting, simply to add more tissue over the implants.
This is the average reason for revision surgery after a One and Done procedure has been accomplished.
3. If a patient requires radiation, the option for one and done surgery should be very carefully considered. Although not always the case, “Radiation and implants sometimes “do not get along very well.”
This can cause health complications, as well as poor cosmetic results.
4. Sometimes Nipple-sparing mastectomy is not the best option for a patient, or a patient might not want to preserve the nipple-areola. However, experts note that “reserving the nipple-areola significantly improves the cosmetic results after breast reconstruction, particularly reconstruction with implants.”
We can see from these four major points that whether we call the double procedure, One And Done or Direct To Implant, great care must be taken with each decision made in the regard to the strategy of both a mastectomy and the breast reconstruction.
If you are a patient, your cancer surgeon and your cosmetic surgeon will meticulously develop an individualized surgical strategy to guard your health as well as your self-image.
At Orlando Cosmetic Surgery, we know the idea of accomplishing everything in one surgery is overwhelmingly appealing to many mastectomy patients. However, the American Society of Plastic Surgeons cautions patients that “unfortunately this will not always be in your best interests.”
Moreover, they remind patients to “discuss your expectations thoroughly with your surgeon prior to proceeding with “one and done” breast reconstruction, to make sure it is the best choice for you.