Dr. L - ? breast auto augmentation

I've had 2 mammos since having it done and I've not heard of a problem with mine.

I began my career doing breast auto-augmentations.  They are called TRAMs and LATs and involve moving tissue from the tummy and back to reconstruct a breast after cancer.  About 10-30% of those patients develop fat necrosis, which are hard lumps in the breast. Calcification can also occur on mammography.

Now....in a patient who had had their breast removed (and possible also had radiation or chemo) these lumps are not a problem, because we know there is no breast tissue there and the chance of cancer jumping in to the middle of a reconstructed breast is exceedingly low. Don't even think its been reported. 

Anyway, these operations are the "gold standard" for breast reconstruction.

However, when mixing the arm and side of chest tissue in with native breast tissue, how do you tell whats a good lump or a bad lump ?  Remember, breast cancer is still a big problem, second most common cancer in women.  And there's no long-term data on the auto-Aug procedure in terms of mammography and cancer screening. 

In fact, both membership societies (ASPS and ASAPS) have come out against transferring fat to the breast until better data is available. 

Don't get me wrong, the spiral flap developed by Dr Hurwitz is an elegant operation.  I met Dennis here in Houston when we sat on a panel together at a post-WLS meeting.  We both admitted we felt like long-lost colleagues, but I respectfully disagreed with him on this.

So, my objection is that breast autoaugmentation may interfere with cancer detection.  Here I am again, raining on the parade being a conservative safety nut. 

 

Thanks for your insight.  I remember you telling me how you disagreed with Dr Hurwitz.  I think it's better to be conservative and be safe than sorry.

Melissa

Thanks so much for taking the time to educate all of us.  I think the infomation is very helpful for all of us, and it allows those of us who've had the spiral flap procedure to be more educated if there should be an issue during cancer screening. 

I'm wondering when the ASPS and ASAPS came out against fat transfer.

This is something that I will ask my surgeon about on Friday when I see him again, and what risks I need to know about.

And you are not raining on my parade - I'm glad to know.  I also wonder if I had been give the option of super extra small for me, or the auto aug and knowing this information, which would I have chosen.  Would I take the risk and balance that with the thought that there is no family history of breast CA, but knowing that if something turned up that I might have to undergo some invasive procedures?  Hmm something to think about today.

Let  me clarify...the ASPS guidelines were for free fat transfers (i.e. fat injected from elsewhere).   The spiral flap technique is different, and that particular technique has not been the subject of debate.

The short answer is that it is simply hard to know what the effect of this procedure on mammogram will be...until we  have larger numbers of patients who have had it and actually begin getting their mammograms.

So my opinion is that in the hands of an expert like Dr Hurwitz (who pioneered the technique), there will be good followup and understanding of the operation and it's followup.  But as far as widespread use by the "average Joe"...I don't think we're there yet, and there are other accepted surgical options.

BTW in spite of the ASPS position on fat grafts to the breast, we have an OB-Gyn here in Houston who advertises the technique.

Thanks for the clarification.  I had thought that you'd meant all the auto-aug techniques. I know that I was told it was very important to keep up with my mammograms and to let them know that I had the spiral flap breast auto aug along with my mastoplexy. 

Since I really didn't have an option of implants at that time to due the guidelines laid out, I feel like it was it was a good choice for me. I'm very happy with the results, except for that upper fullness thing, but I can deal with that.

I know that Kaiser really stresses mammography and I've been good at keeping up on that. I was told that I didn't have free fat transfer, and my operative report records spiral flap.

Thanks again for your input!