European Stars and Stripes (Newspaper) - December 29, 1992, Darmstadt, Hesse                                Phase two5 reconstruction by Steve scholar staff writer choosing How or if to undergo breast reconstruction is an extremely personal decision. Until the 1960s, the options were cumbersome expensive and often not very successful. Many women opted not to have reconstructive surgery when faced with the risks. Advances since then have been rapid and it is generally accepted that any woman who desires breast reconstructive surgery has an excellent Chance of being satisfied with the results. The methods most often chosen by women today Are silicone gel implants skin expansion or the Transfer of tissue from other parts of the body. Despite the ongoing safety controversy Over silicone some women still opt to use it. These implants rely on a rubber like gel that has a consistency similar to the Normal breast. This relatively simple procedure involves inserting the implant Sac under the Chest skin Ollen through the Mastectomy scar thus avoiding further scarring. The operation takes up to two hours and is done with local anaesthesia. Of the current methods used to reconstruct a breast this is the least Complex. A Saline implant is an increasingly popular alternative for those women concerned about using silicone. Tissue expansion techniques involve a gradual Extension of the skin tissue in the affected area by using an inflator creating a Hatwan expander works abdominal Tala a a Silicon in pint a poem under a Chait Motel i tit most common kind of replacement. If tit skin is too tight for it an implant that is gradually filled with fluid can a used to slowly stretch the skin until tha breast has reached the desired size. It is filled weekly with Saline fluid through an outs Lda valve. The breast Mound will soften after about three months. Some expander become permanent implants others Are replaced in an outpatient procedure by a new prosthesis. A nipple and Areola Are constructed in a separate minor operation. Muscle pocket. Filler valve implant a natural Rifae la created by taking a tuck fatha fold under tha breast and stitching it. One approach uses the skin and fat from tha patients own Abdomen to build a breast that looks and feels natural. The inflator is inserted under the skin and gradually Over the course of six to eight visits filled with silicone or Saline fluids. Once the breast is approximately the same shape and size As the other breast the expander is removed and a permanent implant is inserted. During the six to eight weeks the expander is used doctors advise patients that they can maintain most Normal activities. Removing the expander and inserting the implant can be done on an outpatient basis. The most difficult procedure for reconstructing a breast is tissue Transfer. There Are three variations. One transfers tissue from the patient s Back to the Mastectomy area. The Latis Simus Dorsi muscle is moved to the Chest area and an implant is placed under the new Chest muscle. The three hour operation requires a one week hospitalization. This method a and All tissue transfers a Means additional scarring in the area where the skin is removed. Another tissue Transfer technique takes skin and fat from the Chest and abdominal area and places it Over the Mastectomy. Still another makes use of the abdominal Muscles. All tissue Transfer methods Are More difficult than tissue expansion or the simple implant procedure. They require longer Hospital stays involve More scarring and take longer to recover from. Not All procedures Are available at All military hospitals. Also the tissue Transfer methods Are expensive often costing thousands of dollars. Some of that Cost is normally covered by insurance plans. Breast reconstruction is not the Only alternative. Many women use external breast forms particularly those seeking an alternative to further surgery. Breast forms Start at about $10 and typically Are made of a Long lasting fabric. Because there Are Many reconstructive techniques available following a Mastectomy doctors suggest careful consideration before deciding. All methods carry some risk to the  set a it few of  mud Tab no of in in it in it a for Brut cd we a. One inherited Deleot Elim the it e of .45, a flew in Gene ass a Eil the a Lake info Milf with it Reumen syndrome. Inborn a recep Tibithy to to West oui a of Eny Type and at any age May be More common than previously believed., researchers have also found a Gene that May it be Centra to the. Spread of cancer. It to Quot switched on inthe Normal cells around a breast tumor just before the Lump prepares to infiltrate the neighbouring tissue. The Gen makes an enjoy a that helps dissolve the tissue matrix that confines the it cancerous Lump so cells can escape to the. Bloodstream. The enzyme could be a target Tor Early therapy. It v source. N v. To no nows be juice a Mammogram after surgery and for types by Linell Smith the Baltimore Sun for i he first Lime major health organizations have agreed upon standards clarifying which breast cancer patients should be offered the option of Lumpectomy and radiation therapy As an alternative to removal of the breast. At least one third of All breast cancer patients could be eligible for a Lumpectomy a removal of the primary breast tumor and adjacent breast tissue followed by about six weeks of radiation therapy instead of Mastectomy under the new guidelines announced earlier this month by the american College off surgery radiology the american College of surgeons the american cancer society and the College of american pathologists committee on cancer worked with the american College of radiology to develop the standards. They say that women whose Early breast cancer was detected by mammography Are candidates for the breast saving treatment. Women with a Small Lump whose cancer has not spread to surrounding tissues Are also eligible. And depending on the size of the tumor in relation to the size of the breast women whose tutors have spread May qualify. Studies show that the survival rates for Many breast cancer patients Are the same whether they Are treated by Mastectomy or by Lumpectomy and radiation therapy. The new standards also recommend proper follow up that includes a a physician s examination every three to six months for three years after treatment every six months Tor the fourth and fifth year an annual exam thereafter. Before radiation therapy to ensure All of fhe tumor has been removed a Mammogram every six months for the first year after treatment an Annua Mammogram thereafter. Page 16 a the stars and stripes tuesday december 29, 1992