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April 29, 1994 - Image 51

Resource type:
Text
Publication:
The Detroit Jewish News, 1994-04-29

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Diabetes is our Specialty!

New Technique
After Surgery

Jerusalem - Twenty years ago, if
doctors found a malignant growth
in a woman's breast, radical mas-
tectomy was prescribed and off
came the breast. The patient had
to wear a bra with a false breast
when dressed, and a hollow area
remained after surgery in front
of the armpit and the chest wall.
Times have changed. Doctors
have learned that often only part
of the breast need be removed.
But when modified radical mas-
tectomy is called for, chances are
the patient will leave the hospi-
tal a week later with something
very much resembling a breast
at the site of the operation.
Dr. Menachem Ron Wexler,
head of plastic and aesthetic
surgery at Hadassah-Hebrew
University Medical Center, says,
"We come in when general sur-
geons finished their ablative
surgery. They leave us a large
open wound, above the chest
muscles. We make a pocket un-
der those muscles — which are
not removed as they were in rad-
ical mastectomy — and insert a
silicone bag, partly filled with
saline."
Every second day, the bag is
made fuller with fluid injected
through a hidden tube. This caus-
es the chest muscles and skin to
stretch over the bag. By the time
the patient leaves the hospital
she already has a bulge which
simulates a breast.
"This is the first stage," says
Dr. Wexler. During the next three
months the "stretch" becomes
permanent, the patient attends
the outpatient clinic where she is
checked, and the amount of flu-
id is adjusted.
Next is stage two. "We replace
the first bag with one filled with
silicone gel to give a more natur-
al fee," says Dr. Wexler. `hough
we haven't faced a problem in the
past, we now use only silicone
prostheses that are approved by
the FDA (Federal Drug ADmin-
istration) in the U.S.
"But now, more often, we com-
bine stage one and two. That is,
we insert an expander-prosthe-
sis in the first stage. This bag is
composed of separate compart-
ments of silicone and saline, and
remains in place permanently."
Stage three is reconstructing
the nipple and areola. For the
areola, Dr. Wexler uses either
areola skin from the other breast,
or skin from the inner thigh. The
plastic surgeons build the nipple
from local tissue, cutting two S-
shaped flaps, pulling them up,
and suturing them together. "It
look like the real thing," he says,
"but it has no erotic sensation."
Silicone is the simplest recon-
struction method, and the one
that Dr. Wexler prefers because
it "burns no bridges." 0








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