Plastic Surgery can heal the physical, and psychological, scars left by a mastectomy, cont.

THE ARIZONA REPUBLIC

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If a subcutaneous mastectomy was done, then a simple implant was placed in the breast. For the more serious mastectomy, the plastic surgery technique called for using a myocutaceous flap - skin with the underlying muscle attached - taken from another part of the body and used with an implant to replace the breast.

In 1976 at the meeting of the Plastic Surgery Society, a new technique was introduced. It was an update of a technique used in 1957 in Georgetown where a plastic surgeon put a balloon in a child scalp in an attempt to stretch out the skin to reconstruct on ear. It was called soft tissue expansion or tissue expansion. It is based on the ability of the skin to expand, just as the stomach of a pregnant woman expands as the fetus grows.

cottsdale plastic surgeon Dr. John Gibney was in the audience and he grasped the significance of the new technique. About 90 percent of the women requiring breast reconstruction could be treated with the soft tissue expansion technique. Only about

5 percent of mastectomies are subcutaneous - able to take a simple implant - and only two to three percent are radical mastectomies, requiring the myocutaceous flap technique. The rest could be done by soft tissue expansion which is easier on the patient, cheaper (less time in the hospital) and leaves no additional scars.

"I'm no the only one that uses the technique, but I think that I'm the one who uses it the most widely and probably the most experienced with it in the Valley," Gibney said. "There are other plastic surgeons using it."

Gibney didn't set out to establish a practice doing breast reconstruction. After finishing his general surgery training at the University of Utah, he came to Phoenix for his plastic surgery training. He finished in 1977, became board certified, and began his practice. Now he is on staff at five Valley hospitals, as well as the Phoenix Children's Hospital, teaches residents at the County Hospital for a portion of the year, and had written a chapter dealing with plastic surgery on electrical burns for a medical textbook.

"Mostly my plastic surgery practice has evolved into reconstruction, although I still do all kinds of plastic surgery," Gibney said.

Recently, Gibney used the tissue expansion technique at County on a patient with a burned face. The skin of the neck was expanded and then covered the burn.

The breast reconstruction using the soft tissue expansion is a three stage process. The first stage is surgical. A small implant, like a sack, is placed under the skin. It has some liquid in it. The second and longest stage, involves filling the sack periodically with more fluid, forcing the skin to expand, just as a pregnant woman expands.

When the body adjusts, more fluid is added until the desired size is reached. Then, over a period of three to six months, the body forms scar tissue around the implant. It is like a shell, enclosing the implant. Nothing shows on the outside. After the scar is formed, the third stage, also surgical, is performed. The implant is drained of fluid and removed, to be replaced by another, slightly smaller implant. This gives the new breast a slight sag and allows movement, giving it a natural look and feel.

"The first stage takes half an hour to an hour," Gibney said. "It can be done in any hospital operating room under general anesthetic. It could be done on an outpatient basis, but that is patient depenent. The average hospital stay is a day and a half to two days. The second operation, if you're not doing anything to the other breast to make it bigger or smaller or uplifted, is generally done as an outpatient under local anesthetic. The injection of the fluid commences about five to seven days after the initial operation, and takes maybe three to four visits to get full expansion. Once it has expanded, that's when the waiting period comes, three to six months."