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By Dr. Jay Orringer

Today, a wide variety of breast reconstructive options exist. An understanding of the basic concepts will help greatly in the decision making process. In general terms, there are two ways to reconstruct a breast. The simpler method involves the use of a temporary adjustable-volume implant called an expander. Salt water is added to the expander until a pleasing size has been achieved. The expander is then replaced with an implant. The more involved category of reconstruction involves the use of one’s own tissues, transferred from the back, abdomen or buttocks.

Expander, followed by implant, reconstructions have the advantage of being simpler procedures and the scars are limited to the chest. However, these devices require maintenance (replacement) over the course of time. When the chest wall tissues are thin following mastectomy, edges and ripples are more visible unless the padding over the implant is improved.

One common way to improve thickness over the implant is with the use of AlloDerm. This is a sheet up to 3mm thick, derived from human skin. However, it is treated such that the cells are removed from it and the patients cells grow into it. Because the original cells have been removed from it, it tends to be well-tolerated. It becomes, in essence, another layer of one’s own tissue. This may decrease the devices’ visibility and palpability. It has gained widespread use today.

A second way to improve the appearance and thickness over an implant reconstruction is with the addition of tissue transferred from the back. This is called a latissimus flap. A scar on the outer part of the back may be traded for a less conspicuous scar on the breast. The transfer of healthy tissue over the augmentation may increase the natural quality and the durability of this method of reconstruction, but the trade-offs must be weighed in discussion with your surgeon. Implant reconstructions often do not do well long-term following prior radiation, without the addition of healthy tissue as with the latissimus flap.

Breast restoration from the abdomen and buttocks may provide enough skin and fat to make a new breast without an implant. These options avoid maintenance issues, but are much more involved procedures. A potentially more natural and permanent reconstruction may result. However, a scar at the site from where the tissue was taken results. In addition, some weakness occurs from the transfer of muscle. This is usually well tolerated in most people, but each individual has a different experience. The TRAM flap was the first transfer of skin, fat and muscle to make a new breast mound. It has been followed by muscle-sparing free TRAM flaps and DIEP flaps.

The free TRAM flap takes less abdominal muscle and usually has a better blood supply than the traditional TRAM flap. However, it requires microsurgical expertise to perform the transplant and it is not always successful. In an effort to take muscle-sparing further, the DIEP flap was developed. This flap spares more muscle, although the abdominal muscle is not totally spared of damage. The blood supply of the DIEP flap may not be as hearty as that of the muscle-sparing free TRAM flap. The traditional TRAM flap, muscle-sparing free TRAM and DIEP flap are all good options in selected patients.

The gluteal or GAP is the least commonly done and most complex option. It involves the transfer of buttock skin and fat to make the breast. It is usually done in women with little abdominal fat or in those having undergone previous tummy tuck, especially those with chest wall radiation damage. GAP flaps are currently done at limited centers. Again, in the well-selected patient, it can be a very good option.

Skin-sparing mastectomies involve removal of the nipple and underlying tissue while leaving most of the skin. Newer types of skin-sparing incisions may simulate a breast lift, avoiding the less aesthetic scar on the inner aspect of the reconstructed breast. In the appropriately selected patient, this procedure has improved greatly the cosmetic appearance of both implant and tissue reconstructions.

Whether to undergo reconstruction with expander and implant with AlloDerm or latissimus flap or whether to have a reconstruction with your own tissue without an implant is a question that must be carefully considered with your surgeon. The type of reconstruction and incision should be discussed in detail prior to the procedure. A well thought out plan will more likely produce a result that appears most aesthetic and is optimally pleasing to the patient.

About the Author: For most women in Beverly Hills, breast reconstruction is a vital part of recovery from breast cancer. Dr. Jay Orringer has more than two decades of experience performing breast reconstruction and is constantly evaluating techniques for the most natural-looking results.

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By Steve P Smith

Magnesium is one of the most important minerals for human health and is required throughout the body; but by far the largest quantities are found in the bones and muscles.

Almost all the body’s enzymes are dependent to some degree on adequate supplies of magnesium, and these enzymes are essential for several hundred vital metabolic reactions; amongst the most important being the production of energy within cells through the metabolism of dietary proteins, carbohydrates and fats. Magnesium is also needed for the synthesis of protein, the activation of genes and the transmission of impulses between nerve cells.

In addition to the above general functions, magnesium is a vital element in the complex of nutrients required for the production of glutathione, one of the body’s most important fat-soluble anti-oxidant enzymes. Glutathione protects those parts of the body’s cells which are composed of fat, such as the membranes, by neutralizing any free radicals attacking these delicate structures.

Magnesium may therefore be regarded as an important anti-ageing nutrient in its own right, but it has also been the subject of extensive research into a number of more specific health functions.

Adequate levels appear to be particularly important in ensuring the proper take up of calcium by the bones, and low levels of blood magnesium have been shown to be linked with correspondingly low levels of calcium; and to have an inhibiting effect on the action of vitamin D, which is itself essential for the proper functioning of calcium. Logically enough, therefore, some research has suggested a link between supplements of magnesium and increases in bone density.

There is some research evidence to suggest that low levels of blood magnesium may be a risk factor for the development of high blood pressure, and also that magnesium supplements can be of benefit for reducing blood pressure in sufferers who have inadequate intakes of dietary magnesium, but orthodox medical opinion maintains that more work is necessary before this link can be definitively established.

Low levels of magnesium intake are also associated with a significantly increased risk of diabetes, but there have been conflicting results from research studies into the question of whether supplements of magnesium may be useful in managing the disease.

Likewise, the benefits of the use of high doses of intravenous magnesium in the immediate aftermath of heart attacks remain a matter of controversy, but there is good evidence that oral supplements of magnesium may reduce the risk of dangerous blood clots in individuals suffering from cardiovascular disease.

There is also a known association between low levels of blood magnesium and recurring migraine headaches, and there is some evidence that supplementation may reduce the frequency of attacks.

Supplementation has also been shown to help alleviate the symptoms of pre-menstrual syndrome in more than 70% of women.

Unprocessed whole grains such as brown rice or cereals are the best food sources of magnesium. A serving of oats or bran, for example, may typically provide as much as 90 mg or more of magnesium per serving; a cup of brown rice a little less, and a serving of wheat cereal perhaps 60 mg or so. Dark green vegetables such as spinach may provide up to 80 mg; and beans and nuts are also a useful source, a single ounce of hazelnuts or peanuts, for example, supplying almost 50 mg of magnesium. Milk may also supply around 30 mg.

But despite these apparently widespread and rich sources, there is evidence that many people do not obtain sufficient dietary magnesium and that the diets of older people, in particular, are likely to be inadequate. The European Recommended Dietary Allowance (RDA) for magnesium is 300 mg, but in the US higher levels of 420 mg for men and 320 mg for women have been prescribed. Given the importance of magnesium within the body, these findings are a cause for concern, and indicate that most adults should be considering supplementing with magnesium.

However, some caution needs to be exercised when taking extra magnesium in this way; because 350 mg per day has been established in the US as the upper safe limit for supplemental magnesium for adults. Below this level there should be no risk of the relatively minor, albeit unpleasant, gastric side effects, principally diarrhoea, which have sometimes been noted when higher dose supplements have been taken.

It’s important to note, however, that more serious consequences of excess magnesium have been observed in those already suffering from kidney problems. Such individuals appear to have a higher sensitivity to concentrations of the mineral, and may suffer further deterioration in kidney function and possibly blood pressure problems as a result.

No such problems have been observed to arise from high levels of magnesium consumed in the diet, and it needs to be remembered that like all other nutrients, magnesium does not operate in isolation within the body and interacts closely with other vitamins and minerals.

Any supplementation should therefore be taken as part of a comprehensive multi-mineral. And for the maximum anti-oxidant effect through the production of glutathione, this should be taken alongside a good quality multi-vitamin preparation.

About the Author: Steve Smith is a freelance copywriter specializing in direct marketing and with a particular interest in health products. Find out more at

sisyphuspublicationsonline.com/LiquidNutrition/Magnesium.htm

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