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Among nearly 4,000 women studied, 88 percent had at least two breast reconstruction operations, 65 percent had more than two, and 39 percent had four or more, the Canadian researchers reported.
"Women undergoing breast reconstruction should expect to have an average of two operations," lead researcher Dr. Amanda Roberts, a clinical research fellow at the University of Toronto, said during a Thursday morning news conference.
Roberts said that some "re-operations" are expected. These can involve replacing a tissue expander with a permanent breast implant, or recreating a nipple, she explained. The expander is a temporary measure used to stretch breast skin and muscle.
However, some operations are unexpected and deal with long-term complications, such as bleeding, infection or abdominal bulges resulting from the use of abdominal tissue for the breast reconstruction, Roberts said.
"One in 10 patients had one or more unanticipated reapportions," she said. "Additional surgeries after breast reconstruction can lead to problems, potentially reducing the quality of life."
For the study, the researchers collected data on 3,972 women who had breast reconstruction between 2002 and 2008.
The findings were to be presented April 30 at the annual meeting of the American Society of Breast Surgeons, in Orlando, Fla.
Dr. Lauren Cassell, chief of breast surgery at Lenox Hill Hospital in New York City, said having two or more procedures is not unusual.
"This is something we all know," she said. "If you are an honest plastic surgeon, you will tell your patients this from the get-go."
Cassell said the goal of reconstruction is to try to make the breast as perfect as possible. "It's extremely difficult, and the first go-around, sometimes you're lucky and everything winds up symmetrical and perfect and requires nothing further," she said. "But very few patients get away with a single procedure."
In a number of cases, a tissue expander needs to be inserted before the permanent implant is placed, Cassell said. In addition, sometimes a third procedure to recreate a nipple is needed, she said. This procedure ensures that the nipples are perfectly aligned.
"It's amazing how much less we tolerate an imperfection with a reconstruction than patients do in their own breasts before surgery," Cassell said. "For women who want to look the best that they can, it may take more than one procedure," she said.
Usually the first procedure is the major one, Cassell said. After that, the procedures are minor, often involving adjusting the implant or the skin, she explained.
Cassell doesn't think these multiple operations mean that surgeons are incompetent or greedy. "It's part of the procedure," she said. "Everyone is looking for perfection."
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