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11/30/2016

Handing over the Control in Breast Reconstruction Surgery


A company named AirXpanders is in
the process of developing a medical device that will give women a
sense
of control over breast reconstruction surgery
.  The name of the product is AeroForm and it is currently under
review by the FDA.  
It
is approved in Europe and sold in Australia
. AeroForm is currently in clinical trials.

Using an implant is the current
standard of care for breast reconstruction.
  In order for an implant to achieve its
designed purpose, space must be made in the breast tissue.
  Before AeroForm, this space was achieved
through multiple visits to the doctor’s office using a saline injection. It was
a painful process for some women and could take months. AeroForm is a wireless,
needle-free tissue expansion device.
  A
device is surgically inserted into the breast that will deliver small amounts
of CO2 gas to expand the tissue as the saline used to do. The release of the
gas is controlled through an internal valve signaled by a wireless dose
controller operated by the patient. The patient can release the gas at her/his
own rate to make it less painful and can be done at home.
  It also can speed up the process from months
to weeks. The device is more expensive than saline injections but it reduces
the numbers of physician’s visits, so cost is comparable. 

The
process of restoring something so intimate may be embarrassing as well as
medicalizing part of one’s identity.
  This
device may be a way to restore lost confidence for breast cancer
survivors.
  Losing one’s breast can be
damaging to one’s identity. We as a society equate breasts with feminine
identity. Without breasts, according to society, a woman becomes less desirable
or less feminine. A primary goal of reconstructive surgery is to restore the
bodily image of what is socially accepted, but also what the patient wants
personally. Positive body image is an important part of self-identity and
confidence and positive body image connects to what is socially accepted.
Although this device is arguably reinforcing the social norm that women need to
have breasts, this device is ultimately restoring confidence and identity. Allowing
women to have a role in this medical process allows for restoring some of that
lost privacy and identity in an already emotional experience. This restored
control can also have a psychological effect on the patient during recovery. In
a sense, this device is following the trend of our society to favor patient
autonomy and increasing patient involvement in healthcare.

But
when is patient control too much? Physicians may still remain cautious with
devices such as these because it is moving treatment away from the known,
controlled setting of the physician’s office to the patient’s home. This is the
balance between respecting patient autonomy and beneficence. The downside of
using this device at home is if there are any issues during the gas release, a
physician will not be there immediately. Some may argue that care outside a
physician’s office is not beneficial but there are also a lot of benefits to
self-administration of care like this case. This device is only a small part of
the entire reconstructive process. But society should still keep in the back of
its mind that physicians still have a very relevant role to play in health care
decisions, no matter the location of treatment. 

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