Dr. Faeza Kazmier, a plastic surgeon specializing in breast reconstruction with Watson Clinic Women's Center, is among the first physicians nationally using a needle-free tissue expander that relies on the patient self-administering small doses of pressurized carbon dioxide instead of having the saline injections.
LAKELAND — Women who decide to have breast reconstruction following mastectomies may have an option that eliminates having a series of saline injections used to expand breast tissue.
Dr. Faeza Kazmier, a plastic surgeon specializing in breast reconstruction with Watson Clinic Women’s Center, is among the first physicians nationally using a needle-free tissue expander that relies on the patient self-administering small doses of pressurized carbon dioxide instead of having the saline injections.
“I have been a plastic surgeon, doing this, for 17 years. This is a new technology, the first in more than 17 years, for expanders,” Kazmier said. “We have had many different technological advances for implants, especially in the past five years involving shapes and profiles, but no advances in expanders.”
The advantages for the patient, she said, is not having the anxiety of dealing with needles every week or two, having more self-control in that she can administer the carbon dioxide herself at home, one or two times a day, or skip days if she feels it is too tight or uncomfortable, Kazmier said.
“So many patients work and they have to take time off work to come to the office,” Kazmier said. “This helps them feel more in control.”
Typical breast reconstruction treatment following surgical removal of breasts during a cancer-treatment regimen is to put a silicone pouch, called an expander, under the skin to allow healthy skin, muscles and blood vessels time to heal and grow while gradually creating a pocket so the breast implant can be inserted.
For decades, it has been standard procedure to insert a port at the time the expander is put in. Then after a few weeks of healing, the woman comes to her doctor’s office about once a week. Her skin is pierced with a needle and the saline fed into the port so the solution can gradually fill the pouch.
“We try to make it not painful, but it is a needle,” Kazmier said.
Last December, the U.S. Food and Drug Administration announced it had approved the innovative AeroForm tissue expander system. The FDA described it as having two main components: the expander implant, which has a tiny receiver antenna, electronics and lipstick-size container of carbon dioxide in it, and the handheld remote dosage controller.
The woman holds the controller up to her breast and when a light comes on indicating the device is receiving the signal, she pushes a button and the calibrated dosage of carbon dioxide is released, Kazmier said.
Although the device is approved for up to three doses a day, Kazmier said she has been advising her patients to use it once or twice a day.
“This tissue expander may result in fewer office visits for patients by allowing a patient to partially control their breast tissue expansion,” Dr. Binita Ashar, director of the Division of Surgical Devices at the FDA’s Center for Devices and Radiological Health, said in a news release.
Kazmier said that since May she has used AeroForm with six patients, about half those who are undergoing breast reconstruction. Because the expanders currently come in only three sizes and limited shapes, they are not appropriate for all patients. Some women have shorter or longer torsos than average or need a cup size or shape differing from the standard small, medium or large, she said.
However, Kazmier said, the manufacturer, AirXpander of Palo Alto, Calif., is working on providing more options, which would make the AeroForm device appropriate for a wider range of patients.
Kazmier recommended the device for patient Amy Smith, 48, of Vero Beach, who described the procedure as a good experience.
Smith, a real estate agent, has taken a year off work following her diagnosis of breast cancer last December and a double mastectomy Jan. 26. She said that rather than having the expander pocket put in at the time of her mastectomy, she decided she would rather wait until after she had healed.
Although not the typical route, for her it was a good decision, she said, because when she was ready to start the reconstruction process she was not happy with the local plastic surgeon. Her oncologist recommended Kazmier at Watson Clinic and Smith said she found it worth the 118-mile trip each way to be comfortable with her doctor and the procedure.
“I did not have to go back and forth every week as I would have for needle expander,” Smith said. ''It made the choice for traveling to the doctor easier.”
Smith said the device was very simple to use.
“Initially, I was doing it twice a day,” Smith said. “I felt it was stretching the skin too fast for me. I wanted to give the skin time to recuperate so I switched to once a day. That is the nice thing about this; you have that leeway.”
Using a secure patient portal through Watson Clinic, Smith was able to take photos with her cell phone and send them to Kazmier to evaluate the health of her skin as the pocket expanded.
“I could just snap the photos and upload them to the patient portal,” Smith said. ''If I had a question, the doctor’s office could say everything looks great or we need to do this. It has not been a struggle having my doctor that far away.”
Kazmier said that Smith “was great at using the portal. For me, there is nothing like seeing the photo to see what is happening.”
Smith had the expanders removed and her implants inserted Sept. 20.
“I like the implants; they look great and they are a lot softer than expanders. All expanders are stiff — they are filled with air — but the silicone gel in the implants is nice and squishy and it’s warm.”
After the implants are inserted, a patient typically is released for desk work in three or four days, although has physical activity restrictions for about six weeks, Kazmier said.
Marilyn Meyer can be reached at firstname.lastname@example.org or 863-802-7558. Follow her on Twittter @marilyn_ledger.