Breast Reconstruction After Breast Cancer

What Every Woman Needs to Know About Breast Reconstruction After Breast Cancer
Throughout my career practicing both reconstructive and cosmetic surgery, I have had the honor of caring for breast cancer patients, and have specialized in breast reconstruction surgery. Each year more than 254,000 American women are faced with the diagnosis of breast cancer. While breast reconstruction is not an option for all, it can help a majority of the patients regain the confidence and body image that they possessed before their diagnosis.

Once a patient is diagnosed with breast cancer, I spend a considerable amount of time educating her on all the surgical options for breast reconstruction. In general, this will include either utilizing a patient’s own tissue (autologous) or relying on breast implants to obtain a desirable breast shape. Each option has its benefits.

When considering one’s own tissue, the most common source is the abdominal skin, soft tissue and muscle (Transverse Rectus Abdominal Myocutaneous flap, TRAM). It has a very similar feel to the native breast and, if done correctly, has a very desirable cosmetic outcome. Although not every patient is a candidate for this type of procedure, it is often recommended in cases where patients will also require radiation treatment. If the patient has minimal excess abdominal skin and soft tissue, back muscle and skin can be used for reconstruction with a breast implant (Latissimus Dorsi Flap). Most recently, new advances in microsurgery has offered patients a less invasive option for utilizing one’s own abdominal tissue (Deep Inferior Epigastric Perforator Flap, DIEP). Each of these surgical options has their notable benefits, but as recovery from these types of procedures tends to be prolonged, patients with active lifestyles often choose alternative types of reconstruction.

In comparison, implants offer a much less invasive option for breast reconstruction with a desirable aesthetic result. With the new advancements in implant technology, we now offer our patients more natural-feeling implants that have a desirable anatomic shape. Furthermore, the non-affected breast can be lifted or enhanced with a breast implant to improve symmetry with the reconstructed breast. This is often a two staged procedure that is initiated with placement of a tissue expander during the mastectomy. The tissue expander is then slowly inflated over a three to four week period and then a permanent implant is placed. (This may be delayed if radiation or other interventions are necessary.) This ensures that the newly reconstructed breast will have a tear drop shape that women desire. One point of consideration is that a patient should expect that breast implants will require a replacement or revisions within 10 to 15 years of their original surgery.

An open dialogue should exist between the patient and the specialist involved in her care. This would include the general surgeon, plastic surgeon, oncologist, radiation oncologist, radiologist and physical therapist. It is this cooperation that ensures the most seamless pre- and post-operative care and ensures that the patient receives the best treatment regardless of the option she chooses. Here are a few questions concerning breast reconstruction that I think are important to address in the pre-operative setting:

Will I need radiation treatment or chemotherapy following my procedure?
Am I a candidate for a nipple sparring or short incision mastectomy?
Am I a candidate for autologous tissue reconstruction?
If I choose implant reconstruction, am I a candidate for shortened tissue expansion (less than two weeks)?
Do I have any risk factors or anatomical characteristics that preclude me from proceeding with a specific type of reconstruction?

Although breast reconstructive procedures can have varying results, a patient should expect that any reconstructive surgery should create a desirable breast shape and volume that is symmetrical to the opposite breast. Patients should request to view pre-operative and post-operative photographs and have an open and honest discussion with their plastic surgeon. In my clinic, many patients feel that these procedures actually improve the appearance of their breasts, especially when the native breasts have lost their desirable shape after pregnancy. Furthermore, with new advances in nipple and areola reconstruction, the final results of the reconstruction can appear very realistic.

Here are some links to valuable resources for women considering breast reconstruction:

October is breast cancer awareness month. Dr. W. Jason Martin, a board-certified reconstructive and plastic surgeon, is on the advisory board of Komen Aspen and specializes in the care of breast cancer patients who require breast reconstruction procedures.