As a plastic surgeon, I have the privilege of treating women who suffer from breast cancer, a potentially life-threatening disease that is becoming all too common. After the general surgeon completes the cancer removal operation, I am given the job of restoring patients with an appearance that is natural. While some may think that my goal is to have a spectacular result, I actually believe that my best result is one in which a patient incorporates the reconstructed breast into her body image, thereby softening the physical, social and mental trauma of breast cancer.
As a reconstructive surgeon, the most important thing is for patients with breast cancer to know the wide range of reconstructive options available. Even in a country with advanced medical care such as the United States, less than 50% of women are counseled regarding their reconstructive options before undergoing surgery. I am an integral part of the breast care team; if you see one of our breast surgeons you will be able to understand your reconstructive options and make an informed decision which is best for you.
Reconstructive options begin for women that are undergoing a “lumpectomy” procedure, or a procedure where the cancer is completely removed but the remainder of the breast is left intact. Occasionally, these operations may result in a deformity that can be corrected or improved with reconstructive surgery, either immediately or in a delayed fashion. Also, many patients are surprised to learn that in cases where the cancer is only on one side, the opposite breast (without cancer) can be reduced or, if a choice of mastectomy on the non-cancer side is made, reconstructed in an effort to restore symmetry between the two sides.
For patients who are undergoing a mastectomy for their cancer treatment, the reconstructive options are broad, and even patients who have decided against reconstruction may benefit. As described above, if a patient has their breast removed on one side, a breast reduction on the opposite, non-cancer, side may help patients fit into clothes better and feel more balanced after their mastectomy operation.
For patients who do choose reconstruction, their options fall into three categories: using the patient’s own tissue, using breast implants or a combination of the two methods. When patients decide to use their own tissue, it typically comes from the abdomen. The skin, fat and muscle from the abdomen can be used to reconstruct one or both breasts in a procedure called a TRAM flap operation. In recent years, a procedure that spares the muscle and uses only skin and fat, called the DIEP flap operation, has gained in popularity and is one we are proud to offer here at Meriter Hospital. For patients who pursue reconstruction with breast implants, this reconstruction typically begins by placing an inflatable implant inserted at the time of the mastectomy. Over a period of several weeks after surgery, this implant is inflated in the office; this inflation process restores the dimensions of the original breast pocket, and creates a space for a permanent implant, placed in the second stage of reconstruction. Nipple reconstruction may also be performed at that time or later. Finally, in some patients who cannot have reconstruction using their abdominal tissue, a procedure that combines both the patient’s own tissue (from the back) and the use of an implant is performed.
It is important to emphasize that there is no reconstructive option that is “better” or “worse.” Every patient is different, and I will help educate you in the options best suited to your body and to the desires you have for your own reconstruction. Similarly, while there are many reconstructive options available, it is also important to recognize that not every option is available for every patient. Your weight, breast size, history of radiation therapy or previous surgery may have an impact on the type of reconstruction best for you. The rationale and reconstructive recommendations suited to you can only be determined with a consultation. Finally, if you have been treated for breast cancer in the past but did not pursue or were not offered reconstruction at the time and have now become interested, you still have options you can pursue after a “delay” in reconstructive treatment. It is as simple as setting up an appointment with your plastic surgeon to discuss these options.
One of the first plastic surgeons in history described our specialty as one that “restores and makes whole.” This goal holds true today in all types of breast surgery in my practice. It would be a pleasure and honor to see you.