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 tasked with the job of restoring patients with an appearance that is natural. I believe that my best result is the one that patients barely notice because there is such a small difference between their body before and after cancer.
The most important thing to me as a reconstructive surgeon is for patients with breast cancer to know that there are reconstructive options. Even in a country like the United States, less than 50 percent of women are counseled regarding their reconstructive options before undergoing surgery.
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. 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 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 less unbalanced after their mastectomy operation.
Patients that pursue reconstruction have options that fall into three categories: using the patient’s own tissue, using breast implants or a combination of both. 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 just uses skin and fat, called a DIEP flap operation, has gained in popularity, and it is one we are proud to offer at Meriter Hospital. For patients who pursue reconstruction with breast implants, this reconstruction typically begins by placing an inflatable implant at the time of the mastectomy. Over a period of several weeks after surgery, this implant is inflated in the plastic surgery office, restoring the dimensions of the original breast pocket and creating a space for a permanent implant that is placed in the second stage of reconstruction. Finally, in some patients who cannot have reconstruction using their abdominal tissue, a procedure that combines both the patient’s own tissue and the use of an implant is available where an implant is placed and is covered using skin, fat and muscle from the patient’s back.
It is important to emphasize that there is no reconstructive option that is “better” or “worse.” Every patient is different, and the plastic surgeon helps patients pursue an option that is best suited for her body and the desires she has for her 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. The patient’s weight, breast size, whether or not they have had radiation therapy and even previous surgical history may have an impact on the type of reconstruction that is best for her. Finally, if a patient has been treated for breast cancer in the past but did not pursue or was not offered reconstruction at the time and has now become interested, she still has options available to pursue after a “delay” in reconstructive treatment. It is as simple as setting up an appointment with a 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, especially in my practice as I have the privilege of treating women who suffer from breast cancer.