Breast Cancer Awareness Never Ends

National Breast Cancer Awareness Month has come to a close but breast cancer marches on.  As a plastic surgeon, I work with women who are going through breast cancer treatment.  We meet not under the best of circumstances and the journey is long.  At the end, many patients see their breast reconstruction as a positive experience, what we call the “silver lining of breast cancer”.  A diagnosis of breast cancer is scary and most women are stunned, frightened, angry….  But women are fighters, and soon enough they have found their way to my office to start looking ahead to the future, to being a breast cancer survivor with a positive body image.  They have become pink warriors.

Breast reconstruction after mastectomy is an important part of the care of women with breast cancer and promotes a positive body image.  Replacing the breast can be an external breast prosthesis, breast implants, or a woman’s own skin and fat (a tissue flap).  Reconstructing the breast with a breast implant or tissue flap generally requires more than one procedure; it occurs in two to three stages.  Many women are candidates for immediate reconstruction; that means the first stage of reconstruction is done at the same time as the mastectomy.  If your breast cancer is discovered early, you are more likely to be a candidate for immediate breast reconstruction.

If there is a need for subsequent chemotherapy or radiation, reconstruction may need to be delayed until these treatments are completed.  Chemotherapy and radiation can slow your ability to heal and change the final appearance of your reconstruction.   In addition to radiation, diabetes, smoking and obesity increase the chance of complications after any surgery, including breast reconstruction.  Delayed breast reconstruction (breast reconstruction done some time after the initial mastectomy) is an option and is covered by medical insurance.  The term “reconstruction” means to restore normal form and function; breast reconstruction is not cosmetic surgery.  However, the result of your reconstruction should be aesthetically pleasing.

The choice of reconstruction with implants or a tissue flap depends on many factors, including the likelihood of needing radiation treatments, the size of opposite breast, the availability of tissue for a flap, the patient’s medical problems and patient preference.

Other breast cancer survivors that have had a lumpectomy or partial mastectomy followed by radiation may have changes in their breast that require reconstruction.  Breast asymmetries are the norm even in unoperated breasts; however, after lumpectomy, breasts may have significant changes in volume, shape, or nipple position that can be improved with reconstructive surgery.  Commonly employed techniques are scar revision, fat transfers to restore the volume of the breast, flap reconstruction to replace breast volume and skin if needed, and symmetry procedures on the opposite breast.  These symmetry procedures include breast lift or breast reduction and are designed to make the two breasts look more alike.

Your general surgeon may send you to a plastic surgeon for consultation for breast reconstruction or you can refer yourself in cases of delayed reconstruction or reconstruction after lumpectomy.  It’s your body and it may be your next step towards being a breast cancer survivor.