MAKING THE CHOICE:
BREAST RECONSTRUCTION FOLLOWING MASTECTOMY
Education for National Breast Cancer Awareness Month
Fear. Shock. Denial. The emotional roller coaster a woman rides following the diagnosis of breast cancer is tremendous. This year, more than 180,000 women in the United States will be diagnosed with breast cancer. However, if diagnosed and treated early, the breast cancer five-year survival rate is more than 90 percent. For those patients whose treatment includes either partial or full mastectomy, knowing the facts about breast reconstruction will help diminish some of the fear.
Most women who have mastectomies are candidates for breast reconstruction. Nearly 79,000 breast reconstruction procedures following mastectomy were performed last year, a 166 percent increase since 1992, according to the American Society of Plastic Surgeons (ASPS.)
"A large part of this increase is due in part to the passage of the Women's Health and Cancer Rights Act of 1998," said ASPS President Walter Erhardt, MD. "This law mandates insurance coverage for breast reconstruction and the alteration of the opposite breast for symmetry for women who have undergone a mastectomy. Since passage of this law, every woman who loses her breast to cancer also has the option of reconstructive surgery."
There are several reconstructive options available. Typically plastic surgeons make recommendations based on age, health, anatomy, tissues and goals. Managing patient expectations is one of the most important aspects of this process. Women should beware that the goal of reconstruction is improvement not perfection. Patients should candidly discuss expectations with their plastic surgeon.
"A vital factor in choosing breast reconstruction is finding a qualified surgeon," said Dr. Erhardt. "Patients should determine if their surgeon is certified by the American Board of Plastic Surgery (ABPS)."
Surgeons with ABPS certification have completed a minimum of five years of surgical training following medical school, including a plastic surgery residency program. After training, a surgeon must pass comprehensive oral and written exams before being granted certification. ASPS members are certified by the ABPS. In addition they must regularly attend continuing medical education courses and adhere to a strict code of ethics.
"It's important to look for ASPS membership and certification by ABPS because in most states, a licensed physician may perform plastic surgery without being board-certified in plastic surgery," adds Dr. Erhardt.
For breast cancer patients who choose breast reconstruction, there are several available techniques including skin expansion followed by the use of implants or reconstruction with tissue from other parts of the body.
Skin expansion with a breast implant is the most common method for reconstructing a breast. Following mastectomy, the plastic surgeon inserts a balloon expander beneath the skin. Through a tiny valve attached to the expander, the surgeon periodically injects a salt-water solution into the expander over several weeks or months. After the skin in the breast area has sufficiently expanded, the patient is ready to undergo a second operation where a permanent implant is inserted. Some expanders are designed to stay in place as the final implant. The nipple and areola are reconstructed in a subsequent procedure.
Another implant reconstruction approach involves creating a skin flap using tissue from another area of the body, such as the abdomen or back. In one type of flap surgery, the tissue remains attached to its original site. This flap of skin, fat and muscle along with its blood supply, is brought beneath the skin to the chest, creating a pocket for an implant, or creating the breast itself without need for an implant. Another flap technique uses tissue from the thighs or buttocks and transplants it to the chest.
All of these procedures have advantages and disadvantages. Many times the choice of procedures is limited by additional health factors, such as weight, medical conditions or previous cancer treatments. Not all women are good candidates for breast reconstruction. Women who have had radiation treatment to the chest area are typically not good candidates for additional skin expansion reconstruction.
Breast reconstruction can dramatically improve a woman's appearance, self-confidence and overall quality of life, but it is important that the plastic surgeon with the oncologist and the patient determine if it is the right course of treatment for the patient. Before deciding on reconstruction, plastic surgeons will offer the following breast reconstruction considerations to each patient:
- Although the body shape will be markedly improved, the reconstructed breast will not look or feel exactly the same as the breast that was removed
- There is a period of emotional adjustment that may accompany breast reconstruction - just as it takes time to get used to the loss of a breast, it may take time to adjust to the reconstructed breast
Patients need to carefully follow their surgeon's advice and instructions both before and after breast reconstruction surgery because, as with every surgery there are inherent risks. As a team, the plastic surgeon, the patient and her other doctors can make this difficult time bearable. Plastic surgeons provide assistance to their breast cancer patients in more ways than just reconstruction. Helping to heal the patient on the inside and out, many surgeons work and coordinate breast cancer support groups, fundraising efforts and conferences. After the surgery, most women find that the procedure provides both physical and emotional rewards. Many times the breast reconstruction represents a new start to their life.
SOURCES: The American Society of Plastic Surgeons Media Center.