Breast Reconstruction Options Explained
In honor of October, which is Breast Cancer Awareness Month, I thought we would review a little bit about breast cancer reconstruction. My practice is about 30 percent breast cancer reconstruction, and I do most types that are available.
Breast cancer reconstruction is the general term for reconstruction of the breast after cancer. It can come in many forms which we will review here.
First, there can be small abnormalities of the shape of the breast after a Lumpectomy. Lumpectomy is done when there is a small focus of breast cancer that needs to be removed. In this case, the entire breast does not have to be removed. Radiation may or may not follow. Lumpectomy scars can be indented or make the breast appear smaller on one side than the other. We use different techniques to give the breast a more natural shape after surgery. Sometimes an implant is needed, but at times we can take fat from another location on the body and graft the lumpectomy area for a more rounded shape. At times, we need only scar revision after lumpectomy to regain a more natural shape.
Breast reconstruction is commonly done after mastectomy on one or both sides. There are multiple techniques for mastectomy and reconstruction. Let’s first discuss the mastectomy. A mastectomy is when the breast tissue is removed either for an occurrence of breast cancer or for the prevention of breast cancer (in genetically susceptible individuals). The overlying skin is left intact and is called the skin flap, but most of the time the nipple/areolar complex needs to be removed as it contains breast tissue. Once your breast surgeon/general surgeon performs the mastectomy, I will usually come in on the same day and perform part of the reconstruction. Please be aware there are times where we are unable to do reconstruction at the same time; this will be determined by you and your doctors.
With most breast cancer reconstruction, a temporary expander is placed under the skin flaps during surgery. The expander is then gradually inflated with saline over multiple weeks after your surgery to stretch the skin out to allow for a larger permanent implant to be placed later. The expansions are done in the office approximately every two weeks. Once the desired size is reached using the expander, you will return to the operating room and have the expanders removed and permanent implants placed. Some women decide this is where they would like to stop, but other women proceed with grafting and tattooing for nipple areolar reconstruction, and sometimes fat grafting for contouring of the breast.
Sometimes, more involved procedures need to be performed for reconstruction that include a latissimus flap where the latissimus dorsi muscle from the back is moved around toward the front to give more volume or coverage. This is particularly needed after a mastectomy that is accompanied by radiation. Radiated tissue is thinner and, at times, we will need more tissue to help maintain as natural of a reconstruction as possible.
Less commonly, but also possible is a TRAM flap for breast cancer reconstruction. This is where tissue from the abdomen is used instead of the back. Your surgeon will have different reasons based on your anatomy for using each type of procedure.
The government has mandated that breast cancer reconstruction be covered under all health insurance plans. This is been in effect for many years. If you have breast cancer in one breast, insurance companies are also mandated to cover a “matching procedure” on the other side to decrease or increase volume so that the reconstructed and natural breast are as close as humanly possible to each other in their appearance.
If you or a loved one has questions about breast cancer reconstruction please make an appointment with me and your breast surgeon to discuss.