Reconstructive Breast
Breast Reconstruction
[ Patient Photos ]The breast is the most common site of cancer in American women and breast cancer will develop in 1 of every 8 to 9 women in their lifetime. Although a cure has not yet been found, breast cancer is now detected earlier and there are now improved modes of treatment. Still, being informed that you have breast cancer is frightening, confusing and earth shattering. Many women eventually undergo a mastectomy, but remain ill prepared or uninformed about reconstructive options. It is understandable that most are just happy to be alive, but why not restore the body to feel whole and complete once again?
Women who have undergone breast reconstruction have said that the procedure alleviates the pain of loosing a breast and improves their self-esteem and confidence. In fact, many can have an immediate breast reconstruction performed at the time of a mastectomy therefore, minimizing the feeling of loss associated with a mastectomy. Conversely, other women may choose to proceed with breast reconstruction months or even years after their mastectomy (delayed reconstruction). With the many options and advances available today, every woman diagnosed with breast cancer should seriously consider her reconstructive options, as well as the cancer treatment options. Everyone should also be aware of The Women's Health and Cancer Rights Act of 1998, signed into law in October 1998, requiring group health plans and health insurers to cover the cost of reconstructive breast surgery for women who undergo mastectomy for breast cancer. Coverage also includes surgery on the other breast to achieve symmetry.
Some common myths about breast reconstruction must be clarified:
- Immediate breast reconstruction will NOT delay or interfere with chemotherapy.
- There is NO evidence that breast reconstruction increases the risk of cancer recurrence or hides the presence of cancer.
What reconstructive options does a woman have? Breast implants (silicone gel or salt water filled) have been used successfully for many years and newer designs have lead to a more natural appearing breast. Recent studies have demonstrated that a woman with silicone implants is no more likely than the rest of the population to develop cancer or immunologic diseases. However, some women remain concerned about using silicone gel filled implants. Typically, a tissue "expander" is placed under the skin and pectoralis muscle of the chest wall. Over the next 4 to 6 weeks, saline solution is placed into the expander, during office visits, until sufficient expansion of the skin has occurred to create a breast mound. After several months time to allow softening of the tissues, the expander is removed and replaced with the permanent breast implant. An alternative approach available to some women is to use a permanent expander/implant that is left in place after being expanded to the appropriate size. This may avoid the second stage surgical procedure necessary when a temporary expander is used.
Alternatively, many women can avoid implants altogether by having a "flap reconstruction." This method uses a woman's own tissue from the abdomen, back or buttocks to create the breast mound. Most commonly, lower abdominal tissue (TRAM flap) is used to create a new breast that often feels and looks more natural than one reconstructed using an implant. A secondary effect of this reconstruction is a tummy tuck. The Latissimus Dorsi Flap uses muscle and skin from the back to create the breast mound, often with simultaneous use of an implant to provide additional volume. Either of these flap reconstructions can be performed immediately at the time of mastectomy or in a delayed fashion at a future date.