October is a sea of pink. For women without cancer, it is a reminder that yearly mammograms save lives. For women with breast cancer, the public support acknowledges the will to fight with a cancer diagnosis. What options exist for patients after the breast cancer is removed?
Generally, patients decide between a lumpectomy (removal of the cancerous part of the breast) and radiation therapy versus a mastectomy (surgical removal of all of the breast). In 1998, Federal Law mandated that group health insurance plans cover breast reconstruction procedures following mastectomy. Breast reconstruction is the process of building the appearance of a breast. Insurance must also cover surgery on the non-cancerous breast in order to achieve symmetry between the two sides.
Breast reconstruction is an elective procedure and can begin at the same time as the mastectomy procedure, or it can be delayed. The mastectomy is performed by a breast oncology or general surgeon. This surgeon may offer a mastectomy procedure on one or both breasts. Reconstruction is entrusted to a plastic and reconstructive surgeon.
Breast reconstruction is a multi-stage process that often takes approximately one year to complete. There are different ways to begin the process. Most commonly, a tissue expander is used. A tissue expander is similar to a firm balloon with a port. It is placed under the remaining breast skin and the large chest muscle (pectoralis major muscle) following the mastectomy. The port is accessed weekly in the clinic setting and saline is injected. This allows the remaining breast tissue to re-expand to create the appearance of a breast mound.
After the expansion is complete, the tissue expander is removed and replaced with either breast implants (the same devices used for breast augmentation) or the patient’s own tissue. Implants give a higher and rounder breast appearance. The surgical recovery with implants is less difficult; however, implants are not permanent devices and future surgeries may be needed. The recovery from surgery using donor tissue is more arduous, but the result tends to be final and more natural looking. Excess lower abdominal tissue is the most common donor site used.
Other reconstructive options exist. Fat grafting involves liposuctioning excess fat from an area of the body and injecting the fat over breast implants to create a smoother and larger look. Many patients elect to have their nipple and areola (the darker circle of skin surrounding the nipple) reconstructed. Generally, the nipple is recreated using skin on the breast mound (think of human origami) approximately six months after the last surgery. Commonly, the areola is tattooed. There are a small number of tattoo artists who offer 3D nipple areola complex tattooing if a woman does not want the nipple projection.
If a woman elects to have a mastectomy on only one side, the other breast may be altered to match the reconstructed breast. Options include breast reduction, breast augmentation with an implant and a breast lift.
It is difficult to initially find the silver lining with a breast cancer diagnosis. Breast reconstruction does allow a patient to actively participate in deciding the size and appearance of her new breast(s). Every plastic surgeon has his or her opinions and protocols regarding breast reconstruction. Make sure that you are consulting with a board certified plastic surgeon that has considerable breast reconstruction experience.
Dr. Stephanie Beidler Teotia is a board certified plastic surgeon who specializes in facial and breast aesthetic and reconstructive procedures. Dr. Teotia can be contacted at email@example.com or 214-823-9652. Her website address is slow-hearing.flywheelsites.com.