October 11, 2019
Depending on the breast cancer diagnosis, your doctor may recommend a lumpectomy, a surgical removal of a portion of the breast; or a mastectomy, a surgical removal of the whole breast.
If patients choose to undergo either surgery, then they also have a choice to help make themselves feel whole: breast reconstruction.
Breast reconstruction for breast cancer patients has been an option for several years. Unfortunately, it is not usually talked about in conversations about mastectomies and lumpectomies.
Michelle De Souza, MD, a plastic surgeon who specializes in breast cancer reconstruction, answers several questions about this special surgery and how it can help patients recover from these body-changing surgeries.
What is the goal of breast reconstruction?
We're trying to rebuild a woman's body. Having a mastectomy or lumpectomy can dramatically alter your appearance because you don't have your normal form anymore.
Our goal with breast reconstruction is that when you get dressed you have something to put into your clothes. You have your shape back instead of inserting an external prosthesis, which is still an option some women choose.
Long ago, breast reconstruction was considered a cosmetic procedure and few women sought it. As plastic surgeons, we promote breast reconstruction because we want our patients to be well-informed about their options. Legally, insurance companies are required to pay for breast reconstruction if the mastectomy was covered by insurance. Many patients are not aware of this. It's our responsibility as physicians to make sure our patients understand that breast reconstruction is an option for the majority of women who are interested in it.
What are the choices for breast reconstruction?
There are 2 types of reconstruction: implant-based or tissue-based.
With tissue-based, we remove tissue from one part of the body and use it to rebuild the breasts. The advantages are that the tissue is yours and there is no maintenance.
The most common type of reconstruction is implant-based. The advantage of implants is that the surgery is confined to one area. Implants typically require maintenance surgery and may need to be replaced after a time.
How many surgeries does this require?
Although the number of surgeries varies from patient to patient, there are 2 main surgical steps. Immediately following a mastectomy, we place a tissue expander. This device helps create the breast pocket, which will eventually hold the implant.
Once the expander is placed, we fill it with saline to adjust its size. We tailor the size according to the patient's wants and depending on the quality of the skin at the time or how much of the skin envelope we need to fill.
We perform a second surgery to remove the tissue expander and fill the space with either an implant or the patient's own tissue taken from elsewhere on the body.
Some women can skip the tissue expander stage and have their implants placed at the time of their mastectomy.
When can you decide if you want to have breast reconstruction?
Patients can begin the breast reconstruction process at the time of their mastectomy or lumpectomy, or they can choose to have reconstruction months or years following surgery.
The advantage of doing it along with the mastectomy or lumpectomy is that the patient doesn't require another surgery to begin the process. Also, the patient doesn't go without having breasts or some sort of breast mound.
When should the conversation about breast reconstruction begin?
Ideally, the consultation to discuss breast reconstruction is started early in the cancer treatment process.
Patients who come to us for breast reconstruction are often referred by the breast surgeons who will be performing the mastectomy. They are the ones who allow us access to the patients. Otherwise, most people wouldn't know there are options for plastic surgery.