Reconstruction of a breast that has been removed due to cancer or other disease, in my experience, is one of the most rewarding surgical procedures. New medical techniques have made it possible for us to create a breast that can come close in form and appearance to matching a natural breast. Frequently, reconstruction is possible immediately following breast removal (mastectomy), so the patient wakes up with a breast mound already in place, having been spared the experience of seeing herself with no breast at all. Most mastectomy patients are medically appropriate for reconstruction, many at the same time that the breast is removed. The best candidates, however, are women whose cancer, as far as can be determined, seems to have been eliminated by mastectomy.
Still, there are legitimate reasons to wait. Many women aren’t comfortable weighing all the options while they’re struggling to cope with a diagnosis of cancer. Others simply don’t want to have any more surgery than is absolutely necessary. I advise some patients to wait, particularly if the breast is being rebuilt in a more complicated procedure using flaps of skin and underlying tissue. Women with other health conditions, such as obesity, high blood pressure, a need for blood thinners, heart disease, or smoking may also be advised to wait. In any case, being informed of reconstruction options before surgery can help women prepare for a mastectomy with a more positive outlook for the future.
Reconstruction has no known effect on the recurrence of disease in the breast, nor does it generally interfere with chemotherapy or radiation treatment, should cancer recur. Patients can begin talking about reconstruction as soon as they’re diagnosed with cancer. Ideally, the patient and their breast surgeon should work together to develop a strategy that will put the patient in the best possible condition for reconstruction.
Skin expansion with a tissue expander is the most common technique, and combines skin expansion and subsequent insertion of an implant. Most breast reconstruction involves a series of procedures that occur over time. Usually, the initial reconstructive operation is the most complex. Follow-up surgery may be required to replace a tissue expander with an implant or to reconstruct the nipple and the areola. At times, I may recommend an additional operation to enlarge, reduce, or lift the natural breast to match the reconstructed breast. (Keep in mind that this additional procedure may leave scars on an otherwise normal breast.)
It may take up to six weeks for patients to recover from a combined mastectomy and reconstruction or from a flap reconstruction alone.
Talk to your breast surgeon and seek the expertise of a board-certified plastic surgeon for consideration of reconstruction during or after the original removal procedure. It’s important for a plastic surgeon to provide patients with a natural appearance and feel to the affected breast. The ultimate goal is to return the breast cancer patient to an active, healthy and confident way of life.
story by FAEZA R. KAZMIER, MD
BIO: Dr. Faeza R. Kazmier is a diplomate of the American Board of Plastic Surgeons as well as an active member of the American Society of Plastic Surgeons and the Polk County Medical Association. She counsels male and female patients on a wide range of procedures. In addition to offering immediate and delayed breast reconstruction, she offers cosmetic breast procedures as well, including augmentation, lifts and reductions, along with facial cosmetic surgery and cosmetic body contouring procedures. Her office is located at the Watson Clinic Women’s Center.