Breast cancer is a devastating diagnosis and the treatment tends to have a direct impact on a woman’s self-esteem, especially if there has been a mastectomy or partial mastectomy. Just knowing breast reconstruction is an option is consoling; it offers hope for many patients. Yet physicians and patients typically have questions about the process of breast reconstruction:
For women with certain health issues, there are some considerations. For example, more careful management may be necessary for those with type-1 diabetes to help prevent infection. Women taking anti-coagulants will be asked to stop taking that medication before surgery. Smokers will need to stop not just before surgery but afterwards; even a single cigarette postoperatively can destroy the edges of a newly-placed skin flap. Unfortunately, there can be instances where reconstruction is not an option. Women with other cancers, such as leukemia or sarcoma, and patients with serious mental health issues may not be candidates for breast reconstruction.
First the cancer and some surrounding tissue are removed, and the reconstructive surgeon places a temporary implant that stretches the skin in such a way that the body grows new skin. (Interestingly, this approach was discovered when a plastic surgeon saw how his wife’s skin naturally expanded in pregnancy). Over approximately two to three months, the skin is stretched via a small “filling valve” to the temporary implant. Once the size of the new breast is matched to the other side, the temporary implant is removed and the permanent implant is placed.
When women are undertaking chemotherapy and/or radiation, the reconstruction process typically occurs after treatment has been completed. If the patient has metastases, reconstruction is usually not recommended until she is tumor-free.
For those who have had radiation therapy and incurred some burning of the skin, there is the option of transferring a skin flap from their back or their abdomen.
When women have had a single mastectomy, the reconstruction process involves matching the other breast. Sometimes that involves reducing the size of the normal breast to match the reconstructed breast size; or, a small implant can be added to the normal breast to create more fullness.
Today, most implants are made of a gel-like substance that feels something like a gummy bear. The reconstructed breast feels natural and compressible.
After a mastectomy, a new nipple can be created but it will no longer have feeling. That’s because a branch of the fourth thoracic nerve—the one responsible for nipple sensation—is cut during the mastectomy surgery.
The new nipple is made out of skin flaps and the pigmentation is created by tattooing, matching the shade to the normal breast. It’s not likely to be an exact match to the normal breast’s nipple, but it’s close. Some women do not opt to have the nipple created; they are satisfied with the mound itself. The nipple-creating phase occurs after the mastectomy and can be done in the office.
In summary, women need to have reasonable expectations and understand the process and inherent risks of breast reconstruction. Finding a reconstructive plastic surgeon with a great deal of experience in breast reconstruction is key. Reconstructing a woman’s breast is both an art and a science, and it requires broad knowledge and a great deal of experience. But it’s worth the effort.
Having breast reconstruction can have an enormously positive impact on a woman’s body image, self-confidence and sexuality.
By David M. Charles, MD
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.