By Richard B. Schaefer, MD, Board-Certified Plastic Surgeon, Agnesian Plastic Surgery & Cosmetic Services writes when faced with a diagnosis of breast cancer, women are forced to quickly make complex decisions about their health. Newly-diagnosed patients can often find themselves in information overload due to multiple treatment options; for both cancer treatment and reconstruction. Traditionally, the cancer surgeon determines which patients come to see the plastic surgeon. However, every patient regardless of age, stage of disease and treatment selected could benefit from discussing reconstructive options with a plastic surgeon. The following is a brief overview of treatment options.
Treatment of the breast in breast cancer is typically treated with either mastectomy alone or lumpectomy with postoperative radiation therapy, sometimes called breast conserving therapy. Despite the name, breast conserving therapy can disfigure the breast and these patients are often excellent candidates for reconstruction. The other important surgical aspect of treating breast cancer is assessing if the cancer has spread beyond the breast. Typically, the lymph nodes in the axilla (underarm) on the side of the affected breast are assessed by either a sentinel lymph node biopsy or an axillary lymphadenectomy (removal of all the armpit lymph nodes). Few patients start with the complete removal of the lymph nodes, but patients who have breast cancer found in the sentinel lymph node biopsy are recommended to have all of their lymph nodes removed.
When breast reconstruction is performed at the same time the breast cancer is removed, this is referred to as immediate reconstruction. If breast reconstruction is done at any other time from days to years later, it is referred to as delayed reconstruction. Most patients elect to have immediate reconstruction to minimize postoperative recovery, hospitalization, time off of work, time without a breast, to improve psychological health and multiple other reasons. If patients have selected to have or the breast cancer has advanced to the point of requiring postoperative radiation therapy then delayed reconstruction is recommended.
There are multiple surgical techniques used to reconstruct a breast and not all techniques can be used on every patient. There are four basic components to a normal breast and plastic surgeons reconstruct each component as needed for the individual patient. These four components are skin, breast mound volume, nipple and areola. The nipple and areola are the final touches of the reconstruction performed as a minor office procedure after recreation of the other two components. The skin and volume reconstruction are paramount to the overall objective which is to create an aesthetic and symmetric breast with good shape, proportion, projection and contour.
To reconstruct the skin, the plastic surgeon places a tissue expander between the chest and skin. By inflating the expander slowly over time, the patient will literally grow new skin, similar to how a woman’s belly becomes larger during pregnancy. The other option for skin is to bring in new skin from another part of the body which already has enough. There are two main donor areas, the abdomen and the back.
To reconstruct the breast mound volume, the plastic surgeon uses either a breast implant, sometimes called a permanent prosthesis, or can use the patient’s own tissue. Again the two main donor areas are the abdomen and back. Additionally, the surgeon may elect to use both an implant and the patient’s own tissue in order to achieve the desired volume.
Lastly, the unaffected breast should not be forgotten. It is important to continue with routine exams and mammography as dictated by your surgeon and/or primary care provider. Additionally, the aged unaffected breast often does not match the newly reconstructed breast. Therefore, reshaping the unaffected breast can be beneficial to woman’s self-esteem and to how her clothes fit. These procedures are covered by all health insurances as it is federally mandated by law.
In the end, you should remember there is no one best treatment for breast cancer. You do have options and the only way to understand your options is to discuss them with both your oncologic and plastic surgeons so they may individualize a treatment plan for you.