Breast cancer is the most common malignancy affecting women. Breast cancer affects over 200,000 women a year. Fortunately, with advances in breast cancer treatment, mortality has been declining and women are benefited with more choices and less invasive surgical procedures for treatment with an improved quality of life. In fact, the five year survival for women who are diagnosed in the early stage of the disease is nearly 100%.
Based on the stage of the disease, a woman may benefit from non-surgical options such as chemotherapy and radiation therapy. These treatments may be used in conjunction with a mastectomy, a surgical procedure that removes the entire breast, or with breast-preserving surgery such as a lumpectomy, where only the tumor is removed. While mastectomy is sometimes the best treatment and can be life-saving, many women undergoing this procedure often experience difficulty with the loss of their breast(s).
As a result, breast reconstruction has become an integral aspect of management for the patient with breast cancer. Before having a mastectomy, a woman should discuss this option with her oncologist, general surgeon and plastic surgeon to discuss the risks, benefits, and options of reconstruction.
The goal of breast reconstruction is to recreate a natural appearing breast that is soft, symmetric with the opposite breast, and has a similar texture and color to the native breast that was removed. The reconstructive options need to be individualized and objectively discussed with each patient to obtain the best aesthetic result. Breast reconstruction can be done at the time of mastectomy, called immediate reconstruction, or at a later time, called delayed reconstruction. Patients who should be strongly considered for delayed reconstruction are those with larger tumors, lymph node involvement and those with a close margin around the tumor, since they often need radiation, which can create problems with the reconstruction when it is performed before radiation treatment.
There are many types of breast reconstructive surgery. Some procedures involve a breast implant and others use muscle and tissue, called autogenous reconstruction, from other parts of the body, or a combination of both methods. What determines the type of reconstruction depends on many factors, such as the patient's health, size of her natural breasts, whether or not the patient is a smoker, obese, needs radiation, as well as the patient's overall goals.
Generally, implants are chosen for women who have smaller breasts and do not need radiation, and would rather not have a prolonged surgery or the risk of complications from tissue taken from another part of the body. Autogenous reconstruction often takes tissue from the abdomen in a procedure call a TRAM. This type of reconstruction is usually chosen when a patient needs radiation or has slightly larger breasts, since it can provide for a more natural appearing breast than an implant in these circumstances. However, this procedure requires a longer operation with additional recovery needed because tissue was taken from the abdomen to reconstruct the breast.
The decision to have breast reconstruction is very personal, and after discussing the patient's desires the surgeon can help the patient make the best informed decision as to which reconstruction best fits their needs and is most appropriate based on these many factors.
Breast reconstruction should be considered, offered and discussed with any woman undergoing a mastectomy. It is not merely the creation of an illusion of a breast mound. The benefits can be tremendous and positive in many ways. For some women, reconstruction makes them less self-conscious, restores self-esteem, as well as improves social and personal relationships that were impaired after mastectomy. Others just want a more natural, balanced look while wearing a brassiere without the need to wear a prosthesis.
The recovery is very much dependent on the type of reconstruction. Typically, reconstruction with an implant allows for a shorter recovery. Recovery with an implant is usually a week to one and a half to two weeks. Autogenous reconstruction requires a longer hospitalization of approximately one week and a longer recovery of three to six weeks.
A woman can still have reconstruction in conjunction with other types of treatment. Your plastic surgeon will speak to the other physicians involved to make sure there is coordination and timing of the reconstruction for the best care and reconstructive outcome.