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An Introduction to Breast Reconstruction

DanielLiuby Daniel Z. Liu, M.D., Plastic & Reconstructive Surgeon, Cancer Treatment Centers of America

 

As a reconstructive plastic surgeon at a cancer center, my mission is to educate women and men about their reconstruction options after breast cancer diagnosis.  Studies have shown that most women want to learn about breast reconstruction surgery results prior to cancer treatment.  However, a minority of women become familiar with the wide range of breast reconstruction options available.  Even fewer understand the importance of timing and how it impacts their reconstructive options and results.

 

After the initial diagnosis of breast cancer, women receive an abundance of information and recommendations.  During this emotionally tumultuous time, details about breast reconstruction can often become lost or confusing.  Treatment of cancer always remains the highest priority, which may begin with surgery or chemotherapy depending on the type of breast cancer.  Once the breast surgical oncologist makes an operative plan, women should immediately seek consultation with a breast reconstruction specialist.  Even if breast reconstruction is planned for later (“delayed” reconstruction), the type of mastectomy and incision design may influence future outcomes.  It is worth searching for a reconstructive surgeon who performs breast reconstruction routinely, and it may be advantageous to travel to a high-volume institution.

 

The decision to undergo breast reconstruction is highly personal, and every individual will have different goals ranging from symmetry in clothing to minimizing visible scars as much as possible.  The simplest option is to choose no reconstruction, and balance in clothing can be achieved using an external prosthesis.  Breast reconstruction has been shown to improve body image and self-esteem compared to no reconstruction.  All surgeries will leave permanent scars, and breast reconstruction is no exception.  Plastic surgeons often work closely with breast oncologic surgeons to reduce the amount of visible scarring using newer techniques, and the type of reconstruction will determine the extent of scarring elsewhere on the body.

 

Breast reconstruction can be an option for women who require partial mastectomy (or lumpectomy) as part of breast conservation therapy.  Depending on the size and location of the tumor within the breast, certain reconstructive techniques can be used to rearrange soft tissue within the breast or adjacent tissue.  Sometimes a symmetry procedure may be performed on the other breast such as breast lift (mastopexy), breast augmentation, or breast reduction.  Because radiation therapy is usually part of breast conservation therapy, the timing of these procedures should be discussed with all members of the breast cancer team.

 

It is critical to understand that total breast reconstruction can be a lengthy process, which may begin at the time of breast removal surgery (mastectomy).  This is called “immediate” reconstruction, which does not appear to delay treatment or affect breast cancer outcomes.  The main advantages of immediate reconstruction include better aesthetic results by preserving breast skin and psychological benefits of maintaining a breast mound after mastectomy.  In specific scenarios, reconstruction can be completed in one step, but the vast majority of women will undergo multiple procedures in “staged” fashion to achieve a final satisfactory outcome.  Candidacy for immediate reconstruction depends on several personal factors, from overall health to stage of breast cancer to emotional acceptance of enduring more surgery.  The addition of chemotherapy and/or radiation therapy after surgery will determine the timing of future steps and may alter the type of breast reconstruction for optimal outcomes.  Having a plastic surgeon that communicates effectively with the breast cancer treatment team is extremely valuable to make this a smooth process.

 

Following total mastectomy, breast reconstruction options include prosthetic implants, tissue from another part of the body, or a combination of both.  As breast cancer treatment has evolved, scars can be reduced through the use of skin-sparing and nipple-sparing mastectomy techniques for certain women.  In immediate breast reconstruction, the first step involves creation of a breast “mound” at the time of mastectomy using a prosthetic device (breast implant or breast tissue expander) or autologous tissue (skin, fat, occasionally muscle from another part of the body).  The different types of reconstruction explain the wide variability in final appearance, healing complications, amount of recovery, and long-term risks.  Subsequent procedures may include revision of the breast mound, surgery on the other breast to improve balance, and nipple/areolar reconstruction.  In general, breast reconstruction can attractively restore the shape of the breast but not feeling in the breast skin.  After time, the breast skin may regain some sensation, but it will not feel the same as it did prior to mastectomy.

 

Any surgery will carry certain risks, and breast reconstruction may have unique problems for some people.  Some potential complications include bleeding, infection, problems with skin healing, tissue death (necrosis), changes in sensation, fluid build-up (seroma), and problems with general anesthesia.  Occasionally, development of a complication may require additional procedures.  In appropriately-selected candidates, breast reconstruction is usually tolerated very well with stable long-term outcomes.

 

 


 

 

Initially trained as a concert violinist, Dr. Liu attended Hendrix College in Conway, Arkansas as a music scholar. He then turned his focus to medicine. He says, “I wanted to make a more direct impact in people’s lives.”

Dr. Liu graduated summa cum laude with a degree in chemistry in 2002 and earned his medical degree at Washington University in St. Louis in 2006. Dr. Liu then completed an internship and residency in plastic surgery at the University of Washington in Seattle, where he also served as Chief Resident in the Division of Plastic Surgery.

Dr. Liu has worked as a plastic surgeon at several large hospitals throughout northern Illinois. He joined Cancer Treatment Centers of America in August 2014.

Dr. Liu is board-certified by the American Board of Plastic Surgery. A dedicated researcher, Dr. Liu has published several studies on various aspects of plastic surgery in eminent medical journals. He has presented his work at numerous professional conferences, and has contributed chapters to textbooks on plastic surgery. He has been an invited lecturer at medical school grand rounds and professional conferences.

At CTCA, Dr. Liu combines cutting-edge technology with exceptionally compassionate care. He says, “Open communication and tailoring different treatment options for each individual patient are key to maintaining an excellent doctor-patient relationship.” Dr. Liu specializes in all forms of breast reconstruction, including microsurgical tissue transfer, and offers surgical treatment options for upper- and lower-extremity lymphedema.

Outside of CTCA, Dr. Liu enjoys spending time with his wife and daughters. He is an avid photographer and continues to practice the violin.

 


 

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