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Breast Reconstruction: Know Your Options and Decide What’s Best for You

by Courtney Floyd, PRMA Plastic Surgery

Breast reconstruction helps many women feel whole again after breast cancer. Thanks to a 1998 Federal Mandate it is covered by insurance.

Unfortunately, many breast cancer patients are not offered all options for breast reconstruction after mastectomy or lumpectomy.

It is important women know they have several reconstructive options available today. These range from implants to “flap” techniques which use the patient’s own tissue to recreate a natural, warm, soft breast.

Immediate vs Delayed Reconstruction

Breast reconstruction can be performed at the same time as the mastectomy (immediate reconstruction) or any time after a mastectomy (delayed reconstruction).

The biggest benefit of immediate reconstruction is patients wake up from surgery with reconstructed breasts and avoid having no breast. Other advantages include fewer scars and better cosmetic outcomes.

For some, immediate reconstruction is not recommended due to a variety of factors, including the need for radiation.  In these circumstances, reconstruction can be performed any time after the mastectomy. This is called “delayed” reconstruction.

Reconstruction Options

Implant Reconstruction

Implant reconstruction is the most commonly performed method of reconstruction.  It is typically performed as two separate surgeries. The first stage involves placing a tissue expander under the skin and muscle. The temporary implant is filled with a saline solution over time to expand the skin and muscle to the required size. The expander is then replaced by a permanent implant during a second surgery.

Direct to implant surgery is also an option for some.  With this procedure, the permanent implant is placed at the same time as the mastectomy. While not all patients are candidates, this is a very attractive option for many women because they avoid the tissue expander phase of the reconstruction.  This procedure is also referred to as “One-Step” or “Single Stage” reconstruction.  This can be misleading though, as the procedure typically requires additional surgery to achieve desired outcomes.

Implant reconstruction can be the best option for some patients. However, reconstruction with expanders and breast implants are associated with more complications than cosmetic breast augmentation. Complications following radiation therapy and patient reported pain are also higher with implants compared to reconstructions using the patient’s own tissue.

Tissue Reconstruction

The Latissimus flap procedure uses muscle, fat and skin from the back (below the shoulder blade) that is brought around to the chest to create a new breast. Many patients also need an expander or implant to obtain the desired breast size.

Tissue can also be taken from the lower abdomen to create a new breast. The DIEP flap provides a natural, warm, soft breast after mastectomy. The tissue is disconnected from the body and transplanted to the chest using microsurgery.  The DIEP flap spares the abdominal muscles completely making recovery easier and decreasing the risk of complications.

Another added benefit to the DIEP flap procedure is sensory nerve reconstruction.  When breast reconstruction is performed using flaps like the DIEP, sensory nerves can be transferred with the flap to the chest and reconnected to nerves cut by the mastectomy. This extra step provides patients with a better chance of regaining feeling to the new breast in a shorter amount of time.

There are other tissue options available for women who are not candidates or prefer to avoid using their abdominal tissue. These include the inner thigh (TUG flap) and the buttock (GAP flap).

Regardless of the breast reconstruction procedure performed, it usually takes more than one surgery for the best results. A second procedure commonly referred to as a “revision stage,” is needed to improve the overall cosmetic appearance.  Revision surgery can include fat grafting, nipple reconstruction, and scar revision. Breast symmetry surgery may also be performed during the revision stage for women who underwent reconstruction on only one breast.

Although breast reconstruction is not for everyone, it is everyone’s right to be informed of all options (including the option for no reconstruction).  Breast cancer can take away many things, but it does not have to take away your sense of wholeness or confidence.  For many, breast reconstruction is an important part of the healing journey. 

“Reconstruction gave me a part of myself back that cancer tried to take. I feel confident and wear my scars with pride knowing I did everything I could to be here right now. During cancer, you fall into a treatment plan, and while you have choices, it is a regimen of one treatment or another. Reconstruction for me was the first time in the entire process that I got to choose. I chose my doctor (after consulting with several), chose my reconstruction type, and even the details within that type of reconstruction. It was the first time that I was being asked what I wanted versus being told what I needed. It felt empowering after being beat down by cancer, chemo and radiation. For my sister who was BRCA+, reconstruction options also gave her the confidence to move forward with preventative surgeries to reduce her breast cancer risks. And while we traveled different paths we did it side by side, and for that I am grateful. I am proud of her for being so brave, and I know she is proud of me.” -Misty, Breast Cancer Survivor

“I didn’t ask for this chapter, but it is a part of my story and I am going to continue to move forward with enjoying life…. looking and feeling beautiful, confident, sexy and most of all… WHOLE!!” -Amanda, Breast Cancer Survivor

 


 

Born and raised in Howe, Texas, Courtney attended Texas A&M University and received her bachelor’s degree in Communications. She has been a part of the PRMA team since July of 2013 and has gained valuable experience through observing breast reconstruction procedures first hand and working directly with PRMA surgeons and patients.

 


 

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