Breast Reconstruction Awareness
Breast Reconstruction Awareness Day is on October 15, 2014
October is Breast Cancer Awareness Month
1) What is breast reconstruction?
Breast reconstruction is done by a plastic surgeon in women who’ve had a mastectomy for breast cancer or after a disfiguring result after lumpectomy and radiation. It is also done when mastectomies have been done prophylactically in attempt to prevent breast cancer. A reconstructed breast can be created by various techniques, this includes using your own tissues or using breast implants. The reconstructive surgery can be done at the same time as the mastectomy, meaning immedicately after the cancer surgeon has finished, or it can be done at a later date, referred to as “delayed reconstruction”. It usually takes 2-3 surgeries in stages to get to the final outcome.
2) Who is a candidate for breast reconstruction?
Any woman who has been diagnosed with breast cancer is potentially a candidate for breast reconstructive surgery. It is estimated that only 30% of women who are eligible for breast reconstruction actually get it, that means 70% don’t!
This is likely because many women don’t know their rights. The Women’s Health and Cancer Rights Act of 1998 states that insurance companies covering mastectomy must also pay for breast reconstruction. It is very important to know this as all women have the right to know their options. It’s actually the law!
3) Who decides who should have breast reconstruction?
Generally a comprehensive breast care team is involved in the decision along with the patient. This is made up of the surgeon who performs the breast surgery (usually a breast surgeon, general surgeon, or surgical oncologist), an oncologist, a radiation oncologist, and a plastic surgeon. Women should know to initiate the discussion with the surgeon that’s going to do the mastectomy if it has not otherwise been discussed with them. After understanding her right to have breast reconstruction, she then has to learn her options. This can only happen by having a consultation with a plastic surgeon.
4) What are options for breast reconstruction?
Sometimes a woman’s own tissues can be used to make a new breast or reconstruct a disfigured one. For example using tissues from the abdomen, back, or buttock. Other times, reconstruction techniques with breast implants are used. There are also combination techniques using both one’s own tissues and an implant. Other techniques use fat transfer.
It is very important to understand that not every woman is a candidate for every reconstructive option. The reconstructive surgery plan is individualized and varies based on many factors. This includes general health, whether there is need for radiation, timing of radiation, type of cancer operation planned (not all mastectomies are the same), and whether reconstruction will be immediate or delayed. It is also important to have realistic expectations since reconstructive surgery is not the same as cosmetic breast surgery. While some reconstructive outcomes are certainly very good, some are not, but will meet a specific goal. The only way to know what is possible is by consulting with a plastic surgeon.
5) Many women in the past have had a double mastectomy to reduce the chance of breast cancer. Do you notice a decline in this trend?
Not necessarily. It depends on why the bilateral mastectomy option is chosen. Some women have a known hereditary predisposition for developing breast cancers, for example the BRA1 and BRA2 genes. This was recently publicized again when Angelina Jolie, having a BRA gene, had a preventive double mastectomy and breast reconstruction. As with Jolie, these women are generally healthy (and cancer-free), generally young, and are having the surgery as a means of prevention. Other women simply want to reduce the risk of developing cancer in the other breast. While having a mastectomy does not reduce the risk 100%, the risk is drastically reduced and therefore having both breasts removed can offer peace of mind.
From a reconstructive surgery standpoint the double mastectomy generally allows the plastic surgeon to provide the patient with the best cosmetic result. However, not every mastectomy is the same. Skin sparing and nipple sparing mastectomies allow for more aesthetic outcomes, and again, not every woman is a candidate for every type of mastectomy. The woman’s goals and expectations have to be clear. And the coordinated efforts between the members of the comprehensive breast care team, particularly the surgeon, oncologists, and plastic surgeon, are key to creating a personalized surgical treatment plan.