The Complete Guide to Understanding Breast Reconstruction: Exploring Your Breast Reconstruction Options | Part 1/5
Exploring Your Breast Reconstruction Options
When you are faced with two little words, “breast cancer,” you probably don’t think about the reconstruction options immediately. You think about your loved ones and your future.
What you don’t realize yet is that choosing to reconstruct your breast after a mastectomy – or choosing not to – is a life-altering decision that will be one of the first steps on you road to emotional recovery.
When you and your doctor first begin the conversation about mastectomy, you may be overwhelmed at the information coming your way and the amount of decisions to be made in what seems like a very short amount of time. Luckily, there are many tools and resources to help you make that decision.
Join Dr. Finkel in a five part series on the road to learning about your breast reconstruction options. We’ll explore treatment options, surgery techniques, recovery time, cost, and finding your surgeon.
Breast Reconstruction Options With Mastectomy
Also called an “immediate reconstruction,” breast reconstruction with mastectomy is an attractive option for many patients. With an immediate reconstruction, you never have to deal with not having a breast. For an immediate reconstruction or a delayed-immediate (more on that in a moment), your breast cancer surgeon and your plastic surgeon must work together so that both procedures go seamlessly.
When you wake up, both the mastectomy and the reconstruction are finished. Many patients find that this relieves part of the stress that they feel dealing with both the cancer and breast reconstruction as well.
An immediate reconstruction happens while you are still under anesthesia from the breast or lump removal. Immediately following your procedure, your plastic surgeon will perform the reconstruction you have chosen. If you are having a prophylactic mastectomy – a mastectomy done on patients who do not currently have breast cancer but who are at a high risk – then your reconstruction will most definitely be done immediately following the mastectomy.
If you choose to have an immediate reconstruction, you will need to discuss in detail with your plastic surgeon the results you expect before your surgery.
The delayed-immediate reconstruction is becoming a more popular option because it gives patients and doctors time to decide the best course of action. For this procedure, your plastic surgeon would insert a breast implant or a tissue expander underneath the skin after the mastectomy simply to maintain a pocket of skin for the eventual permanent implant. When you and your doctor decide what follow-up treatments are necessary, then your plastic surgeon would go back and finish the breast reconstruction.
The determining factor between an immediate reconstruction and a delayed-immediate reconstruction is usually whether or not you will require further treatment. Implants do not always respond well under further radiation and chemotherapy treatments. If you will be requiring follow-up treatment after your surgery, your doctor may recommend that you wait about having reconstructive surgery. Radiation, particularly, can affect the healing of tissues.
Breast Reconstruction Options Post Mastectomy
There are many reasons you may choose to wait about having breast reconstruction after a mastectomy.
- You don’t want to undergo unnecessary surgery.
- You can’t focus on your reconstruction options while also planning for your mastectomy.
- You will be undergoing further treatments.
- You aren’t prepared for the costs of reconstruction on the breast unaffected by the cancer (if necessary).
In any case, post-mastectomy reconstruction is a popular option. This choice, too, gives patients time to think about what they will do long-term. It is not uncommon to see patients wear a prosthesis or “go flat” for years before they are ready to undergo breast reconstruction.
Reconstructed breast tissue has been known to interfere with follow-up radiation. The major benefit of delayed reconstruction is that there is nothing to interfere with treatments meant to destroy remaining cancer cells not removed during the mastectomy.
Additionally, chemotherapy and radiation both have a tendency to change the volume, shape and even the color of reconstructed breast tissue. A post-mastectomy reconstruction avoids all possibility that the reconstruction is damaged during additional treatments.
Delayed reconstruction does bring about the obstacle of working with scar tissue that may be present after your mastectomy. After a mastectomy, patients in the past have typically had a long, horizontal scar at the nipple level. Now, however, options exist to preserve as much tissue as possible for later reconstruction.
Of course, the placement of the scar depends on the location and severity of the lump, but in most cases, your doctor can make an incision that will be mostly or, in some cases, completely camouflaged after your reconstruction. This is why it is so important to discuss your reconstruction plans with your cancer surgeon and your plastic surgeon before your mastectomy.
Your plastic surgeon will do his or her best to make the reconstructed breast tissue match the breast that is not being removed. In some cases, the surgeon may want to do some reconstruction – implant, lift, or reduction – on the other breast as well. Having a delayed reconstruction can give patients time to decide if these are options they would like to consider and time to prepare for the financial obligation of any reconstruction procedures that insurance may deem as cosmetic.
Timeline for Treatment
Let’s begin by saying that every case is different and no one course of treatment is going to be right for every patient, but here are some basic guidelines for treatments.
If your cancer is diagnosed in stage I or stage II, it’s likely that you are choosing to do the mastectomy or lumpectomy because of biopsy results. The cancer is still small, and your cancer surgeon is confident that he or she can remove all of it during the removal procedure.
In this case, it is doubtful that you will need radiation after your mastectomy. For that reason, an immediate reconstruction is a good choice for you. After a mastectomy with reconstruction, you may be in the hospital for a few days. You may also have a drain in your breast area for up to 2 weeks (removed at your first follow-up appointment), or the doctor may remove it before you leave the hospital.
Within a few weeks, the stiffness, pain and soreness will begin to dissipate. After about two months, you should be doing most of your regular activities. Some patients take up to six months to fully recover from mastectomy and reconstruction, though. Every patient is different, so don’t push yourself to do anything you don’t feel ready to do.
On the other hand, delayed reconstruction is a better option for women who are diagnosed with stage III or stage IV breast cancer. In the case of stage III or stage IV cancer, mastectomy is almost always combined with a follow-up treatment such as chemotherapy or radiation. To maximize the effectiveness of these treatments and to nullify the chance that treatment would damage the reconstruction, it’s a good idea to wait until all treatments are finished before undergoing reconstruction.
If a skin extender is inserted after mastectomy (in the case of a delayed-immediate reconstruction), your doctor may choose to leave it deflated until after all treatments are finished. Then, about 2 weeks after treatments, he or she will begin to inflate the skin extender to make room for the implant or flap.
Delayed reconstruction is done after the skin and underlying tissues have had a chance to heal, usually 4 to 6 months after the last radiation treatment. It isn’t uncommon, though, for women to do reconstruction 6 months to a year after treatments are finished.