By C. Andrew Salzberg, MD, New York Group for Plastic Surgery
Breast cancer gets a lot of attention during October’s Awareness Month, but women are diagnosed every day, all year long. Many aren’t aware of their surgical options for cancer removal or breast reconstruction. I’ll provide an overview, but keep in mind that chemotherapy or radiation will play a part in surgical treatment decisions for some women.
Many women with breast cancer can keep, or preserve, their breast by having a lumpectomy. We remove the tumor (“lump”) and an area of surrounding healthy breast tissue. Tumor removal can cause a breast indentation, or the two breasts can appear asymmetrical (uneven). We then use nearby healthy breast tissue to fill the indentation, and sometimes reduce (make smaller) the unaffected breast to match up size and shape. (Note that radiation treatments are almost always required after lumpectomy to destroy any remaining potential cancer cells.)
Mastectomy, on the other hand, is complete removal of breast tissue. Breast reconstruction procedures have improved enormously over the decades, and can result in breasts that look very natural. Most often we can preserve and fill the breast skin to create the new breasts. In fact, a woman whose cancer is located far enough from the nipple area may be eligible for “nipple-sparing” mastectomy; the nipple is never surgically removed from the breast at all.
Breast reconstruction is most frequently performed in multiple procedures using implants. After mastectomy, a deflated balloon-like device called a “tissue expander” is put in the breast and filled with salt water over three to six months until the preferred size is achieved. A second surgery is required to put in the permanent implant.
To avoid this lengthy and uncomfortable expander process, and enable a woman to wake from mastectomy with breasts in place, I developed a new method of reconstructive surgery called “Direct-to-Implant” or referred to as "One-Step." With this procedure, we put a permanent implant in the breast immediately following the mastectomy. Simply put, we use a specially prepared tissue material that makes a space for the implant without having to use tissue expanders. There is no months-long filling process or need for a second surgery.
Another mastectomy breast reconstruction option is using microsurgery to transfer a woman’s own skin, fat and muscle from her abdomen, buttocks, back, thigh or hip to form the breasts. This procedure is commonly referred to as a “free tissue flap” or “DIEP.” This surgery is complex and has a longer recovery time than using implants, but results in breasts that look and feel very natural.
I’d like to offer some tips for women facing cancer-related breast reconstruction:
- Do your homework: Gather information on types of mastectomy and breast reconstruction procedures and surgeons that perform them. Talk to other women about their experiences. Read discussion boards on support group websites. Find information on medical websites or journals.
- If a surgeon says you’re not eligible for a certain type of surgery, there may be a valid reason OR it may be that he/she doesn’t perform that surgery. Find a surgeon with expertise in the procedure, and be sure to ask how many they’ve done.
- Ask the surgeon to show you patient before-and-after photos, and not just successful cases. A skilled, confident surgeon will also show you cases that did not have ideal results, and explain why not.
- Get a second opinion to find a procedure and surgeon that feels right for you; insurance will usually cover a second opinion.
- Insist on great results and do not compromise, as breast reconstruction can help make you feel “whole” again. If your breast or general surgeon tells you to wait until later for reconstruction, make a plastic surgery consult with a board certified (ASPS) surgeon to explore the option of immediate reconstruction.
Dr. C. Andrew Salzberg, a board certified plastic and reconstructive surgeon, is Associate Professor at NY Medical College and Chief of Plastic Surgery at Westchester Medical Center and St. John's Riverside Hospital at Dobbs Ferry Pavilion. He also operates at the Institute for Aesthetic and Reconstructive Surgery within the Hudson Valley Hospital Center and at The Mt. Sinai Hospital Center in New York City. He is a partner with the New York Group for Plastic Surgery. http://www.nygplasticsurgery.com