Breast Reconstruction Article

For Hilton Head Island, Bluffton, SC, Beaufort, SC and Savannah, GA.
An Article by Frederick G. Weniger, M.D., F.A.C.S.

Although breast conservation therapy has increased in popularity over the last decade, there are still patients who may be better served with a mastectomy. Certainly, the most important goal of breast cancer treatment is curing the cancer itself, but sometimes mastectomy patients can be left with physical defects that can be difficult to accept. In fact, it is known that mastectomy can lead to psychological problems such as depression, loss of sexual interest, a negative body image and loss of femininity, and increased fear of cancer recurrence, and self-consciousness even in clothing. Breast reconstruction lessens these emotional burdens and allows the patient to focus on her success and her recovery.

30 years ago, breast reconstruction was a relatively new concept. Today, we benefit from living in a time when reconstruction is considered to be an important, routine part breast cancer treatment. After decades of development of new techniques, we now enjoy multiple options for breast reconstruction. In general, breasts can be reconstructed with breast implants or with tissues of a woman’s body moved from other areas to create the new likeness of a breast. These procedures are often done immediately after the mastectomy is completed on the operating table, so that the woman awakens with her breast reconstruction procedure completed, not ever having to cope with the frank absence of her breast.

For some women, the best reconstructive option is a breast implant. Although this was the very first reconstructive option available approximately 30 years ago, technology has developed to make this a very attractive option for some patients. Implant reconstructions are relatively fast, safe operations that add little extra recovery to the mastectomy operation. Both saline and silicone breast implants are available for this purpose. Currently, many implant reconstructions are done in stages, with the immediate operation consisting of placing a mostly empty tissue expander prosthesis. This device, which is shaped like a breast implant, is then gradually filled in the plastic surgeon’s office over the following few months in order to slowly stretch out the skin. Eventually, the expander is removed and the permanent breast implant is placed into the stretched “pocket” of skin and muscle, thus more reliably delivering a soft, natural appearing breast.

In contrast, other patients will elect to have an “autologous tissue” reconstruction, made of their own excess tissues taken from other areas. Most commonly, the excess skin and fat is taken from the abdomen, similar to an abdominoplasty. This operation is called a Transverse Rectus Abdominus Myocutaneous Flap (TRAM Flap). Another option is to take skin and fat from the back and create a new breast mound out of this tissue. As one might expect, there is often not much bulk from this area compared to the abdomen. For this reason, a breast implant is often added underneath this new breast to give more volume. This procedure is a Latissimus Dorsi Myocutaneous Flap. Other real tissue procedures exist as well. Although these techniques avoid some of the issues related to the use of implants, they generally are larger procedures than implant reconstructions, and require a more difficult recovery period

The best option for an individual patient is a decision which should be achieved through discussions between the patient and the plastic surgeon, and must include dialogue from the breast cancer surgeon as well as the medical oncologist. Complicated issues such as the possible need for radiation therapy play integrally into this decision over reconstructive options. In the end, the decision must be a conclusion individualized to the patient’s desires and her particular medical circumstances.

Regardless of whether an implant or tissue option is chosen, a new nipple can eventually be created on the new breast mound. Additionally, either tattoo or skin grafting techniques can be used to recreate the areola (the dark, pink or brown colored circle around the nipple). Finally, a symmetry procedure such as a breast lift or reduction may be needed on the opposite breast to better match the size and shape of the reconstructed breast.

In the end, the goal of the breast cancer surgeon and the plastic surgeon is not just to treat breast cancer, but to treat the breast cancer patient. This includes the physical as well as the emotional impacts of cancer, by restoring the patient’s physical femininity. It is for this reason that Garspare Tagliacozzi’s words from 1570 are as true now about plastic surgery as they were then: “We restore, rebuild, and make whole those parts which nature hath given but which fortune has taken away not so much that it may delight the eye but that it might buoy up the spirit and help the mind of the afflicted.”