{"id":17943,"date":"2018-11-19T15:16:43","date_gmt":"2018-11-19T20:16:43","guid":{"rendered":"http:\/\/thepapergown.zocdoc.com\/?p=17943"},"modified":"2023-03-22T14:08:29","modified_gmt":"2023-03-22T19:08:29","slug":"a-guide-to-post-mastectomy-breast-reconstruction","status":"publish","type":"post","link":"https:\/\/www.zocdoc.com\/blog\/guides\/a-guide-to-post-mastectomy-breast-reconstruction\/","title":{"rendered":"A Guide to Post-Mastectomy Breast Reconstruction"},"content":{"rendered":"

An estimated <\/span>266,000 new cases<\/span><\/a> of breast cancer are diagnosed in the U.S. each year, the vast majority of which are in women and those assigned female at birth. <\/span><\/p>\n

Meanwhile, a growing number of women are undergoing genetic testing for mutations in <\/span>BRCA<\/span><\/a>, the \u201cbreast cancer gene.\u201d As a result, thousands of American women get mastectomies, removing one or both breasts as a means of halting or preventing the spread of cancer. <\/span><\/p>\n

Mastectomies save lives. They also alter women’s bodies.\u00a0As of 1998, with the passage of the <\/span>Women\u2019s Health and Cancer Rights Act<\/span><\/a>, insurance companies are required to cover the cost of post-mastectomy breast reconstruction. The choice to reconstruct is a highly personal one, although medical complications, access to specialist care and other socioeconomic barriers may influence a woman\u2019s decision. About 35 percent of women have their breasts surgically rebuilt following mastectomies, <\/span>according to BreastCancer.org<\/span><\/a>. <\/span><\/p>\n

Fortunately <\/span>for breast cancer survivors who are able and want to reconstruct their breasts, surgical options have improved and expanded. We spoke with<\/span> Dr. Constance M. Chen,<\/span><\/a> a plastic surgeon specializing in breast reconstruction and an assistant professor of plastic surgery at Weill Cornell Medical College, and put together a guide to post-mastectomy reconstruction options. <\/span><\/p>\n

Planning ahead<\/strong><\/h2>\n

Women might assume they should schedule their mastectomies first and then figure out breast reconstruction later. But the manner in which a mastectomy is performed actually dictates reconstruction options and outcomes. That\u2019s why patients are often encouraged to make decisions about reconstruction beforehand, as well as select a breast surgeon and plastic surgeon who work as a team. \u201cIf <\/span>you can find a breast surgeon who thinks about skin and tissue preservation,\u201d Chen says, \u201cyou\u2019ll be in the best place for reconstruction if that\u2019s the road you decide to go down.\u201d <\/span><\/p>\n

Timeline of reconstruction: <\/i><\/b>A mastectomy and breast reconstruction can be performed during the same surgical session or as separate operations. Medically, there\u2019s nothing wrong with leaving time between the two procedures \u2014 some women wait months or even years to rebuild their breasts. But there are some advantages to doing them together. <\/span><\/p>\n

For one thing, undergoing an additional surgery can be a stressor, both mentally and physically. Additionally, depending on the type of mastectomy and reconstruction performed, undergoing both procedures at once might obviate the need for <\/span>tissue expanders,<\/span><\/a> which stretch out the skin in order to make room for breast implants or tissue flaps. <\/span><\/p>\n

Type of mastectomy: <\/i><\/b>When you think of a mastectomy, you might picture a long, horizontal scar stretching across the chest where the breast and nipple used to be. While this <\/span>\u201ctotal\u201d<\/span><\/a> or \u201csimple\u201d mastectomy is the most common type, it\u2019s only necessary when the nipple and breast are compromised by cancer. Total mastectomies, Chen says, aren\u2019t the best choice for many women who get them. \u201c<\/span>Once you throw away some of that tissue with the total mastectomy and you throw away the nipple areola, it changes the breast envelope and flattens the breast,\u201d says Chen. \u201cIt makes it more challenging to fix.\u201d<\/span><\/p>\n

The<\/span> ultimate goal of every type of mastectomy is to remove cancerous cells. But mastectomy procedures that leave more of the breast intact make it easier for surgeons to reconstruct natural-looking breasts and, in some cases, offer women the possibility of returned nipple sensation. Skin-sparing mastectomies preserve the breast envelope (the skin), while <\/span>nipple-preserving mastectomies<\/span><\/a> preserve both the skin and nipple. <\/span><\/p>\n

The nipple can be spared by removing the breast tissue through either an opened areola or a \u201clollipop scar\u201d tracing the underside of the breast. \u201c<\/span>If you don\u2019t have nipple discharge or a tumor pushing into your nipple area, you may be a candidate for a nipple-sparing mastectomy,\u201d Chen says. \u201cThat removes all the breast tissue, but preserves your entire breast envelope.\u201d <\/span><\/p>\n

If patients aren\u2019t candidates for a nipple-sparing mastectomy or can\u2019t find a surgeon near them who will perform one, Chen recommends finding a breast surgeon who will design an incision that preserves as much of the breast envelope as possible. <\/span><\/p>\n

Reconstruction options<\/strong><\/h2>\n

There are two options for breast reconstruction: implants and autologous (or flap) surgery. <\/span>Eighty percent<\/span><\/a> of American women who undergo post-mastectomy reconstruction get implants, and<\/span> Chen says they\u2019re more popular for a reason:<\/span> \u201cImplants are the simplest option. Everyone knows how to do them.\u201d<\/span><\/p>\n

Implants<\/h3>\n

If you go the implant route, you\u2019ll need to decide which type of implant to get and how to position it (or them). <\/span><\/p>\n

Type:<\/i><\/b> Most plastic surgeons give patients the choice between silicone and saline breast implants. The natural feel of silicone makes it the more popular choice, but both types carry the same three main risks: infection, rupture and hardening due to the presence of scar tissue.<\/span><\/p>\n

While some breast implants now come with a \u201clifetime guarantee\u201d from their manufacturers, many women need to have them replaced within seven to 10 years. Also, with every type of implant, <\/span>some women report<\/span><\/a> numb, cold breasts and pain during exercise. <\/span><\/p>\n

Positioning: <\/i><\/b>\u201cSaline or silicone?\u201d isn\u2019t the most important decision to make about implants. Instead, it\u2019s choosing where they\u2019ll go. Implants can either be placed under or over the pectoralis muscle in the chest. <\/span><\/p>\n

Traditionally, plastic surgeons have stuck them below the muscle in order to prevent the implant from rupturing skin, a complication known as implant erosion. This placement lets the muscle tissue function as an extra barrier between the implant and the outside world.<\/span><\/p>\n

Today, Chen says, more surgeons are placing the implant above the muscle. Part of the reason for this shift is that the risk of skin <\/span>\u201crippling\u201d<\/span><\/a> is lower than previously thought. Also, many women believe above-the-muscle placement looks and feels more natural, given that the implant sits where the breast tissue used to be. <\/span><\/p>\n

Chen also says above-the-muscle placement is less painful for patients. \u201cHaving the implant underneath the muscle is like having a rock in your shoe at all times,\u201d she says. Patients who\u2019ve had radiation are especially likely to experience high levels of discomfort, because the treatment can adversely <\/span>affect the cells<\/span><\/a> of tissue, muscle and skin. Thus, due to reduced elasticity of skin and tissue after radiation, implants in general can be painful, and under-the-muscle placement may be unbearable. These patients should ask their surgeons about those specific risks before settling on implants.<\/span><\/p>\n

Autologous or \u201cflap\u201d surgery<\/h3>\n

This innovative surgery \u2014 or surgeries, since there are many subtypes \u2014 involves reconstructing the breasts using tissue from other parts of the body, such as the abdomen, thighs, back and buttocks.<\/span><\/p>\n

If a patient decides to undergo a mastectomy and flap-surgery reconstruction at the same time, their plastic surgeon will start harvesting tissue from the body during the mastectomy. Immediately after breast removal, tissue will be placed into the (spared) breast envelope, right below the nipple. <\/span>If the breast skin and\/or nipple weren\u2019t spared, then a tissue expander, which stretches out the skin, needs to be inserted instead. When expanders enter the equation, reconstruction can\u2019t be performed immediately, as the skin-stretching process takes time. <\/span><\/p>\n

Next, a plastic surgeon skilled in microsurgery reconnects the arteries, veins and nerves. <\/span><\/p>\n

Compared to implants, flap surgery requires both more time on the operating table and in recovery \u2014 about six weeks, on average. But it does have several advantages:<\/span><\/p>\n