As I have said before, in Australia I see a distinct limitation in access to “immediate” breast reconstruction, performed at the time of mastectomy. Many surgeons agree that women who have an immediate reconstruction to replace the breast at the time of a mastectomy do better psychologically and physically. Certainly, the aesthetic outcome of an immediate reconstruction is superior to a “delayed” reconstruction.
So, we will be publishing a series of articles about breast reconstruction, examining the options available, the relative benefits and risks of certain procedures and the ways in which your Plastic Surgeon makes a decision with you about what procedure is best for you.
Breast reconstruction is a complex and challenging task. Patients now have more choices than ever, which may only add to the confusion.
One of the first, and most important goals for your surgeon is helping you navigate through the dizzying array of options. You must remember, every patient is different; each patient’s breast cancer, her surgery and her preferences are different. Working through each of these details helps to arrive at the best option for breast reconstruction.
By the time you see a Plastic Surgeon, you will know quite a lot about your breast cancer. Some women will have had their initial surgery, and may also have had additional treatment before being referred for reconstruction. Other women will be referred for “immediate reconstruction”: this means that the breast cancer surgeon and the Plastic Surgeon work together so that at the time of a mastectomy, the patient has, in the same procedure, a breast reconstruction.
Depending on how far along in your treatment you are, there are other pieces of information that have significant impact on the discussion you will have about reconstruction. These details will guide your breast surgeon and your oncologists in making the necessary decisions about what kind of surgery you require to treat the cancer and what kind of additional treatment you require (including chemotherapy, hormone therapy and radiation treatment) after your surgery. This information is also of particular importance to your Plastic Surgeon: some reconstructions may not be advisable depending on the nature of your cancer and the type of surgery you require. There are a number of possible cancer treatment combinations, all of which can impact on the reconstructive options available to you.
Whether you have had surgery, or your surgery is being planned, obviously what is taken away will determine what must be restored.
The extent of your surgery is determined by the nature of your cancer. In all cases, the first priority must be the adequate treatment of your cancer. Once the cancer has been completely removed, the determination for more treatment needs to be made. It is important that we distinguish between treating your cancer, and reconstructing the breast. Whilst, ideally the two can be considered as a whole, this is not always the case.
Depending on whether you are planned to have, or have had a lumpectomy, or a skin-sparing or nipple-sparing mastectomy, or a simple mastectomy, certain reconstructive procedures will be more or less appropriate for you.
The question of whether you require radiation treatment is one most important factors which must be considered when planning breast reconstruction.
The reason that radiation treatment is such a challenge for your Plastic Surgeon relates to the side effects of your radiotherapy. The side effects of the radiotherapy can distort the reconstructed breast, and cause problems with wound healing. However certain forms of reconstruction are better able to withstand the treatment. Radiotherapy can completely rule out certain reconstructive options. The greatest difficulties arise with implant-based reconstruction in women who require (or have had) radiotherapy.
Where your Plastic Surgeon is involved in the treatment of your breast cancer from an early stage, and the entire range of reconstructive options are considered, your options for reconstruction may be improved.
We will deal with each of these options in subsequent articles. What each operation entails and how it works determine their suitability for each patient.
Over the next few weeks, we will consider implant based reconstruction and “autologous” (using a patient’s own tissues) reconstruction. I will discuss the most common (and best) procedures available to Plastic Surgeons today, and how we arrive at a decision to use one technique or another.
QUICK FACTS:
Reconstructing a breast requires consideration of multiple factors. Your options will be determined by:
Remember, your GP may not know much about breast reconstruction. Unfortunately, these days it is often the patient who must research and ask for a referral to an appropriately trained plastic surgeon.