Reconstruction: Building a Better Breast
Great strides have been made in breast cancer surgery since the days of the barbaric and disfiguring radical mastectomy. Today, breast cancer surgeons strive to excise the smallest possible amount of tissue, while still ensuring as low a risk of cancer recurrence as possible. Many practice a new specialty: oncoplasty, a combination of oncology, and plastic surgery.
Actress Angelina Jolie’s recent announcement that she’d had prophylactic surgery to remove both breasts, due to a genetically high risk of being diagnosed with breast cancer, has inspired a major increase in public awareness of breast surgery.
And that increased awareness has, of course, filtered down to women currently facing decisions about breast cancer surgery. Unlike Jolie, these women don’t have the luxury of making the decision to keep or remove their breasts; with cancer, surgery is pretty much a given.
The decision-making around the surgery itself can be a huge challenge, though: mastectomy, or the less invasive lumpectomy?
If mastectomy is the choice, another tough decision awaits: reconstruction, or a prosthesis? And if reconstruction is the path a woman elects, she then has to decide what type: autologous, or implant?
Despite advances in breast reconstruction, and notwithstanding Jolie’s example – she made it sound pretty simple – most women still choose not to rebuild their breast(s). For some, it’s not even a matter of choice; many women simply aren’t offered reconstruction by their surgeon, either because the surgeon feels the woman isn’t a candidate, or a surgeon with the necessary skills isn’t available.
And for women who do opt for reconstruction, the process can be long and painful, often with unsatisfactory cosmetic results. This alone has discouraged many of us from considering this difficult, invasive surgery in the past.
Thankfully, breast reconstruction surgery has been getting better and better over the past 5 or 6 years, and women opting for it today have a much better chance of a superior outcome: good-looking breasts, with less pain along the way.
Oncoplasty, a specialty that’s grown significantly over the past 10 years, combines cancer treatment (removal of the tumor) with plastic surgery (reconstruction of the breast) in one seamless process.
Where before it might have been common for reconstruction using implants to be performed in three separate operations – mastectomy, followed several months later by insertion of expanders, followed up to 6 months after that by positioning of the implants themselves – implant reconstruction can now be done in one or two procedures. Nationally, about 30% of women having implant surgery are able to have at least their expanders placed at the time of their mastectomy; and that number is growing all the time.
In addition, women having any type of reconstruction, either body tissue or implant, are often able to save not just their breast skin, but their nipple, as well. While skin-sparing mastectomies have been common for 10 years or more, the advent of nipple-sparing procedures is much more recent. Some women even find that not just the nipple has been spared, but its nerve endings, as well – an important erotic zone has been preserved.
For most of us that have had a mastectomy, the idea of keeping the entire outside of your breast – skin, nipple, and all – was never an option.
And to still have feeling in that reconstructed breast, as well? A dream come true.
If you’re facing breast cancer surgery, don’t let your oncologist and surgeon push you towards the surgery of their choice. The choice is yours, and one you’ll live with the rest of your life.
Research all your options – including finding a new surgeon, if the one recommended by your oncologist doesn’t perform the procedure you’d like to have. Try to take your time; don’t be pressured into a quick surgery because “the cancer is growing.” Most breast cancers are very slow-growing, and a couple of extra weeks spent doing research and possibly setting up an appointment with a different surgeon shouldn’t make a difference in your cancer outcome – but could make a big difference to you (and your body image) in the long run.
Facing a decision about reconstruction? Check out our reconstruction series for helpful information about decision-making, types of reconstruction, and more.
Marchione, M. (2013, May 14). New options for breast cancer surgery treat women faster, gentler and preserve more tissue. Retrieved from http://www.startribune.com/lifestyle/health/207344391.html