breast reconstruction

Breast Reconstruction Surgery

PJ Hamel Health Guide January 04, 2009
  • Seven years ago, after I learned the lumpectomy I’d gone through hadn’t gotten rid the cancer in my right breast, I was told a mastectomy was necessary. At the same time, my surgeon, Kim Grafton, recommended I speak with the plastic surgery team at our cancer center about a TRAM flap breast reconstruction.


    With totally inappropriate visions of picks and shovels and front-end loaders in my head—BREAST reconstruction?!—that’s what I did.


    And I ended up with a new right breast, constructed from muscle and fat that originally padded my midsection. My right breast matches my left breast so well that, in clothes, you can’t see a difference.

     

    See? Looks pretty good, right? Hey, I would have worn a more revealing halter top, but it's January, I'm in New Hampshire, and it was 9°F out on my deck!

     

    Even in the women’s shower room at the gym, my breasts don’t draw any second looks. Oh sure, more than a casual glance would reveal the faint scar, the wacky-looking nipple. But bottom line, I’m not shy about revealing my naked breasts (in the appropriate circumstances!)


    Like most of us, I always assumed the options I was offered during cancer treatment were about the same as everyone else’s: surgery, reconstruction, chemo, radiation.

     

    Not so, says a recent New York Times article. While mastectomy/lumpectomy, chemo, and radiation are pretty much a given for all women in this country diagnosed with breast cancer, the availability of reconstruction, including its more advanced types, is definitely limited.


    And what, exactly, imposes those limits?


    Three things. First, the failure of many doctors to inform their surgery patients about reconstruction—ANY type of reconstruction. According to Dr. Amy K. Alderman, an assistant professor of plastic surgery at the University of Michigan medical school, a study she led showed that only one-third of women undergoing breast cancer surgery were offered the option of reconstruction.


    Now that’s appalling. Especially since insurance and Medicare, by law, is required to pay for reconstruction when a woman undergoes a mastectomy covered by her plan.


    Second, the availability of surgeons trained to perform autologous (body tissue) reconstruction is limited. Breast reconstruction using tissue from another part of a woman’s body—the so-called TRAM flap, lat flap, and the newer DIEP flap and GAP flap procedures—is still a fairly new procedure.


    And finally, reconstruction with saline or silicone implants is a more profitable procedure for doctors and hospitals than body-tissue reconstruction. The more advanced reconstruction is labor-intensive; it can take up to 12 times as long as an implant, but is only billed out at about twice the cost of implant surgery. Hey, do the math, right? Health care is a business.


    Breast reconstruction after a mastectomy does have its downside. There’s the possibility of ruptures and leaks with implants; fully one-third of women undergoing an implant need a “repair” operation within 4 years. And implants don’t last forever; they need to be replaced eventually.


  • Body-tissue reconstruction is a longer surgery, with a more prolonged recovery. It carries the risk of more complications, and can result in a hernia or weaker abdominal wall (in the case of the most common procedure, the TRAM flap).


    Still it would be nice, given we’ll spend the rest of our lives living in our carved-up bodies, if we were at least given the option of reconstruction. And if we were told about ALL kinds of reconstruction, not just what one particular surgeon prefers.


    Let’s face it, looking “normal” takes away some of the hurt. And seeing those familiar soft contours on our chest allows us, at least some of the time, to forget we have cancer.