By Dr. Jeffrey M. Feiner
There are no more frightening words than to hear you have breast cancer, a disease that affects 1 in every 8 women. After you deal with the diagnosis, you are left thinking about not only how I will survive this, but when I survive this how will my life be changed. With advances in treatment and early detection, more women are surviving and leading full lives after treatment. Those diagnosed with breast cancer or with positive genetic testing for the BRCA gene who are planning to undergo surgery should know that the surgery for breast cancer can have a profound and lasting impact on a woman’s identity and her sense of femininity. As a plastic surgeon, it is my goal to restore your physical appearance and sense of well-being after mastectomy or lumpectomy. Understanding the different types of surgical reconstruction can help women make the best decisions for their body and help long term with self-esteem and adjusting to life after cancer.
As plastic surgeons, we will guide you through the process, planning around your other treatments such as chemotherapy or radiation. There are many different options available for breast reconstruction and it can easily become quite confusing. The two most common procedures involve creating a breast shape using an implant or using a woman’s own fat. The best cosmetic results are achieved when the plastic surgeon and breast surgeon work together with the patient as a team. Reconstructive surgery can be started at the time of the mastectomy or it can be delayed until after your cancer treatment has been completed. In fact, there is no time limit on this and we will occasionally operate on women who have had their mastectomies done years earlier, but for one reason or another decided against or were not given the opportunity to have reconstruction at that time.
In some cases, we can do the entire reconstruction in one procedure at the same time as the mastectomy. In most cases, we place a temporary adjustable implant (tissue expander) to stretch the skin and create the shape of the breast in stages. Implants have improved so much over the last decade. The latest silicone implants are now filled more with a thick silicone gel like a gummy bear that makes them soft, but durable. They create a very nice shape with a natural feel and have better longevity.
The state of the art is now placing the implants above the muscle. This has become possible because of the improvement in the quality of the implants. The result is a very natural look, with less pain, and avoids the problems we used to see when we placed the implants under the muscle. Some of those women would have problems when they moved their arms because the muscle would cause the implant to shift and the breast skin to ripple. This is often quite noticeable and distressing. There are many women with this issue from prior surgery who can now be helped by changing the position of the implant and securing the muscle. These have been some of my happiest patients in recent years.
Women who don’t want or may not be good candidates for implants may benefit from reconstruction utilizing their own fat. This fat is often removed from the lower belly and transplanted to the chest to create the breast. This has the added benefit of eliminating unwanted excess belly skin and fat to create a very natural breast shape. This is not typically done by all plastic surgeons and is only offered at specialized centers. It is called the DIEP (deep inferior epigastric artery perforator) flap procedure and has the added benefit of leaving the abdominal muscles intact.
Women who have had a lumpectomy and radiation also have several options for reconstruction to correct differences in breast shape or symmetry. Many women are often unaware that these procedures even exist and are covered by insurance. We can do liposuction and inject fat into areas that have shrunken from radiation. Sometimes we may lift or make the opposite breast smaller to try to achieve better symmetry. A wide variety of techniques exist to improve the final cosmetic result.
With such a wide and complex range of surgical options for women undergoing breast cancer treatment, it is important to consult with a board-certified plastic surgeon to discuss your individual situation and to develop a surgical plan that is individually customized. I am happy to answer questions or to arrange a consultation. E-mails can be sent to Drjfeiner@gmail.com