It is estimated that 1 in 8 women will be diagnosed with invasive breast cancer in their lifetime. After a breast cancer diagnosis, there is a whirlwind of worries, questions, information, and decisions to juggle in a time of high stress. First and foremost is treating and removing the cancer which may involve removal of a portion of the breast (lumpectomy) or the entire breast (mastectomy). But what about moving forward after? Studies have revealed that less than a quarter of women are aware of the wide range of breast reconstruction options available as part of their cancer treatment.
A Covered Benefit
The Women’s Health and Cancer Rights Act of 1998 (WHCRA) is a federal law that mandates insurance coverage for breast reconstructive procedures that provide for the following:
- All stages of reconstruction of the breast on which the mastectomy has been performed
- Surgery and reconstruction of the other breast to produce a symmetrical appearance
- Prostheses and treatment of physical complications of all stages of the mastectomy
It is important that breast cancer patients understand they have a variety of options to choose from when it comes to breast reconstruction, the first being whether or not they even want to pursue it. The goal of breast reconstruction is to restore breast form in shape, appearance, and symmetry. Some women may choose to ‘go flat’ and opt for no reconstruction. The majority of women, however, have found it to be a physically and emotionally rewarding procedure that improves their self-image, confidence, and quality of life.
Timing of Surgery
Women can elect to pursue reconstruction in an immediate fashion at the time of mastectomy, or in a delayed fashion once all their cancer treatment (surgery, chemotherapy, radiation) is complete. The benefits of doing it immediately include preservation of natural breast skin, combining the recovery of their surgeries, and never having to cope with the scar of a mastectomy defect. Psychologically, the loss of a breast is as impactful as an amputation of any other body part, and to be able to wake up from your mastectomy surgery having already started or completed your breast reconstruction can be mentally healing. Some woman may not be ready to handle the additional stress of reconstruction and will prefer to delay it, focusing on treating the cancer first.
Types of Reconstruction
Fundamentally, the breast volume can be restored using implant material or your body’s own tissue.
Now there are numerous combinations of techniques and advances that can be utilized by plastic surgeons to perform these surgeries. In both instances, these procedures tend to be performed in stages or series in order to achieve the greatest symmetry and cosmetic outcome.
Implant reconstruction surgery can involve using a temporary device called a tissue expander. In a combined surgery with the mastectomy, the expander is placed either above or below one of the chest muscles and preserves breast skin in order to create a pocket for future placement of the permanent implant. After the surgery, patients will have multiple visits to the office in order to ‘fill’ the expander with saline, enlarging the implant pocket until the woman’s desired breast volume is achieved. A second, shorter surgery is then performed to change the expander out to a permanent implant. Sometimes, a permanent implant can be placed at the time of mastectomy in order to forego the tissue expansion step. A discussion with your reconstructive surgeon will help determine if you’re a candidate for this procedure.
Autologous reconstruction involves borrowing tissue from another part of the body to restore breast form, with the most common source being the lower abdomen. Utilizing microvascular surgery techniques, a traditional tummy tuck is performed and the blood supply to the excess tissue is preserved and connected to new blood supply in the chest. The transplanted tissue is then shaped into a breast. This surgery, known as a DIEP (deep inferior epigastric perforator) flap, is quickly growing in popularity due to the appeal of being a more natural reconstruction, avoiding potential complications of having implants such as rupture, and removing the excess lower abdominal tissue resulting in improved abdominal contour at the same time. For women who are not candidates for this procedure, other options are also available that involve using back tissue or other areas of tissue excess in the body.
Breast Reconstruction is a Choice
Restoring a woman’s breast form can play an integral part in her recovery after cancer and emphasis needs to be placed on informing women of their choices and legal rights to healthcare coverage. A plastic surgeon can help map out an individualized treatment plan tailored to each woman’s cancer biology, body type, personal preference, and lifestyle. Survivors can attest that breast reconstruction helps complete the breast cancer chapter in a woman’s life, allowing her to move forward feeling whole physically, mentally, and emotionally.