Frequently Asked Questions
According to the American Society of Plastic Surgeons 79,000 women underwent breast reconstruction last year. Women who consider reconstruction are doing for themselves and not for anyone else. Usually it is the desire to feel whole again. To maintain a complete body image. To look good in and out of clothes. To allow themselves to be less self conscious in public. These are only a few of the reasons, but there are numerous studies that show that women who have mastectomies followed by reconstruction have a positive attitude. This improves the function of a woman psychologically, socially, and sexually. Satisfaction is similar in patients who have immediate or delayed reconstruction. Studies have also shown that reconstruction does not affect the recurrence rate of breast cancer.
WHEN SHOULD I HAVE RECONSTRUCTION?
The decision as to the timing of the breast reconstruction either immediate or delayed should be made by the patient, her surgical oncologist, plastic surgeon, oncologist, and other members of her medical team. The stage of the breast cancer at the time of the mastectomy, a woman's general health, her anatomy, the need for radiation treatment, and age are several factors that must be considered when choosing the reconstructive option best suited for her. There are advantages and disadvantages to all forms of breast reconstruction.
The reconstruction of the breast can be performed immediately at the time of the mastectomy or delayed for a later time. Women whose cancer is not advanced are candidates for immediate reconstruction. What determines advanced stages is usually defined by a woman's oncology team, and this is whom she should consult. Immediate reconstruction provides a women with cosmetically superior breast reconstruction compared to delayed reconstruction. This is because the laxity of the breast skin is used to take advantage in making a softer breast. In addition, the psychological state of the woman who wakes up following a mastectomy with a new breast mound is often better then those of women who must wait for the reconstruction to reestablish their body image.
It must be remembered that the primary goal for a woman diagnosed with breast cancer is to maintain surveillance and achieve a cure. Often this requires that woman undergo radiation or other therapies. There, reason to delay a woman who is undergoing radiation from reconstruction is to allow her to complete her treatment. It also preserves the newly reconstructed breast from the effects of radiation. In general this is in the form of autogenous reconstruction. Women that may have advanced breast cancer are often advised to delay reconstruction until the medical team feels comfortable that the cancer can be monitored and that they are responding to medical treatment. Implants or autogenous reconstruction can be performed in a delayed setting.
WHAT ABOUT THE OTHER BREAST?
Often after breast reconstruction there is an asymmetry between the reconstructed side and the unaffected side. A second stage of the reconstruction in usually performed 3 months after the first stage. At that time the expander is exchanged for a permanent implant. Or a flap is revised or finely shaped. At the same time the opposite breast is matched to the reconstructed breast. This may be in the form of an implant, a breast lift, or a breast reduction.
SHOULD A MASTECTOMY BE PERFORMED ON THE OTHER BREAST?
This is a decision that is based on many factors. It is essential that a woman discuss this issue with her medical team in advance of the mastectomy procedure. A strong family history, a suspicious mammography finding, a diagnosis of lobular carcinoma, difficulty in monitoring the breast, or emotional concerns are some of the indications for doing a mastectomy on the opposite breast- a prophylactic mastectomy. If this is recommended, it should be done at the time of the other mastectomy. This limits the anesthesia and operative time. Both breasts are also reconstructed at the same setting.
WHAT IS A SKIN SPARRING MASTECTOMY?
Studies have shown that taking less breast skin at the time of a mastectomy does not result in any greater risk of recurrence of breast cancer. Therefore, experienced oncology surgeons and plastic surgeons will work together to preserve as much of the woman's breast skin envelope as possible. This is referred to as a skin sparring mastectomy. Often the only incision that is made is around the areola. There are no scars anywhere on the breast. Sometimes the scar extends outward away from the nipple areola region and preserves the central chest area. This allows women to wear clothes with a 'V' neckline without concern for scars being visualized. In those women who have large breasts the skin sparing mastectomy may be in the form of a breast reduction procedure. This may be in anticipation of performing surgery on the opposite breast to match it for symmetry with a similar incision.
Dr. Gary J. Rosenbaum,
M.D., P.A.
Mount Sinai Hospital Medical Staff Office Pavillion
4302 Alton Rd, Suite 420
Miami Beach, FL 33140
Phone: (305) 538-7726
Facsimile: (305) 538-7725
Email: info@miamidiepflap.com
Please consult your own physician or call Gary J. Rosenbaum, M.D. for information on treatment options, medical questions or to schedule a private consultation. The content provided on this Internet site is for informational purposes only. In no way shall any of the information, articles, pictures and texts contained herein be regarded as medical advice or recommendations.