The Other Breast Reconstruction

In all I’ve seen about breast cancer awareness, there is not enough said about the very difficult decisions women who are diagnosed with breast cancer must make.

One of these is how to treat the breast surgically. Women either undergo mastectomy, removal of the entire breast, or lumpectomy/partial mastectomy, removal of the cancerous mass and some healthy tissue around it. Not all women have this choice, such as those with cancer in several locations in the breast, or for those who have the genetic mutation for breast cancer. When people think of breast reconstruction, usually it is a reconstruction of the whole missing breast. These are women who may have reconstruction with implants, like Angelina Jolie, or reconstruction with excess tissue from their abdomen or back. Much has been discussed about this type of reconstruction, but I want to draw attention to the other type of breast reconstruction, lumpectomy reconstruction.

Lumpectomy reconstruction goes by other names, aesthetic oncology or oncoplastic surgery. It refers to rearranging the breast at the time of lumpectomy to improve the shape of the breast to avoid contour deformities which can arise if that space where the cancer was removed is not closed. What is important about this type of breast reconstruction is that it is time-sensitive, and must happen immediately, before radiation therapy (the other part of lumpectomy treatment) occurs. This is not something to do “after I worry about cancer,” because radiation, while effective at treating cancer, renders the blood supply to the breastless predictable and stiffens the tissues.

Why is this important? For many women who have had a lumpectomy, reconstruction was never discussed. There is legislation requiring surgeons to offer a referral to a plastic surgeon, but some women may not realize that this option exists. Unreconstructed lumpectomy defects after radiation can be quite disfiguring and not easily fixed. Coordination with a plastic surgeon at the time of lumpectomy is essential for optimal outcomes in breast cancer surgery, adding little time to the operation and creating a natural and balanced appearance postoperatively. Breast conservation is an option for many women, but more people need to be aware that reconstruction for this option exists.