For women diagnosed with breast cancer, a consultation with a plastic surgeon early after diagnosis is imperative, even—and especially—if a woman is considering a lumpectomy. For most patients, breast reconstruction is performed immediately, meaning, at the same time as mastectomy or lumpectomy. While this adds an additional decision to be made during what is an overwhelming time, the importance of a consultation with a reconstructive surgeon is essential.
Immediate breast reconstruction has been shown not only to be a safe option but more importantly, has been shown to benefit overall well-being of the woman treated. To learn more about breast reconstruction in Troy, give us a call today.
How Breast Reconstruction is Done
There are essentially three types of reconstruction: reconstructing a breast after lumpectomy (breast conservation), reconstructing a breast after mastectomy with an implant, or reconstructing a breast after mastectomy with a flap (or your own body’s tissue). If a woman chooses, the unaffected breast may also be changed for symmetry. Sometimes, breast disease is present in both breasts at the time of diagnosis.
Lumpectomy reconstruction: for cancer that is not encompassing the entire breast, a plastic surgeon can work with a breast surgical oncologist to optimally remove the cancer while rearranging the remainder of the breast tissue. Called aesthetic oncology or oncoplastic surgery, plastic surgeons often rely on cosmetic breast techniques such as breast lift or breast reduction to conceal that a tumor was removed. A symmetrizing operation is done on the unaffected breast to make the breasts look more even.
Mastectomy reconstruction with an implant: for cancer in many areas of the breast, for women with the breast cancer gene (BRCA+), or for women who opt to remove their breast as treatment, implant reconstruction after mastectomy can be performed. This may be done with a tissue expander, or adjustable implant, that allows the reconstructed breast to be gradually enlarged once healing is completed. For some, an implant can be placed directly. Often, a tissue support is placed at the initial surgery. At a later date, the adjustable implant or expander is removed and a more permanent implant placed. If a woman has a bilateral (double) mastectomy, the operation is performed on both sides. If not, a symmetrizing operation on the other breast may be performed at a later time. If the nipple is not saved during the original surgery, reconstruction of the nipple and areola can be performed at a time later in the reconstructive process. Other surgeries are often required to achieve a better cosmetic result.
Mastectomy with flap reconstruction: For some women undergoing mastectomy, using her own tissue may be a choice. This may use skin, fat, and muscle from the abdomen or back, though other sites may also be considered. This operation involves a second surgical site (a donor site) and involves the longest recovery. The blood supply to the flap may remain attached to the body (pedicled) or attached after removal to a new blood supply (free, or by microsurgery). Reconstruction of the nipple and areola are not usually performed at the time of mastectomy, but later in the reconstructive process. If you choose a flap based reconstruction, Dr. DeLuca-Pytell can refer you to a surgeon in the area.
With immediate reconstruction, there is no point where a woman is without a breast, though the nipple may be absent. Evidence shows that immediate reconstruction is psychologically beneficial. As breasts are associated with beauty and femininity, breast reconstruction is chosen by most women undergoing breast cancer treatment. Federal law covers mastectomy reconstruction as reconstructive (not cosmetic) procedures as well as procedures to improve symmetry with the unaffected breast.
Recovery from mastectomy reconstruction is difficult. Multiple drains and adherence to strict activity restrictions are imperative. Risks of complication are highest in my practice among those choosing implant-based mastectomy reconstruction. Mastectomy reconstruction from beginning to end is a long process—up to a year for some. It is not unusual for women to require additional procedures after the initial breast reconstruction operation. Ancillary procedures to improve symmetry or shape may be needed. Nipples which remain after nipple-sparing mastectomy or which have been reconstructed will not have sensitivity. For symmetry, it is often necessary to operate on both breasts even if only one is affected by cancer.
Who Pays for Breast Reconstruction
This operation is usually covered by insurance, though precertification may be required. Insurance plans vary, so out-of-pocket cost may be required.
Length of Operation
2-4 hours (depending on procedure and extent of operation).
General anesthesia, you will be asleep the whole time.
In or Outpatient
Lumpectomy reconstruction: outpatient
Implant-based reconstruction: outpatient recommended
Time until Final Appearance
6 months to 1 year.
Length of Results
Should be long lasting, but breasts can increase or decrease in size with weight changes. Pregnancy or other hormonal changes can also increase breast size.
Temporary swelling, bruising, and some pain. Drains are used for implant based reconstruction, and these may stay for a long time.
Risks of Breast Reconstruction
All surgery carries risk. I recommend patients carefully weigh the benefits of having surgery against the potential risks which may arise. Risks include pain, bleeding, infection, damage to nearby structures, need for other procedures, recurrence of skin laxity, dissatisfaction with appearance, asymmetry, seroma, sensory changes including permanent loss of sensation, temporary or permanent changes in facial movement, wound healing delays requiring wound care, deep vein thrombosis, and pulmonary embolus. A complete list of risks will be discussed with you before surgery.
Reach Out About Breast Reconstruction in Troy
Breast reconstruction in Troy can be a great option for restoring your appearance and your confidence after a lumpectomy or mastectomy. If you have been diagnosed with breast cancer, scheduling a consultation with an experienced surgeon is essential. Contact our office today to learn more about your options.