Breast Cancer - Choices in Reconstruction

by Dr. Kabeer

Breast cancer is a disease which is diagnosed ever more frequently in the USA. In fact, almost every one of us will know someone who has had breast cancer, either in our own family, our friends or their families or an acquaintance. The incidence is higher in Long Island than other parts of the United States. The American Cancer Society reports that 1 out of every 8 women will develop breast cancer in her life time, and it is the second most common cause of death from cancer for women between the ages 15 and 75.

Diagnosing breast cancer frequently starts with breast self-exam by a physician. The use of mammogram, ultra-sound and MRI has aided in diagnosing or finding of smaller lesions yielding better cure rates and survival rates. In addition to surgical removal of the cancer (lumpectomy) or the entire breast (mastectomy), adjuvant chemotherapy, hormone therapy and radiation therapy have aided in keeping the patient disease free.

With improvement in cure rate and survival rate, the patients are now more interested in breast reconstruction procedures. In addition all insurance carriers are now mandated by legislation to provide coverage for breast cancer reconstruction. Patients facing the loss of a breast (partial, complete or bilateral) have several options in reconstruction of their breasts, either using prosthesis or their own tissues. Giant steps have been made, resulting in a more aesthetic breast shape and appearance, although it is important to recognize that reconstructed breast will not feel or look exactly the same as a natural breast.

The timing of breast reconstruction may be immediately following the mastectomy or delayed weeks to years after the loss or disfigurement of the breast due to removal of the cancer. Both immediate and delayed reconstruction may take several stages to compete.

Choices in Reconstruction

The type of breast reconstruction surgery will depend on the medical situation, breast shape and size, general health and life-style of each individual patient since we are all unique.

Reconstruction with Implant

When using an implant, a temporary device called a tissue expander is placed under the skin and muscle at the site of mastectomy. The tissue expander has metallic part which allows for increasing the amount of fluid (saline) in the expander and therefore expanding and creating more skin and soft tissue by stretching the available tissue, rather like pregnancy does to the lower abdomen. The process of expansion will take considerably less than nine months for breast reconstruction. Once the tissues are expanded, the expander implant is removed and a permanent implant is placed in the pocket on the chart wall. This will be softer and without the metal part. At the same time, the opposite breast may be lifted, reduced or enlarged with a small implant for obtaining improved symmetry. Three months following this procedure a new nipple-areola complex may be reconstructed to complete the reconstructive process.

The advantages of using an implant for breast reconstruction are reduced operative and anesthetic time of 1-2 hours, reduced hospital stay of 0-2 days, no additional scars and no donor site weakness due to transfer of muscle. A blood transfusion is unlikely and average time to reserve daily activity is within 2-3 weeks.

Reconstruction with Tissue Flap

The breast can also be reconstructed by surgically moving a portion of skin, fat and muscle from another area of the body such as the lower abdomen or upper back and transferring this to the chest wall site of the missing breast. The flap as it is called may be tunneled under the skin (a pedicled flap) or attached by microsurgical techniques (a free flap). Operating time is generally longer and complications may be more likely. Flap surgery is a major operation and requires hospital stay of several days with longer recovery time compared to implant surgery. In addition, this is a donor site. Second and Third stages of the breast reconstruction using flap techniques are similar to using the implant for reconstruction and involving surgery of the opposite breast for symmetry and the final stage of nipple areolar reconstruction.

For more information regarding breast reconstruction we invite you to watch a video on the procedures and discuss your specific details call us at (352) 367-2268 or (386)758-6093