Although breast cancer is the most common form of cancer, finding accurate information and guidance, particularly about the options you have for breast reconstruction, can be more difficult than expected. Dr. Tanna has provided answers to many of the most common questions about breast surgery and reconstruction to assist you to make an educated decision.
It is estimated that 1 in 8 women will develop breast cancer. The American Cancer Society's estimates for breast cancer in the United States for 2018:
Breast cancer continues to be the most common type of cancer in the United States, with over 300,000 cases of breast cancer diagnosed yearly. About one in eight women will be diagnosed with the disease. While a breast cancer diagnosis is a frightening situation, treatment is very effective. The American Cancer Society reports the estimated five-year survival rate for women with stage 0 or stage 1 breast cancer is almost 100 percent. For women with stage II breast cancer, the five-year survival rate is about 92 percent, and for women with stage III breast cancer have a five-year survival rate of about 72 percent.
3D mammography, also known as digital breast tomosynthesis, takes more images than a traditional 2D mammogram. Instead of a single image, 3D mammography produces multiple thin overlapping slices. This allows the radiologist to examine the breast in greater detail. Imagine a book. With 3D mammography you are able to open the book and look through the book page by page or in the case of a breast you can look at it later by layer.
It is overwhelming, intimidating, and frightening to be diagnosed with breast cancer. There is an abundance of information available, but the sheer magnitude of data can be a source of confusion. The first step is to understand that a mastectomy is a safe and reliable procedure, and that time and time again the procedure has been proven to be one of the best treatments for breast cancer. In many cases, it is either the recommended procedure, or one of the choices. And with modern breast reconstruction surgery techniques, undergoing a mastectomy does not mean having to lose a feminine, natural breast appearance.
During a nipple-sparing mastectomy, the breast tissue at the base of the nipple is removed. This can affect the projection, position, sensation, and healing of the nipple after surgery. This procedure should only be done if the primary cancer is distant from the nipple areola complex, and when your breast surgeon is experienced in this technique. Finally, it may be a possible treatment option if your nipple is in a relatively good position for breast reconstruction. Otherwise, a skin sparing mastectomy is the better choice.
Women often have a misconception that a mastectomy is synonymous with amputation of the breast. In fact, this is quite the opposite from the truth, as almost all the breast skin is preserved in a skin-sparing mastectomy. As most of the breast skin (called the pocket) is preserved during a skin-sparing mastectomy, this option is by far the best for cases in which the breast reconstruction is performed at same time of the mastectomy (immediate reconstruction).
The pocket that the reconstruction is to be placed in already exists and does not have to be created. This is your normal breast skin and it is basically draped over the reconstruction. When breast reconstruction is not performed at the same time as the mastectomy (delayed reconstruction), the pocket of skin will contract and not be useable in the future. Instead, a new pocket will need to be created.
The different reconstruction options available can be overwhelming to patients when considering treatment. Although plastic surgeons are rapidly advancing and developing new breast reconstruction techniques, about 70 percent of women who are eligible for breast reconstruction have not been fully informed about their options.
This problem led to the passage of a law in New York State in 2014 that requires physicians to inform their patients about the options of breast reconstruction at the time of mastectomy consultation. For detailed information on each type of breast reconstruction, go to our breast reconstruction page.
Breast reconstruction has become well-integrated into the treatment of breast cancer. Some women consider foregoing breast reconstruction, choosing to use an external prosthesis (worn within a bra) instead. Even a well-fitted breast prosthesis can end up being a source of frustration and dissatisfaction.
Some women find the breast prostheses to be uncomfortable, hot, and heavy. The false breast may shift with movement and will restrict clothing choices. Aside from the physical discomfort associated with wearing a prosthesis, many women will only wear it when outside the home, resulting in less confidence in appearance while in the home environment. Some patients eventually choose to undergo breast reconstruction after using a prothesis for a period of time (delayed reconstruction).
Studies have demonstrated the immense benefit of breast reconstruction for your overall health and wellbeing. Women who have had breast reconstruction report feeling comfortable in and out of the home. This helps women when getting out of the shower, during intimacy, when looking in the mirror, wearing certain clothing, and when sharing time with loved ones. The choice to pursue breast reconstruction is personal -- one that is yours and yours alone.
There are many arguments that can be made for either having or not having the other breast removed. Many women choose to have the opposite breast removed. This may reduce their risk of breast cancer recurrence and may allow you to achieve better symmetry in reconstruction.
Some women choose a bilateral mastectomy if they feel that the healthy breast will require extensive adjustment to achieve a symmetrical look in reconstruction. Others choose to undergo prophylactic or preventative mastectomy of the opposite breast to avoid the ongoing testing required when the other breast is not removed. After a mastectomy you will no longer need to undergo sonograms, MRIs, or ultrasound testing.
For women who decide not to have a double mastectomy, with only the one breast removed (unilateral mastectomy), it may be important to alter the unaffected breast to match the newly reconstructed breast. Options to match the healthy breast to the reconstructed breast include a breast lift (mastopexy), breast reduction, or adding an implant (breast augmentation).
These symmetry (matching) procedures on the healthy breast are covered by insurance. Alternatively, if a woman chooses to have a double or bilateral mastectomy, reconstruction surgery is then performed on both breasts. Insurance also covers the reconstructive surgery of both breasts.
There is no data to suggest that undergoing breast reconstruction places a woman at higher chance of breast cancer recurrence than those who have mastectomy alone (without reconstruction).
Considering the timing of your breast reconstruction is important. While delayed breast reconstruction (after mastectomy) is almost always possible, the best reconstructions are usually performed at the same time as the mastectomy. There are very few patients who have cancer that is so advanced that immediate reconstruction at the time of the mastectomy is contraindicated.
One of the most important and personal decisions during your consultation with your plastic surgeon is choosing the type of breast reconstruction to undergo. Once you have opted to have a mastectomy, the discussion of breast cancer reconstruction naturally follows. There is no one option that is the “right” choice for every woman. Instead, women are encouraged to understand the advantages and limitations of each option.
In general, breast reconstruction falls into two categories – implant reconstruction or reconstruction using a patient’s own tissue, which is referred to as a “flap” or microsurgical breast reconstruction. A plastic surgeon will consider factors such as the type of mastectomy, indication for mastectomy, patient preference, and patient’s body type when considering which reconstructive option is best for the patient.
It is important that your plastic surgeon is very open with you and clearly answers all your questions – but what are the questions you should ask? These are a list of important questions to get answered by a plastic surgeon you are considering for your procedure:
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