The Five Do’s and Don’ts of Breast Cancer Reconstruction
By: Dr. Steven Pisano
Do seek experience. Breast reconstruction is complicated. Broadly speaking, there are two main categories of breast reconstruction—implant based and tissue based. Within each of these categories there are many options. Seek a practice whose physicians are experienced with all methods of reconstruction. Just as important, look for a practice in which breast reconstruction is the primary focus of the practice. Volume matters; you want to find a practice that does a large number of breast reconstructions year in and year out. In March of 2013, we at PRMA performed our 5,000th breast reconstruction with 4,500 being tissue transplant reconstructions with the DIEP flap.
Do research your options. Do your homework. Become an informed patient and learn the basics of implant based and tissue based reconstruction. Search “Breast Reconstruction” and this will get you started. The PRMA website has a ton of information. You’re not going to medical school, but you want to have a basic understanding of what each of the major types of reconstruction looks like and how it is performed. As your breast cancer treatment unfolds, make your oncologic surgeon and oncologist aware that you are interested in breast reconstruction and that you are aware of the various types of reconstruction.
Do set the timing. Breast reconstruction can be immediate or delayed. At PRMA we prefer to do the reconstruction immediately, that is, at the time of the mastectomy. An immediate reconstruction allows the patient to wake up with at least the breast mound in place; with a nipple-areola sparing mastectomy and immediate reconstruction the breast may look almost normal. On the other hand, not all breast cancer patients are candidates for immediate reconstruction. For example, patients who are advised to have radiation therapy may be better served by having a delayed reconstruction. Post-mastectomy chemotherapy in our practice, does not require a delayed reconstruction. But, for whatever reason, some breast cancer patients may not be ready for an immediate reconstruction, and the additional recovery that it entails.
Do choose your team. Choose a reconstructive surgeon who is Board Certified by the American Board of Plastic Surgery. Choose a plastic and reconstructive surgery practice that has a staff that is experienced and dedicated to breast reconstruction. Choose a facility that is well-run in general and has a good reputation for nursing care and is accustomed to performing reconstructive breast surgery specifically.
Do set realistic expectations. The reconstructed breast may not look like the native breast. It may end up being a different size, shape or texture. It may have a reconstructed nipple that lacks normal sensation and erectile function. Not all mastectomies are the same and some oncologic surgeons are more aggressive than others and remove more soft tissue from the breast. Radiation therapy may render the native remaining breast and chest wall skin tight and tethered to the underlying chest wall, which along with the mastectomy, contributes to what we at PRMA term a large “absolute tissue defect.” After reconstruction there may be asymmetry between the reconstructed and native breasts or in the case of bilateral reconstruction, between the two reconstructed breasts.
Don’t let anyone talk you out of breast reconstruction. Make it clear to your surgeon, oncologist, radiation oncologist, significant other and children that you are interested in breast reconstruction. The vast majority of breast cancer patients are candidates for some type of reconstruction, whether implant or tissue, immediate or delayed.
Don’t settle for reconstruction that is not right for you. Pursue the type of reconstruction that fits your needs and appeals to you most. An experienced reconstructive surgeon will help you in your decision making process. He or she will review the pros and cons of the major types of reconstruction and determine whether you are a candidate for one type of reconstruction verses the other.
Don’t be impatient in your recovery. Breast reconstruction takes time, energy and patience. In our practice at PRMA, the time to complete breast reconstruction takes from four months to one year, maybe longer if chemotherapy and or radiation therapy is required.
Don’t be hindered by location. You may live in an area in which breast reconstruction is not available. Or it may be that you are interested in a tissue reconstruction such as the DIEP flap but no one performs it in your area. Consider traveling to a practice that offers breast reconstruction. PRMA has become a destination practice for breast reconstruction and patients routinely visit us from all over the United States, Mexico and Canada for breast reconstruction.
Don’t compromise your cancer treatment. Taking care of the breast cancer comes first. Reconstruction may need to be put off in the case of a large, aggressive tumor. Chemotherapy and radiation therapy may take priority over reconstruction. The vast majority of women are candidates for some type of reconstruction; it just may be that the reconstruction is delayed.