Dealing with a diagnosis of cancer is always an incredibly traumatic ordeal for the patient and their family. Breast cancer can be even more stressful because of the visible nature of the disease. The combination of having to deal with the emotional stress of being diagnosed with breast cancer on top of the changes in appearance that are associated with the treatment can be difficult to cope with. Whether it is the prospect of temporarily losing all of your hair from chemotherapy, or the loss of a portion or all of one or both breasts, these are often significant symbols of a woman’s self-image.
Every year almost 300,000 women face this same situation. Unfortunately studies have shown that more than 75% of women do not know all of the options available to them for reconstruction after mastectomy or lumpectomy. Without all of the information, many women choose to forego reconstruction; or they don’t even realize it’s an option for them. Frequently, breast cancer survivors are too overwhelmed or embarrassed to ask. Congress passed the Women’s Health and Cancer Rights Act in 1998 to ensure that insurance companies that cover mastectomies must also cover breast reconstruction. It does not matter how long ago the mastectomy was done, the woman is still eligible for breast reconstruction.
I’m always saddened when a woman tells me she wished she had known more about breast reconstruction before her mastectomy or lumpectomy, because she would have done things completely differently. Sometimes a sister, daughter, or husband tells me their family member feels deformed, and she thought there was nothing she could do about it because it was so long ago.
There are numerous options for breast reconstruction. There is no single answer for everyone. A lot depends on the cancer itself of course, but with so many options there is bound to be a right choice for everyone. I typically break down the options into a few categories, but there can always be overlap or hybrid procedures. The simplest, is an external prosthesis you wear in a bra. This can be sized to match the remaining opposite breast, and it doesn’t require any surgery. It is very straightforward, but the prosthesis can be heavy or irritating to the skin especially in the summer.
Surgical options after complete mastectomy are broken down into those using breast implants, or those using your own tissue. When using implants, we typically start with a tissue expander that is placed at the time of mastectomy. This is then slowly filled with saline over a few months until it gets to a size that either matches the opposite breast, or is the desired breast size. The tissue expander is then removed and a softer implant is placed in the same pocket to recreate the breast.
Breast reconstruction using your own tissue typically involves using the abdominal skin and fat and transferring that up into the breast pocket created by a tissue expander. However, there are multiple other options, and tissue can also be taken from the back or buttocks. The benefit of using your own tissue is that it changes size as you gain or lose weight. It softens and becomes more natural looking over time. Beyond creating a breast we can also recreate nipples using your own skin, and we use tattooing to recreate the color of the areola as well.
Breast Reconstruction Awareness Day, or BRA Day, was October 15th, 2014. BRA Day, sponsored in large part by the American Society of Plastic Surgery, helps raise awareness for women with breast cancer so they can feel empowered to ask questions about their breast reconstruction options. It can feel selfish or embarrassing to ask about wanting to keep or reconstruct your breast in the midst of dealing with cancer, but it shouldn’t. We want to make you feel comfortable, so you can ask all the questions important to you and help you make an informed decision that’s right for you. Everyone on the breast cancer team has the same goal — to treat the cancer and help you feel whole again.