With the incidence of breast cancer at nearly one in eight females, I see patients with this diagnosis almost every day in Encino and the Los Angeles, California areas. The patients that I treat are in various phases of care, ranging from newly diagnosed to survivors beyond five years. Nowadays, many are receiving chemotherapy and radiation, and many are undergoing mastectomy rather than breast-conserving lumpectomy. As one member of a team of specialists, the plastic surgeon tries to focus on the restorative aspect of breast cancer care.
Patients with new cancer diagnoses are faced with an early decision of lumpectomy and radiation versus mastectomy. While conserving the breast is an appealing idea, it does not work well for many women, and can result in a deformed breast that is difficult to improve. I have also seen a number of cases that developed cancer in the remaining breast tissue left behind after lumpectomy in spite of radiation treatment. Nevertheless, I tend to advise the option of breast preservation if it is likely to give a good cosmetic result. If not, the mastectomy, which removes almost all of the breast tissue from the cancer site, may be the better option.
Patients who are potential candidates for mastectomy should, ideally, see the plastic surgeon early on in the workup process to ascertain the role of plastic surgery for them. There is no substitute for a detailed and thorough examination, assessing each patient for options involving both implant approaches as well as body tissue reconstructions. I have heard so many women say, “I wish I knew that before . . .,” as they had never seen a plastic surgeon until they were already healing from the mastectomy. As a general rule, use of implants and expanders are shorter procedures involving less hospitalization. Implants are limited in how they can be placed and used to shape a breast, do not fare well in areas that have had or will have radiation, and can be difficult to match to an opposite “natural” breast. Because of these limitations, they often work better in cases of double mastectomies.
Tissue reconstructions can require longer operative and hospitalization times, but offer advantages in shaping and in radiated areas. Their success relies on adequate blood flow into the tissues, a factor that the plastic surgeon is attentive to throughout the surgery and post-operative period. The two most common sources of body tissue are the tummy and the back areas. Not everyone is a good candidate for this approach; your plastic surgeon can guide you.
Some words of advice if you are facing breast cancer or know someone who is . . .
1) Take a deep breath, and try to stay focused to make the best choices you can. Experienced plastic surgeons know that you are sometimes under short time constraints to make decisions about your care, and they will try to give you as much information as possible. Meet with them as early as possible.
2) With the current state of chemotherapy and additional treatments, survival with this diagnosis has made great progress in the last few decades.
3) The changes in your body tissue that result from a course of radiation may never go away. They may have a major impact on your reconstruction in the future.
4) If a lumpectomy will likely deform your breast in a way that could disappoint you, think carefully about whether the mastectomy option would be a better choice.
5) All other factors being equal, the body tissue reconstruction frequently offers the best long-term result.
6) If you need reconstruction after mastectomy, good integration of your plastic surgeon with the other members of the team is a strong advantage.
To your health,
Saul R. Berger, MD, FACS