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What a Plastic Surgeon Wants You to Know About Breast Reconstruction

contributed by Kevin Joy

graphical representation of a woman with question marks around her

Opting for reconstructive surgery after a mastectomy comes with questions and choices. A U-M plastic surgeon helps address them.

Women undergoing a mastectomy for breast cancer already have a lot to manage in regard to treatment and recovery.

Beyond monitoring their health, they must also weigh a decision that could alter their appearance and quality of life after cancer treatment: whether to have breast reconstruction surgery — and, if they do, which type to choose.

The procedure can have physical and mental implications for patients whose cancerous breasts are surgically removed.

"There are clear advantages … We’re restoring form," says Adeyiza Momoh, M.D., a clinical assistant professor of surgery at the University of Michigan Medical School."Multiple studies have shown the benefits."

"It has an impact on quality of life, but it’s not a life-or-death decision."

Which is why women and their doctors should have a wide-ranging discussion about options, timing and risks, says Momoh.

Still, whether by personal choice or other circumstances, breast reconstruction isn’t for everyone.

Nor must the operation -- which can involve either transferred body tissue or synthetic implants -- occur immediately after a mastectomy.

In any case, and no matter the course of surgery, a patient and her medical team have a shared objective.

"The goal is to get back to life as usual," says Momoh, who shared some key points about the surgery.

Start the conversation early.

Although Momoh says women ought to focus first on the immediate particulars of their cancer care, it can help to begin the reconstruction talk in advance with a doctor (and, ultimately, a board-certified plastic surgeon). Don’t be afraid to come to an appointment with questions and seek a second opinion, if desired, he adds.

The thought process and decision can affect the timing: If deemed healthy enough and with early stage cancer, a woman might opt for reconstruction surgery at the same time as her mastectomy to avoid multiple rounds of anesthesia and recuperation -- and to lessen the shock of losing an important part of her body.

Explore all possible options.

There are two main types of breast reconstruction: those involving saline or silicone-gel implants, and those that use a patient’s body tissue from areas such as the thighs, back, buttocks or lower abdomen -- a choice known as a flap procedure.

About 75 to 80 percent of surgeries use the synthetic route, Momoh says, in part because of the simplicity of the procedure that all plastic surgeons are trained to perform. Flap reconstructions, on the other hand, require plastic surgeons with additional skills. But the lack of a specialized plastic surgeon locally shouldn’t discourage a woman from pursuing a flap procedure if that’s her best and preferred option.

Other patients might favor noninvasive action: external breast prostheses or nothing at all (recently described as “going flat”).

Surgery can be delayed.

For emotional or physical reasons, some women seeking reconstruction may choose to wait. And cancer-related circumstances could postpone others, Momoh says, including advanced disease that might require extended monitoring to ensure the cancer doesn’t return. Active smoking or pre-existing comorbidities can also push back the time of reconstruction.

Those who must undergo radiation treatments post-mastectomy are often encouraged to hold off, too. “Radiation can have a detrimental effect on the reconstructed breast,” Momoh says.

Both options have risks. A flap procedure, Momoh notes, is “labor-intensive and resource-intensive.” It requires a larger surgical team, and patients can expect a lengthier operation and inpatient recovery because of the increased technical complexity of the tissue transfer. Still, he says, “Patients with tissue reconstruction tend to be more satisfied over time.”

Synthetic implants, meanwhile, could one day rupture or leak and require corrective surgery. Over time, scar tissue around the implant (also known as a capsule) can thicken and harden, ultimately changing the shape and feel of the breast; this also requires corrective surgery.

Age is not a factor.

According to a comprehensive U-M study, older women who had a breast removed and reconstructed saw no greater frequency of post-surgical complications than their younger counterparts -- findings that the researchers affirm shouldn’t discourage a woman from pursuing surgery because of her age.

That’s good news for many women, given that 40 percent of the 250,000 who will be diagnosed with breast cancer this year are 62 and older, according to National Cancer Institute data. Older flap procedure patients, the study noted, had better physical, psychosocial and sexual well-being after reconstruction compared with younger patients.

Learn more about breast cancer treatment

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