What is Breast Reconstruction?

For women, it is important to consider breast reconstruction when removal of the whole breast or a significant portion of the breast is necessary in your treatment of breast cancer.  This aspect of managing the breast cancer patient is normally looked into after the surgical plan and any adjunctive therapy such as chemotherapy and radiation therapy has been chosen. 

Reconstructing the “lost” breast does a world of wonders for self-esteem, self-image, and the way a woman feels about herself and how she feels she will look to her partner. It speeds up the “healing” process, mind, body, spirit and relationship with her partner. Whether we wish to admit it or not, losing one or both breasts will cause a woman to worry about her attractiveness to her spouse or if she is still single, how it may affect her attractiveness and confidence in future relationships.
 

How does breast reconstruction differ from cosmetic surgery?

Firstly, we need to understand what is reconstructive surgery in general. The goals of reconstructive surgery differ from those of cosmetic surgery. Reconstructive surgery is performed on abnormal structures of the body, caused by birth defects, developmental abnormalities, trauma or injury, infection, tumours, or disease. It is generally performed to improve function, but may also be done to approximate a normal appearance. In the case of reconstructive surgery following mastectomy, it is for the latter reason of approximating a normal appearance.

On the other hand, cosmetic surgery, strictly speaking, is performed to reshape normal structures of the body to improve the patient's appearance and self-esteem.

Although no amount of surgery can achieve "perfection," modern treatment options allow plastic surgeons to achieve improvements in form and function thought to be impossible 10 years ago.

While some reconstructions can be completed in a single procedure, many techniques may require two or more operations for completion of the reconstructive process. 

The key “ingredients” in breast reconstruction is by using fat and skin from the woman's own body. Fat and skin from the lower abdomen, buttocks, “saddlebag” or the back may be used. Exactly what is done will depend on the patient and her plastic surgeon’s recommendation. 

Depending on the surgical plan for the patient’s breast cancer, other reconstructive options exist such as insertion of a breast implant, the use of tissue expanders as well as tissue transfer. Women who are interested in reconstruction should discuss all options fully so that they can make informed choices. 

In the right setting, there is a technique known as skin sparing mastectomy where only the nipple and breast tissues are removed and subsequently the breast is reconstructed with fat and muscle either from the patient’s back or abdomen. It is reported that the reconstructed breast will age like the opposite breast and behave just like its companion when weight is gained or lost.  Hopefully this will encourage women who would choose lumpectomy when the lump is too large to consider this option. Many feel mastectomy is mutilating and this leads many to opt for a lumpectomy (removal of the lump with a margin of normal tissue only) even when it is not the best surgical option for their cancer.
 

When should breast reconstruction be performed? 

Depending on the situation, breast reconstruction can be performed at any time. However, the best time to discuss reconstruction is before any mastectomy is done.

The advantage of immediate reconstruction lies in the surgeon's ability to work with tissues that are undamaged. The primary surgeon and the reconstructive surgeon are able to discuss and collaborate on the surgical plan.

Delayed reconstruction is performed after mastectomy when there has not been an opportunity for immediate reconstruction. This can occur because of lack of local reconstructive expertise, because of logistical problems, which prohibit appropriate scheduling or the patient may change her mind after some time. Delayed reconstruction can be performed before or after radiation/chemotherapy. Again, it is necessary for discussions between the patient and her surgeons to decide on what is best.

FACT: When considering reconstructive surgery, it does not mean that a person is vain. It does not mean that they are more concerned with outward appearances than their “internal” health. A person’s psychological well being is just as important in ensuring that they recover well from their disease and that they have the best “fighting” chance possible to prevent recurrence of the disease. In addition, they may find it easier and have a wider choice of clothes to wear. In more large breasted women, the absence of one breast may upset the “balance” or posture as well. Achieving or restoring symmetry is important!
 

Know your treatment options

The treatment should take into account the patient’s physical, emotional,
psychological and rehabilitation needs.

Breast reconstruction may not be for every patient but do not discount how it can help you feel better, look better and therefore smoothen and quicken your road to recovery. Our psychological well being is equally important.