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Cancer -- any cancer -- affects not only the patient but also the patient's family and everyone who loves the patient. The diagnosis of breast cancer can be particularly devastating for most women.
Our society attaches so much to the female breast form. It is a source of love and nurturing, and certainly a source of sexuality in our culture. Breast reconstruction is one of the options that can enable a woman to live a satisfying, rich life after a breast removal.
A patient may choose to have her reconstruction done at the time of the mastectomy, or it can be delayed. The delay can be several months, a year, or even longer.
There can be some advantages to doing reconstruction immediately. The tissues are soft and pliable immediately following the mastectomy, so the surgeon does not have to recreate the natural droop of the breast because the original skin is there. There are also emotional advantages to performing reconstruction immediately. The patient does not have to go through the mourning of a lost breast.
There are also advantages to postponing reconstruction. The patient may want to simply concentrate on recuperating from her surgery and dealing with the possible chemotherapy and/or radiation treatment her medical treatment plan may include. By postponing her breast reconstruction, it may free her mind from having to deal with any other surgery and recuperation concerns. In short, she simply may not be mentally prepared for additional medical procedures.
Not every woman is a candidate for reconstructive surgery. For example, patients in poor health cannot tolerate the hours under anesthesia required for breast reconstruction. However, for suitable candidates there are three options for breast reconstruction. The physician can use muscles and tissues from the patient's own body. These tissues may come from the abdomen, back, and sometimes in extreme cases the buttock area. The tissues are moved up onto the chest wall and molded to recreate the shape of a breast. Implants that are saline-filled or silicone-gel filled may be used to replace lost tissue. There can also be a combination of the muscle flap and a filler implant used to create the necessary volume. The physician will discuss all these options with the patient. Together they decide which option will be best for her both physiologically and emotionally. When doing reconstruction, the physician also looks at the other breast. On occasion we may alter it, make it larger or smaller, so as to create a more symmetrical match.
Recovery from reconstructive breast surgery is usually four to eight weeks. If a woman had a mastectomy even 15 or 20 years ago, reconstructive surgery is still possible, depending on her state of health.
Over the past several years, legislation has been passed, first state-by-state and now through a national bill, that requires insurance companies to cover the cost of reconstructive breast surgery.
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Dr. Grotting
