Know Your Options
Reconstruction and Prosthesis After Breast Cancer
by Vladimir Lange, MD
Almost any woman who has had a mastectomy can have her breast reconstructed. New techniques and better skills enable surgeons to achieve results that can be remarkably natural and pleasing.
For many women, a breast reconstruction is a milestone that symbolizes that they have completed the treatment and are ready to get on with their lives. It is also an opportunity to regain their feminine silhouette and restore their self-image.
Today, about three out of four women choose to have breast reconstruction. Even if your physician doesn’t bring up the topic, or if you can’t stand the thought of additional surgery right now, don’t dismiss the possibility of rebuilding your breast, at the time of the mastectomy, or at a later date. Give it careful consideration. In the future, you might be glad you did.
Choosing a Plastic Surgeon
If you are considering reconstruction, even if it’s to be done at a later date, arrange a meeting with a plastic surgeon well before your mastectomy to discuss the details of the procedure. It is crucial that you select a surgeon who has extensive experience in reconstructive breast surgery and is a board-certified specialist because the cosmetic results will depend significantly on the surgeon’s skill. Your primary surgeon can refer you to one.
Be sure to ask the surgeon who will perform your reconstruction to show you photos, and perhaps arrange for you to interview some of the women who had the same procedure you are considering. General surgeons who are trained in oncoplastic surgery techniques should be able to give good results with implant procedures, but be sure to check out their training and performance.
Even if your physician doesn’t bring up the topic, or if you can’t stand the thought of additional surgery right now, don’t dismiss the possibility of rebuilding your breast.
One more key point: it is important that your expectations be realistic. The new breast can look natural and feel normal to someone touching it, but you will not have sensation in the nipple and will have decreased or no sensation in the skin of the breast. Your satisfaction with the result will depend as much on the surgeon’s skill and technique used as on your healing pattern and your expectations.
Reconstruction can be done at any time: at the time of mastectomy – which is called immediate reconstruction – or at a later date – which is called delayed reconstruction. There are two main methods for reconstruction. One uses synthetic implants to create the shape of a breast. The other relies on the woman’s own tissues, transplanted from another area of the body.
Very commonly, you may need a minor plastic procedure, such as a breast lift, on the other breast to achieve the best similarity possible to the reconstructed breast. Reconstruction may be easier if you have a skin-sparing mastectomy, where much of the skin of the breast is left in place. Once the breast is rebuilt, you can go on to have a reconstruction of the nipple and the areola to achieve an even more natural look.
External Breast Forms
Many women choose to have no reconstruction of any type after mastectomy. Some make this decision because they want to avoid extra surgery. Others because they’re comfortable with their appearance and body image. A few view their scars as battle scars from a war they waged.
If you choose to have no reconstruction, you may want to use a breast form instead. Breast forms, or prostheses as they are also called, are available in a variety of sizes, shapes, and colors. Some are designed to fit into a special bra. Others can be attached securely to your chest using a special adhesive. Prostheses range from inexpensive foam inserts to custom-molded replacements with realistic color and texture, designed to duplicate your natural breast as closely as possible.
The decision about whether to have breast reconstruction or to wear an external prosthesis instead is a very personal one. It should be based on your own feelings about your body, your sexuality, and your tolerance for additional surgery. Your decision is legitimate and must be respected by your healthcare providers and your loved ones.
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Dr. Vladimir Lange, a graduate of Harvard Medical School, is a leading expert in helping women and their families in their battle with breast cancer.
Excerpted with permission from Be a Survivor: Your Guide to Breast Cancer Treatment, 5th edition, by Vladimir Lange, MD, copyright © 2010 by Lange Productions.
This article was published in Coping® with Cancer magazine, March/April 2011.