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Ask the Breast Cancer Expert

Publication: D Magazine

More than 22,000 women in Texas are expected to face a new breast cancer diagnosis in 2023, according to the American Cancer Society. The loss of one or both breasts may change a woman's self-perception or body image, becoming a factor in deciding if breast reconstruction surgery is the right choice for them. Breast reconstructive surgery rebuilds the shape and appearance of a woman's breast following surgery to treat breast cancer. Several types of reconstructive surgery are available, and the process may include more than one operation.

Patients should work with their breast surgeon and plastic surgeon to discuss which option is most appropriate, taking into consideration health concerns and personal preferences. Breast surgeon Melissa Kinney, M.D., FACS, addresses questions about breast reconstruction and the importance of this individual decision-making opportunity for those who have had breast cancer surgery.

Who is a good candidate for breast reconstruction?

Any woman should be considered for breast reconstruction if removal of the cancer is anticipated to leave a deformity. Reconstruction can be performed with both a lumpectomy and a mastectomy. An aesthetic flat closure may be offered for those wanting reconstruction without an implant.

Can breast reconstruction be performed at the same time as a mastectomy?

There are no differences in cancer outcomes by having reconstruction at the same time as a mastectomy. Most breast surgeons can perform same day reconstruction in conjunction with a plastic surgeon. It is preferable to coordinate reconstruction at the same time to save the skin and nipple. Otherwise, the reconstruction can be a longer process to recruit or move tissue from other parts of the body. There are a small number of situations where same day reconstruction is not recommended, such as inflammatory breast cancer.

Will reconstruction interfere with ongoing cancer treatment?

If chemotherapy or radiation therapy is anticipated after surgery, it may be recommended for the patient to have an implant or a temporary tissue expander placed at the time of the mastectomy. Once all active treatment is complete, she can return for her final reconstructive surgeries.

What are the different types of breast reconstruction procedures?

Reconstruction options include implants, natural tissue flaps, or an aesthetic flat closure. Implants, typically made of a gel-like silicone, need to be changed out every 10-20 years. Some women elect to use portions of fatty tissue from other areas of the body, like the stomach, to reconstruct the breast, which feels more natural. While other women prefer an aesthetic flat closure, where extra sculpting is performed to create an even chest wall or the use of extra skin to rebuild a small breast mound.

If reconstruction is needed for only one breast, should patients consider surgery on the other breast to help them look alike?

Choosing to do a mastectomy on one versus both sides is a personal decision. There is no survival benefit from a cancer standpoint by removing the other breast. Some women choose to do both sides for symmetry. It is advised to discuss with a plastic surgeon as each patient is unique.

Will breast reconstruction affect the ability to check for breast cancer recurrence in the future?

Reconstruction does not interfere with the ability to monitor for breast cancer recurrence. After a mastectomy, no further mammograms are needed, and concerns will be evaluated with an ultrasound or MRI.

Melissa Kinney, M.D., FACS, is a board-certified, fellowship trained breast surgeon specializing in breast surgical oncology and surgical diseases of the breast. Dr. Kinney is certified in the Hidden Scart approach for breast cancer surgery and is a member of the American College of Surgeons and American Society of Breast Surgeons.

This article originally appeared in D Magazine.

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