When a woman has to face breast cancer, chemotherapy, a mastectomy and
then breast reconstruction, she can begin to feel overwhelmed.
Henry Lin, MD, a board-certified plastic/reconstructive surgeon at
St. Jude Medical Center, understands the anxiety that the prospect of breast reconstruction can
cause, and he also has seen the positive change that reconstruction has
made in women’s lives. Dr. Lin answers frequently asked questions
about reconstructive breast surgery.
Q. The prospect of any kind of surgery makes me nervous. Are breast cancer
survivors who choose reconstruction glad they did?
A. Overwhelmingly, in my experience, patients who are good candidates for
breast reconstruction are much happier when reconstruction is performed.
This is supported by research. The psychological benefits are enormous.
It restores a sense of wholeness, and emotional and spiritual well-being,
that strengthens breast cancer survivors on their road to recovery.
Q. Will having breast reconstruction interfere with ongoing monitoring
of my breast cancer?
A. Breast reconstruction does not interfere with ongoing monitoring of
breast cancer. It is important that you continue to undergo routine self-
and physician-performed physical exams on the mastectomy site for general
surveillance. But once you have a mastectomy, there is no breast tissue
left, so no further mammograms are necessary on that breast. Routine screening
mammograms are still recommended for the opposite breast; however, these
are routine procedures and you should feel confident that your reconstruction
surgery will not hinder your ongoing preventive measures.
Q. What are my choices if I elect to have breast reconstruction surgery?
A. You have two options to consider for breast reconstruction: implant-based,
or autologous reconstruction using your own tissue. In my practice, most
patients choose implant-based reconstructions because post-operative recovery
is easier, and no extra incisions are necessary to gather tissue from
other parts of the body.
Q. What are the types of implants typically available today, and are there
any safety issues with implants that I should be concerned about?
A. There are two types of breast implants currently approved for use: implants
filled with saline, and implants filled with silicone gel. In the past,
there have been concerns around silicone gel implants. This is because,
in 1992, the Food and Drug Administration placed a ban on silicone implants
due to allegations that ruptured implants lead to connective tissue disorders
like lupus, rheumatoid arthritis, and fibromyalgia. These allegations
were eventually shown to have no merit, and there is no proof of a connection
with these disorders. Large studies done by Allergan and Mentor, the two
largest implant manufacturers in the U.S., show no increased incidence
of these disorders in patients who have had implants placed versus the
general population. In 2006, the FDA re-approved silicone implants for use.
You can feel comfortable knowing that both saline and silicone are safe
and successful materials for implants. Of the 93,083 breast reconstruction
procedures performed in the United States in 2010, around half used saline
and half used silicone gel.
Q. What does the process of implant-based reconstruction involve?
A. Implant-based reconstruction requires at least two surgeries. The first
surgery involves placement of a tissue expander under the pectoralis major
muscle. After the incisions heal, you will come to the surgeon’s
office weekly for expansions until the expanders are fully filled. This
process generally takes eight to 12 weeks to accomplish.
Q. Should I be prepared for pain when the implant is expanded?
A. Most patients don’t experience much pain during the expansion
process. Some will take a an over-the-counter pain reliever for the first
two days after each expansion. All patients are able to go back to their
normal activities during the expansion period.
Q. Given that breasts are shaped differently, how can I be sure the implant
will match my opposite, natural breast?
A. Once the breast has been fully expanded, we generally wait another six
to eight weeks to allow the expander and tissues to settle prior to performing
a second operation. At the second surgery, the tissue expander is removed
from your breast and a permanent saline or silicone implant is placed.
At the same surgery, we will perform a symmetry procedure on your opposite
breast to make sure the breasts are as evenly balanced as possible. Each
breast is different, so this procedure may be a breast reduction, a breast
lift, or placement of an implant.
Q. When is autologous reconstruction the preferred choice, and what part
of the body is the tissue taken from?
A. Autologous reconstructions are also an excellent option for breast reconstruction.
They are usually recommended for patients who are going to need radiation
therapy as part of their cancer treatment, or for those whose prior implant
fails after receiving radiation. Radiation therapy can lead to complications—like
asymmetries or infections--in an implant-based reconstruction. Bringing
non-radiated tissue to the site provides a fresh blood supply, and additional
healing potential, for the radiated chest wall. The most common areas
to borrow tissue to make a breast is from the lower abdomen or the upper
back. These tissues can also be used to supplement an implant reconstruction.
Because these procedures require collecting tissue and muscle from other
areas of the body, the recovery times are longer than with implants.
Q. Are there other advances in breast reconstruction that I might benefit from?
A. Ongoing strides are being made in breast cancer surgery, and new techniques
are accompanied by more reconstruction options. For example, if the cancer
is far away from your nipple-areolar complex and your nipple is well positioned
on your breast, we can offer nipple-sparing mastectomies with implant
reconstruction. The nipple-areolar complex is often the most difficult
area to reconstruct, so it if can be spared, the reconstructive results
can be very impressive. Since we are not removing any skin, for certain
patients it is possible to place a permanent implant at the time of the
mastectomy in a one-stage (direct to implant) reconstruction, without
the use of a tissue expander.
Another exciting technique for breast reconstruction is something known
as “onco-plastic” reconstruction. Implant-based reconstruction
is often challenging for larger breasted patients, and it is certainly
harder to match a reconstructed breast with an implant to a large, natural,
opposite breast. For these patients, if the cancer is small, we can offer
breast cancer removal with a lumpectomy and perform what’s called
an “oncoplastic reconstruction.” We are essentially combining
a lumpectomy procedure with a breast reduction. These procedures have
an extremely high rate of satisfaction, as patients are able to have their
breasts reduced at the time of lumpectomy. To complete the cancer treatment,
patients who elect to have this type of treatment will still need to have
Q. How soon after a mastectomy should I anticipate undergoing reconstruction?
In most cases, we are able to offer immediate reconstruction at the time
of mastectomy. Timing of reconstruction is really dictated by the stage
and oncologic treatment of breast cancer. For more advanced stage 3 or
4 cancers, it is common that chemotherapy and radiation will be involved
as part of the cancer treatment. If radiation therapy is involved after
your mastectomy, it is preferable to have radiation treatment completed
prior to engaging in breast reconstruction. This allows me to examine
the quality of the chest skin after radiation and plan for possible autologous
reconstruction. If your skin quality is favorable after radiation treatment,
it may still be possible to undergo tissue expansion and implant-based
Q. How do I choose the best surgeon for my breast reconstruction?
Every patient who is contemplating breast reconstruction should have a
consultation with one or more board-certified plastic surgeons to discuss
the benefits and risks of all reconstructive options. You should be prepared
to ask questions of the surgeons, especially about the type of experience
they have in performing the procedures they are offering. You should look
at sample photos of reconstructed patients--pictures are the best way
for me to educate my patients about the reconstructive process.
Communication and trust are vital in every patient-doctor relationship.
Each breast reconstruction typically involves two to four surgeries before
completion, so you should feel extremely well-informed about each procedure
and be able to effectively communicate your concerns to your surgeon.
My team is excellent at performing breast reconstructions, and I truly
care about each patient as a person. I make sure that each patient gets
the time he or she needs to understand each part of the reconstruction
process. Most of my patients feel that they are treated like family.
How has breast reconstruction made a difference in your recovery from breast
cancer? Share a comment below.
Kathryn T. McCarty Breast Center at St. Jude Medical Center is a nationally-recognized Breast Center of
Excellence, a recognition given to only five percent of centers in the
U.S. by the American College of Surgeons Commission on Cancer.