Options for breast reconstruction

BREAST RECONSTRUCTION is surgery to recreate breasts after a mastectomy or lumpectomy. There are several types of breast reconstruction and some techniques use implants, including silicone or saline. Others use tissue from your body, such as the belly or buttocks, to form a breast.

Breast reconstruction can happen right after breast cancer surgery, or it can happen months or years later. You may have surgery to reconstruct both breasts, or your doctor may replace one breast and reshape it to match the other. Your doctor may also recommend multiple surgeries over several stages.

According to Dr Rajeev Venugopal, consultant plastic surgeon and associate lecturer in surgery at the University of the West Indies, some people choose to have breast reconstruction after a mastectomy, but many do not.

“Breast reconstruction surgery can improve self-confidence after a mastectomy or lumpectomy. After breast reconstruction, many people feel better about how their clothes fit. They may also feel more comfortable wearing a swimsuit,” Dr Venugopal said. “However, many people choose not to have breast reconstruction after a mastectomy. Instead, they wear a breast form/ prosthesis inside a special bra. They may also choose to go flat and not wear prosthetic breasts. The decision is very personal, and varies from person to person,” he added.

Dr Venugopal, who presented at the Jamaica Cancer Society’s Breast Cancer Medical Symposium on ‘Options for Breast Reconstruction’, ’indicated that breast reconstruction generally falls into two categories, implant-based reconstruction or flap reconstruction.

“Implant reconstruction relies on breast implants to help form a new breast mound. Flap, or autologous, reconstruction uses the patient’s own tissue from another part of the body to form a new breast. There are a number of factors that should be taken into consideration when choosing which option is best, including type of mastectomy, cancer treatments, and the patient’s body type,” Dr Venugopal said.

In flap reconstruction, the surgeon takes tissue from your own body, or autologous tissue, and uses it to form a breast. Usually, they take the tissue from the lower abdomen, but it can also come from your thigh, back or bottom.

In implant reconstruction, the surgeon uses saline or silicone implants to recreate breast tissue. Sometimes surgeons use a combination of implants and tissue from your body. Implant reconstruction can happen along with a mastectomy, or you may choose to have this procedure after a mastectomy.

“If you are a candidate for lumpectomy, you may benefit from oncoplastic reconstruction. Your oncologic breast surgeon will help you know if you are a candidate for breast conservation. However, you will require radiation when a lumpectomy is performed,” he said.

“In oncoplastic reconstruction, surgeons use the techniques of breast reduction or breast lift at the same time as the lumpectomy. The breast reduction or breast lift helps to fill in the defect created by the lumpectomy and improves the breast shape. You will need a breast reduction or lift on the other breast for symmetry,” Dr Venugopal added.

If you have decided to have breast reconstruction, you will still have many things to think about as you and your doctors talk about what type of reconstruction might be best for you. “Some of the factors you and your doctors will need to think about when considering your options include your overall health, the size and location of your breast cancer, your breast size, the extent of your breast cancer surgery, and whether you will need treatments other than surgery for your cancer,” Dr Venugopal said.

Other factors, he said, include the amount of tissue available; for example, very thin women may not have enough extra tummy tissue to use this area for breast reconstruction, whether you want reconstructive surgery on one or both breasts - your desire to match the look of the other breast, your insurance coverage and related costs for the unaffected breast. Also to be considered is how quickly you want to be able to recover from surgery, your willingness to have more than one surgery as part of the reconstruction, and how different types of reconstructive surgery might affect other parts of your body.

Everyone recovers from surgery differently, he said, and your recovery time depends on several factors. These include your overall health and the type of procedure you had. You will need to avoid lifting, exercising or doing some activities for a while, to give your body time to heal. Talk to your doctor about when you can get back to the activities you enjoy.

Cancer can return after breast reconstruction surgery, so you must see your doctor for regular check-ups. If you had one breast reconstructed, you will need regular mammograms on the other breast to check for cancer.

keishahill@gleanerjm.com