RECONSTRUCTIVE SURGERY: BREAST RECONSTRUCTION AFTER CANCER
How many people have breast reconstruction after cancer? About 56% of women have some type of reconstruction after mastectomy, and this number continues to grow each year.
Breast reconstruction surgery is essentially the rebuilding of the breast after a woman has undergone a mastectomy (surgical removal of entire breast) or lumpectomy (removal of cancerous breast tissue) after a cancer diagnosis. The reconstruction is done with a traditional breast implant or fat transfer injections.
How long do you have to wait to get implants after a mastectomy?
For some women, the answer is that you don't have to wait. In fact, many women choose to have breast reconstruction surgery at the same time as their mastectomy or lumpectomy. Often, your exact breast cancer diagnosis helps you and your doctors choose whether immediate or delayed reconstruction might be a better option for you. For example, immediate reconstruction is indicated for women with average-to-moderate breast volume when there is little likelihood of the need for postoperative radiotherapy. DCIS patients typically fall within this category. Most doctors advise patients to delay reconstruction or consider hybrid alternatives if their cancer diagnosis requires post-operative radiation.
The good news is that women have the option of breast reconstruction at any time after their mastectomy. There are, however, some important items to consider as you are making the decision of when, or if, to have reconstructive breast surgery.
Benefits of Immediate Breast Reconstruction
Decreased anxiety and depression
Increased body image, self-esteem and sexual feeling of attractiveness and satisfaction over patients who elect delayed reconstruction (European Journal of Surgical Oncology)
Your breast skin retains its original size and shape, often allowing for a more aesthetic outcome and very little difference between the original breast and the reconstructed breast
Fewer surgical complications caused by scar tissue
Reasons to Consider Delaying Reconstruction
Some women simply aren't ready to make a decision on reconstruction right after their breast cancer diagnosis. Delayed reconstruction can be performed weeks, months, or even years after the original mastectomy surgery
Lower risk of wound healing complication from surgery
"Are there any alternative reconstruction options?"
Dr. Bindewald Discusses Immediate-Delayed Breast Reconstruction Technique
"Although it is not discussed as frequently as other options, some patients may find value in a compromise approach between immediate and delayed reconstruction. In the scientific literature, this approach is referred to as 'immediate-delayed' breast reconstruction. Using this technique, the breast cancer surgeon performs a skin-sparing mastectomy. During the same surgery I reconstruct the breast with an expander underneath the pectoral muscle. Then, after the patient completes their course of radiation therapy, I come back in an replace that expander with either a permanent breast implant or an autologous flap."
Types of Surgeons Who Work With Breast Cancer Patients
Understanding what type of surgeons perform different surgeries for breast cancer patients is important
Breast Cancer Surgeons vs Plastic and Reconstruction Surgeons
Understanding all of the different types of doctors and surgeons who work with breast cancer patients can be confusing. Most cancer patients have both a medical oncologist to manage their chemotherapy treatment and a radiation oncologist to determine the need for and management of radiation therapies, but when it comes to a patient's surgical needs there could be one or more different types of surgeons who work with patients.
For example, prostate cancer patients are often referred to a urologist who specializes in robotic prostate cancer surgery. Patients with a cancer in their mouth or neck area will likely be referred to an ENT oncologic surgeon, and then possibly to a reconstructive surgeon. Breast cancer patients typically see at least two types of surgeons - a breast cancer surgeon who specializes in removal of the actual tumor and a reconstructive surgeon to reshape the aesthetic of the breast.
Why can't one surgeon do both the tumor removal surgery and the reconstruction?
Interestingly, the techniques and knowledge required to perform mastectomy and lumpectomy surgeries versus those required to reconstruct the breast are very different. For breast cancer patients, removal of the cancerous tumor is of utmost concern. Breast cancer surgeons have extensive training on how to resect different types of breast tumors in order to ensure the highest likelihood of removing 100% of the cancerous tissue with the lowest likelihood of recurrence. This specialty is so extensive and important to patients that it is a study within medicine all to itself.
Similarly, breast reconstruction is an extensive and complex procedure, requiring training within many types of surgical techniques. If a breast cancer surgeon were to also perform breast reconstruction surgery, they would likely be limited to implants, latissimus dorsi flaps and contralateral mammoplasty without the ability to perform the wide range of free flaps such as the TRAM, DIEP, SIEA or gluteal flaps now available to plastic and reconstructive surgeons. study link
Considerations for Choosing a Breast Cancer Surgeon for your Mastectomy or Lumpectomy
Although many surgeons can perform mastectomy and lumpectomy procedures, It's important to look for a breast cancer surgeon with a lot of experience. Further, it's a very good idea to ask the surgeon about their incision technique for mastectomy and lumpectomy. Why? Because in general, since breast cancer surgeons are trained with a primary goal of removing the tumor, this means they are typically trained to make the incision right across the midline of the breast. Thus, even with the best post-mastectomy reconstruction, patients are often faced with a large, unsightly scar that permanently reminds them of their breast cancer, even after recovery.
Recently, there was this great sharing of knowledge between breast cancer surgeons and plastic surgeons, where breast cancer surgeons were taught plastic surgery techniques specifically on where and how to make incisions during breast surgery that would later be hidden. So basically, instead of making a large cut right across the breast, some breast cancer surgeons now make an incision underneath the midline of the breast, just like a plastic surgeon does during breast augmentation surgery. This way, a patient can have a mastectomy followed by breast reconstruction surgery with incredible results and no visible scar.
Since the training for this surgical technique is extensive and pretty new, very few surgeons have become certified to perform the procedure. In San Antonio, Dr. Maria Palafox at South Texas Breast Surgery and Dr. Brittany DeBerry of General Surgical Associates are known both for their breast cancer surgery experience as well as their training and certification with this Hidden Scar technique. Dr. Palafox has some great resources on her website regarding breast cancer and Hidden Scar techniques that can be accessed here.
Considerations for Choosing a Plastic Surgeon for your Breast Reconstruction
Breast reconstruction surgeries are performed by Plastic and Reconstructive Surgeons. To start, it's helpful to know that although we often hear the term "plastic surgeon", that plastic surgeons are technically titled "Plastic and Reconstructive Surgeons". This is because in the U.S. we are trained during residency within both fields of specialty, and then can later choose if we want to practice exclusively within plastic surgery, reconstructive surgery, or a combination of both.
Plastic surgery includes mostly aesthetic cosmetic procedures such as breast augmentation surgery, facelifts, and eyelid (blepharoplasty) surgery. Reconstructive surgery typically involves more complex and lengthy "repair" procedures such as breast reconstruction after cancer, skin removal surgeries after bariatric surgery, and the re-building of tissues such as a nose after a patient undergoes Mohs or has experienced disfiguring trauma such as a dog bite or car accident.
So one of the first things you will want to take a look at is how much reconstructive surgery that doctor performs, or whether their practice mostly revolves around elective cosmetic procedures. Secondly, you will want to specifically look at whether or not breast reconstruction after cancer is a specialty of that doctor.
The decision for breast reconstruction surgery is complex and often comes at a time when you are still experiencing the initial shock of your cancer diagnosis. Dr. Bindewald's soft-spoken, no pressure personality puts patients at ease. He takes time to explain all of your post-mastectomy or post-lumpectomy options. Further, his experienced staff specializes in working with patients through both the emotional and financial aspects of their surgery. They are well-versed in working with insurance companies to secure the required prior authorization for surgery, and will hold your hand through the entire process.
You can schedule an appointment with us at any time. Some patients want to meet with us before their mastectomy or lumpectomy to discuss having Dr. Bindewald perform an augmentation during the same operation when your cancer surgeon removes your tumor. Other patients schedule with us months or even years after their cancer surgery.
Feel free to call or email us via the information below, or submit an inquiry directly from our website. Dr. Bindewald answers all patient questions directly and maintains a HIPAA-compliant website and email to ensure your utmost discretion and privacy. You can reach us at the phone number or email address listed below.
Contact us online or schedule an appointment in our San Antonio office today. You can reach us at the phone number or email address listed below, through this web form, or schedule your own appointment via our online request form, which can be accessed here.