PHYSICIAN VOICES

An Expert’s Perspective on Breast Reconstruction

The breast reconstruction experience is not just physical but also emotional. There are many decisions to be made when it comes to rebuilding your breast after mastectomy or lumpectomy. Dr. Catherine Hannan, a board-certified plastic surgeon specializing in breast reconstruction, shares the common questions she hears from her patients as she guides them through the process.

A: In the most general sense, we’re reconstructing a breast after a woman has been treated for breast cancer and had a mastectomy or lumpectomy. Our job as plastic surgeons is to create a mound in the breast area that matches your original breast, or your other remaining breast, as closely as possible. It’s typically not a completely ideal copy, but our techniques have improved dramatically over time, and we can provide you with a breast that is a close match.

Our goal is to help you feel more like yourself – physically and emotionally – after undergoing a challenging breast cancer treatment process. Data based on quality of life questionnaires shows that women who have breast reconstructions have overall better mental health than women who don’t. And sometimes, our goal is just to make your life a little easier. I’ve had patients come to me seeking a breast reconstruction years after their mastectomy because they’re just tired of using a filler in their bra, or needing to wear bathing suits with padding.

Whatever your reason, rebuilding your breast is a surgical procedure, so there are risks and recovery time involved, but ultimately many of my patients feel it helps them get back to their normal lives after breast cancer.

A: Depending on your situation, you may choose to rebuild your breast using your own tissue, called a flap reconstruction, or you may go with a prosthesis implant. Implants are either filled with silicone or saline. In the past, implants were made with different materials and not all of those materials were safe. That’s all changed now. Although implants still carry with them a risk of rupture after 10 to 15 years, in most cases, the rupture isn’t typically a crisis.

If saline implants rupture, the breast will deflate and the salt water will absorb into your body. There are still risks attached, but some patients find comfort in knowing that if their implant ruptures, they’ll know immediately and they can take appropriate actions.

Silicone implants are also called gummy bear implants – even if they rupture, they still stay in place and are less likely to bleed gel outside of the breast. That said, this makes it harder to know if there’s a crack in the shell. The Food and Drug Administration recommends regular imaging via MRI or ultrasound of silicone breast implants 5 to 6 years after your initial surgery, with follow-up imaging every 2 to 3 years thereafter.

A rupture isn’t always an emergency; your body makes a scar tissue pocket around your implant, called a capsule. Typically, the silicone stays within that capsule. Even if there’s a cracked shell, many women don’t experience any problems. Some people feel differently about this; they’re concerned about ruptured silicone in their body, which is understandable. At this point, though, we don’t have good data to show that it’s harmful. If you’re feeling well, you’re not in pain, and there’s no changes in your breast, you may not have to get the implant swapped out immediately. If you have any concerns about your implants, of course, reach out to your surgeon and discuss the best way forward for you.

A: Many surgeons will be able to offer immediate reconstruction after your mastectomy, so it’s important to start by asking about the timing. Ask if you’re a candidate for reconstruction the day of your mastectomy. Sometimes there are logistics in the way, but assuming you’re a healthy patient and the necessary resources are available to you, you can go that direction.

You’ll also want to ask your surgeon about their recommendations as far as technique.

• Based on your body and their experience, should you go with a flap or an implant?
• Which implant type makes more sense?
• How many of the different types of reconstruction has your surgeon performed?
• Do they prefer using a tissue expander, or do they go direct to implant (DTI)?

I also recommend people ask about the possibility of saving their nipple during mastectomy and reconstruction. It may or may not be an option, but many women appreciate the appearance of their original nipple in the final result. Keep in mind, too, that there are some really amazing 3D nipple tattoo artists out there who can create a nipple for you; it’s called 3D because the shadowing makes it look three dimensional. We can also build you a nipple during your breast reconstruction, so there are a few options to consider.

Lastly, it’s important to ask what your recovery will entail. How long does your surgeon anticipate you’ll need to restrict your activities? If you don’t have family in town, how long would a loved one need to come stay with you until you’re independent and functional? Planning ahead is crucial, although it’s helpful to keep in mind that everyone’s recovery is different.

Undergoing breast reconstruction can seem intimidating, as it’s yet another procedure after surgery to remove your breast cancer, on top of possible other treatments like chemotherapy, radiation, immunotherapy, and more. However, my patients often find it’s worth the added challenges. Partner with your oncologist, breast surgeon, and plastic surgeon, and keep your eye on the prize: a life where you feel like yourself with your breast cancer behind you.