Breast Reconstruction

Preferably immediately after diagnosis. I feel it is very important for patients to learn about all their breast cancer treatment options, including breast reconstruction, at the very beginning of their journey. This is the only way to ensure they are truly involved in their treatment plan. It also allows those patients interested in immediate breast reconstruction to pursue it if they are candidates. For those that may not be candidates, knowing they will have the option once all their other breast cancer treatment is completed is often a huge source of strength.

Dr C
http://www.PRMA-enhance.com

I see. I did not realize it was an individual plan related to autonomy. Very helpful.

Scars are permanent but to improve their appearance we start a scar control program 3 weeks after surgery and continue it until the scars are flat, smooth and the right color.

There are many different materials that are given to patients regarding Breast Reconstruction. Some are form the plastic surgeon's office, some are from the implant company, others are from our society ASPS. Some patients receive all types. There is not a requirement to give out the booklets from the company but it may be helpful.

No, there is not one company that is better than the other.The silicone implants by the company Mentor or Allergan can be used equally. There is a new company named Sientra that has FDA approval to sell silicone implants but I have no experience with them yet.

This may be a woman's individual choice - if a woman is a candidate for immediate reconstruction, she may have a preference regarding the timing of the surgery. Some prefer to undergo the mastectomy and other treatment first, delaying the reconstruction, while some women like the idea of having a large part of the reconstruction performed at the time of the mastectomy. Some patients with more aggressive tumors are not candidates for immediate reconstruction, but if the woman has a choice, it is really an individual decision.

Reducing reconstructed breasts is usually not a problem. Just be sure that whoever is doing the reduction is familiar with the details of your original free flap procedure so that the reduction procedure does not jeopardize the blood supply to the portions of your breasts that will remain and are not being reduced.

I would say that this is very normal to have these difficulties, but would also say that with time most of my patients are very happy with their reconstructions, and these emotional difficulties usually go away with time. I also have a number of patients who have finished the reconstruction process and have volunteered to speak with new patients, and this can often be very helpful for new patients. Additionally, having a very understanding spouse or significant other, as well as family and/or friends, is usually very helpful.

I have annual breast MRI because I still have one natural breast and one of my original breast tumors was only discovered on MRI. My most recent breast MRI noted that there is residual breast tissue in the implant side. For this very reason I would say that yes, you should have annual breast MRI, both to check the integrity of the implant and to check for further malignancy. Unfortunately it is usually the insurance companies placing restrictions on doing this, not he doctors or the patients. I would pay for it myself to be sure I was cancer free.

There are different types of necrosis. Necrosis of the remaining breast skin is probably more likely to occur at the time of mastectomy than with delayed reconstructions, but even with immediate reconstructions this is usually not a problem. With regard to a flap used for breast reconstruction, I do not think there is a big difference in flap necrosis rates with immediate versus delayed reconstructions.

I have performed many silicone implant reconstructions over the years, and have never had anyone "reject" an implant. Thus, while I think the chances of this happening are very small, nearly anything is possible in medicine. As mentioned in one of the responses to the above questions, however, there are other issues that can develop over time with implants, such as capsular contracture formation or leaks, but most patients do well with implants.

There are usually a number of options. Perhaps minor adjustments can be made to the implant reconstruction in the surgeon's office or as an outpatient procedure in an operating room. If more significant revisions are needed, this may require replacing the implant with a new implant, or replacing it with a flap. An experienced plastic surgeon can give you more details on what would be appropriate for you after he or she examines you.

The scars vary widely, and are determined by the incision used for your mastectomy, and the type of reconstruction you are having. Some incisions are very well hidden, such as in the inferior fold of the breast, while others need to be placed on the more visible areas of the breast, depending on where the cancer is and the comfort level of your breast surgeon with different approaches. Furthermore, implant reconstructions usually involve some type of a single line closure, whereas flap reconstructions sometimes involve more circular or elliptical shape inicisions, depending on the amount of skin removed by the breast surgeon. Your breast and plastic surgeons can probably tell you preoperatively what type of scar you will have, as they will know the specifics of your surgery.

With current technologies, I think there is a limit to how much reconstruction can be done with fat injections or fat grafting alone. Thus, at the current time, I think the fat injections are more useful for secondary breast reconstruction procedures, such as for smoothing out the transition from a reconstructed breast to a woman's remaining chest wall.

Everyone is different, but I have had patients who have had reconstructions with implants and others with TRAM flaps who have become pregnant, and had no issues with their reconstructions during their pregnancies. Thus, there may be no affect on the reconstructed breast. However, your natural breast may become larger during the pregnancy, so you may develops some asymmetries with the pregnancy that may or may not go away after the pregnancy. Additionally, if your reconstructed breast is made from your own tissue, it may enlarge during the pregnancy as you gain weight elsewhere.

The 2 main breast implant manufacturers in the U.S. are Allergan and Mentor, and both have very long records of excellent safety.

Depending on the specifics of your situation, you may still be a good candidate for another type of flap, or for a tissue expander. If you feel more comfortable getting a second opinion, then I'm sure your original plastic surgeon will understand. Because of the complexity of your case, if you do see another plastic surgeon it would be best if it is someone with significant experience in breast reconstruction, either here in the NYC metro area, or closer to your home if you prefer and can locate someone with the appropriate experience.

I love this question too! Thank you!

During my post surgical complications, I knew I could not continue healing at my best in my current state of mind. I also knew that I could not change my surgeon and how he interacted with me. The only change I could create was in myself and how I chose to engage with him and his staff. With the help of author Caroline Myss, (Defy Gravity), I meditated and focused on reinventing my relationship with my surgeon (and my life). I surrendered to the situation and flipped my state of mind from one of fear and anger to love and trust. I genuinely fell in love with my surgeon. I had to in order to be authentic to my new path. I softened and relaxed ………,and he did too. He slowed down and got to know and care about me as a person. This was an amazing gift that I really did not appreciate the signifiacance of at first. Actally being a person that mattered rather than one of many patients was critical to my "survival" (primitively speaking).
Needless to say, my reconstruction surgery went very well and I am continueing to heal with full appreciation for my new life that seems to be brimming with grace and opportunities.

It sounds like a broken record, but this too varies from person to person. I'm one year out from my implant surgery and I'm still adjusting to them. Sometimes my chest feels tight. Sometimes it feels pretty good. I find at the end of the day they do feel heavy. I think I'll be adjusting to them for quite a while yet. And yes, I also miss sensation or feeling there. It's a major body alteration with many ramifications, no getting around that fact.

My mother was diagnosed with breast cancer 23 years ago. My father, a General Surgeon, recommended a mastectomy. My mother was very active and particularly enjoyed water sports. She did not want to lose her breast, and if that were necessary, would desire reconstruction. I was put in charge of the breast reconstruction and planned a possible pedicle TRAM flap procedure knowing my mother would miss the function of her rectus abdominus muscle. Fortunately margins were clear on re-excision of the cancer and she was treated with lumpectomy and radiation. After this I was determined to develop better options for breast reconstruction. By studying the blood supply to the skin and fat of the lower abdomen, I discovered how to reliably transfer only the skin and fat without muscle sacrifice using microsurgical technique. Thus was born the whole field of Perforator flaps for breast reconstruction starting with the DIEP flap.