Every case of breast cancer is highly individual. There are some standards; but every standard has exceptions. Therefore, you must consult with your doctor, your oncologist, and your cosmetic surgeon in every case. In cases where your breast cancer is more advanced, or depending on the type of cancer diagnosed, you may be advised to undergo radiation therapy or chemotherapy in addition to ablative breast surgery.
In general, women who will undergo radiation may have immediate reconstruction. However, radiation may not likely begin until healing has progressed. It is important to understand that radiation may cause changes to skin that may potentially distort the natural or reconstructed breast tissue. Therefore, to delay reconstruction following radiation therapy may, in fact, limit your options in reconstruction, such as tissue expansion and subsequent implant placement. However, radiation after immediate reconstruction may damage the reconstructed breast and require further surgery. Therefore, it is important that your oncologist and cosmetic surgeon consult prior to any surgery, and the pros and cons of immediate and/or delayed reconstruction be fully discussed relative to any planned radiation.
Women who will undergo chemotherapy may be advised to delay reconstruction depending on the extent of the cancer and the woman’s overall prognosis. However, immediate reconstruction is a safe option for many women who will also undergo chemotherapy, so long as chemotherapy may be delayed until initial wound healing has completed, which is generally three to four weeks following surgery. A 2001 study published in the Plastic and Reconstructive Surgery Journal stated that patients who underwent immediate flap reconstruction and subsequent chemotherapy experienced similar complications and delays to post-operative chemotherapy as patients who delayed reconstruction. The most common reason for postponement of chemotherapy following reconstruction or mastectomy was waiting for the wound to heal. Delays in chemotherapy treatment were defined to average three weeks, and the delays did not have significant impact on the effectiveness of chemotherapy treatments. The National Cancer Institute offers the latest standards in breast cancer treatment on their Web site, www.nci.nih.gov, with links to “breast cancer” and then to “treatment” and “patients.”
Learn about all of the options, even if they are not all appropriate for you. It helps you to understand the differences between them and to better understand why your doctor and cosmetic surgeon recommend a specific reconstruction technique for you. There are four general options in breast reconstruction techniques, or surgery to rebuild the breast mound. Not all of these options may be appropriate for you.
• The use of a breast implant, often in conjunction with a technique called tissue expansion.
• Alatissimus dorsi flap, using a woman’s own muscle, fat, and skin from her back. This is most often used to support a breast implant where little tissue remains at the chest wall to support and cover the implant. In a minor percentage of cases, this flap alone may be used to reconstruct the breast.
• A pedicled TRAM or transverse rectus abdominus musculocutaneous flap, using a woman’s own muscle, fat, and skin from her abdomen. A pedicled TRAM flap remains tethered to its original blood supply.
• A free flap, using a woman’s own, muscle, fat and skin from the abdomen, buttocks or thigh, transplanted to the chest wall, using microsurgical techniques.
All of these procedures result in creation of the breast mound, and all can be used in immediate reconstruction, although tissue expansion requires time before the complete breast mound has been formed. Creation of a nipple requires an additional procedure or procedures and is typically achieved using local flap, grafting, and/or tattooing techniques. Determining what procedure is right for you is highly individualized based on your degree of deformity, the condition of any remaining breast tissue, your physical build, and your health. Your cosmetic surgeon will also take into consideration your personal preference and goals for reconstruction. You must accept that not all procedures for reconstruction are appropriate options in every case. You must also understand that not all cosmetic surgeons perform all breast reconstruction techniques. For example, a minority of cosmetic surgeons perform free flaps for breast reconstruction. Therefore, it is important to know all the options, and if the cosmetic surgeon you consult with cannot address an option you feel you wish to consider or need more information about, ask for a referral to a cosmetic surgeon who can address these options.
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