There is little in the life of a woman that is more deeply frightening than hearing the words, “You have breast cancer.” It has become so prevalent in the United States that researchers estimate 1 in 8 women will be diagnosed with breast cancer in 2014. Thankfully, only 1 in 36 of these women will actually die from breast cancer. After mastectomy, breast reconstruction is a comforting final step to rebuilding a woman's pre-cancer life.
Despite the gradually lowering mortality rates, however, breast cancer remains the most prevalent form of cancer in women in the United States, and there are very few of us who have not felt its impact.
Of the women who are diagnosed with breast cancer that are eligible for a lumpectomy or other tissue saving procedures, 75% still choose to have a full or double mastectomy. Their reasons vary only slightly. Most women want the procedure that best ensures complete removal of the cancerous tissue. Others fear the radiation therapy and how it will affect their lives. Still others fear the ongoing costs of multiple lumpectomies, and realize that they cannot afford surgery after surgery.
While some mastectomies are able to save the skin and nipple, most mastectomy procedures remove the tissue of the entire breast. Such a drastic procedure certainly does have its benefits, but there is always an emotional trauma that accompanies mastectomy, having far reaching effects that stretch beyond the months or years of treatment. While the physical recovery of a mastectomy is relatively short, the pain a woman feels upon losing this most intimate part of her anatomy can cause a lack of confidence, depression, and a feeling of lessened value as a woman.
Thankfully, there are plastic surgeons who are able to come alongside women during this difficult time, and help restore her positive self image through breast reconstruction.
Breast reconstruction is a procedure that rebuilds the breast using a woman’s own tissues or prosthetic materials or tissues to construct a natural looking breast following a mastectomy. The surgical oncologist performing the mastectomy will complete the procedure of removing cancerous tissue, saving as much skin as possible. As soon as the breast surgeon is finished, a reconstructive surgeon can begin the breast reconstruction process.
Occasionally, there is enough tissue remaining and a low enough risk factor that the reconstructive surgeon can put in full implants immediately following the surgery. This option is desirable because immediate reconstruction reduces the trauma of having the breast removed. It also reduces expenses and the shock of two major operations.
Most women are unable to do immediate reconstruction, as the majority of mastectomies take too much tissue to do a full implant. In this case, tissue expanders followed by implants are the most common and effective route. This can be performed weeks or even years after a mastectomy. For women who have ongoing radiation therapy and chemotherapy treatment, this will be the option best suited to their needs.
The use of tissue expanders followed by implants will occur in three stages. The first can performed during or weeks after the initial mastectomy operation, in which a tissue expander is placed beneath the pectoralis major muscle. This is an inflatable breast expander designed to slowly stretch the surrounding tissue, both skin and muscle, to make room for a future permanent implant.
Over the next several weeks or months, the expander is slowly filled with saline injections during visits to the physician. The first expansion usually begins shortly after surgery, 7-10 days. Generally, patients experience a mild discomfort and feeling of pressure, easily managed with over the counter pain killers.
This expansion will continue using saline injected over the course of a couple months. Once the volume of the expander has reached the desired breast size, a volume proportionate to the woman’s body habitus or similar in size to the intact breast, the second surgery will be scheduled. Because expansion happens slowly, it allows the patient to decide the breast size that she’ll be most pleased with, or what is closest to the original breast size.
During the second surgery, the reconstructive surgeon will remove the tissue expanders and insert into the breast pocket a permanent implant of either saline or silicone. If there is any scar tissue build up, the surgeon will remove this to ensure a soft appearance of the breast.
Saline implants will generally produce a more firm breast. Silicone implants are softer, feeling more similar to the original breast, and will usually have a more natural appearance. Your reconstructive plastic surgeon will discuss which option will best achieve the look you desire.
Once the procedure is complete, you can expect to experience some soreness, swelling and moderate bruising around the area. This will last approximately two to three weeks. Patients also frequently report a feeling of numbness and tightness in the breast, rather than pain. Both the numbness and scarring should fade over time. Your reconstructive surgeon will advise the proper medications to apply to the suture area, how to change the bandages, and managing bathing and other aspects of wound care.
The recovery period for breast implants may vary, between 4 weeks to 4 months. The healing process may be slower if the patient continues ongoing chemotherapy or other treatments. The shape of the breast following reconstructive surgery will change as well as the tissue heals and becomes adjusted to the implant. Its shape should soften and become increasingly natural over time. If any lumps or rippling occur, you should go in to see your reconstructive surgeon again for possible repair. Regular check ups will be advised, as well as screening exams and mammograms. Mastectomies do not guarantee that cancer will not return.
As women go through this difficult journey, it is important to remember that you as a woman are not defined by your illness. You can emerge on the other side of your battle, beautiful and victorious! Let your doctors be your cheerleaders, helping to restore your confidence and health in this difficult stage of life.
Dr. McIntosh loves performing reconstructive surgeries for cancer victims. He loves to help women come out of the battle with cancer, not only physically healthy, but emotionally and spiritually healthy as well. You can read more on his blog.