Breast Cancer Reconstruction

By Susan K Buenaventura, MS, MD

The Sendi Center for Cosmetic Surgery

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Breast Cancer Reconstruction

Many plastic surgeons specialize in breast cancer reconstruction. The word “reconstruction” covers a broad range of treatments for breast cancer patients, all aimed at preserving the shape and symmetry of the breast after tumor removal. This requires coordinated care with the breast surgeon, the plastic surgeon and the radiation oncologist and oncologist. While everyone's priority is curing the cancer, recognizing that the patient's quality of life after cancer surgery is improved when the breasts look as normal as possible is important as well.

Early stage breast cancer can usually be treated with lumpectomy (partial breast removal) and radiation. While only part of the breast is removed, it can result in a scar, a deformity and lack of symmetry between both breasts.

If the plastic surgeon and breast surgeon work together, they can often rearrange tissue so that the breast has a well hidden scar and nice shape after lumpectomy. If there is a significant loss of tissue, it can be rebuilt with the patient's own fat (fat grafting). If the opposite breast needs a lift, reduction, or enlargement to match, this can be performed by the plastic surgeon. Best of all, surgery on the opposite breast to match the cancer side is considered part of the reconstructive process and is usually covered by insurance.

In cases of more advanced breast cancer, a mastectomy may be performed or the entire breast removed. In these cases the plastic surgeon can rebuild the breast, nipple, and areola. This can be started the day of the mastectomy using temporary implants (tissue expanders) to stretch the chest skin and make room for a permanent implant. There are now implants available that are shaped like a breast and look very natural.

The nipple can be rebuilt from your own skin and the areolar color is usually tattooed on later. Again, if the opposite breasts needs to be enlarged, reduced, or lifted to create a better match, this can be done as well and can usually be covered by insurance as part of the reconstruction.

As an alternative to implants, plastic surgeons can take your own tissue from your lower abdomen or back and use it to create a breast shape. The abdomen provides enough tissue to reconstruct both sides in the event that a patient needs or chooses a double mastectomy. Sometimes an implant will be needed as additional volume for flap reconstructions but often the patient's own fat provides sufficient volume. We are seeing more patients choose bilateral mastectomy in cases where they have a strong family history of breast cancer and having mastectomies and reconstruction done prophylactically.

Breast cancer patients should seek the support of a plastic surgeon during their breast cancer journey, because a plastic surgeon is an integral part of your breast cancer team and can help rebuild your breasts.

You have many options, including implants and your own tissue, or sometimes a combination of both. Reconstruction is often a positive focus in the midst of a stressful time for patients. You can call the American Society of Plastic Surgeons for referrals to expert plastic surgeons in
your area.