Breast Reconstruction It's Nver Too Late

By Nia D. Banks, MD

Breast reconstruction after mastectomy is an important part of the care of women with breast cancer. Not all women are candidates for immediate breast reconstruction and some women did not know that breast reconstruction after a mastectomy was an option. It is never too late to restore a positive self-image. Delayed breast reconstruction (breast reconstruction done some time after the initial mastectomy) is an option and is covered by medical insurance. The term “reconstruction” means to restore normal form and function; breast reconstruction is not cosmetic surgery. However, the result of your reconstruction should be aesthetically pleasing.
Women that may not be candidates for immediate breast reconstruction include women with larger tumors, women with known spread of breast cancer to the lymph nodes or other parts of the body, and women with other medical problems that make a long surgery risky. If there is a need for subsequent chemotherapy or radiation, reconstruction may need to be delayed until these treatments are completed
As in immediate reconstruction, there are two main types of delayed breast reconstruction expander-implant based reconstruction and reconstruction with autologous tissue/flap (a womans own tissue). As discussed in last months article, the choice of reconstruction with implants or a flap depends on many factors, including the size of opposite breast, the availability of tissue for a flap, the patients medical problems and patient preference. For women that choose to have a flap, the most common source of tissue is the abdomen. The deep inferior epigastric artery perforator (DIEP) flap includes excess skin and fat from the lower abdomen and employs the latest microvascular techniques in breast reconstruction. This technique is not available in many hospitals but is now available at Doctors Community Hospital in Lanham, Maryland. Women in Prince Georges County now have access to this state of the art reconstructive technique in their own community.
Other breast cancer survivors that have had a lumpectomy or partial mastectomy followed by radiation may have changes in their breast that require reconstruction. Breast asymmetries are the norm even in unoperated breasts; however, after lumpectomy, breasts may have significant changes in volume, shape, or nipple position that can be improved with reconstructive surgery. Commonly employed techniques are scar revision, fat transfers to restore the volume of the breast, flap reconstruction to replace breast volume and skin if needed, and symmetry procedures on the opposite breast. These symmetry procedures include breast lift or breast reduction and are designed to make the two breasts look more alike.
Your general surgeon may send you to a plastic surgeon for consultation for breast reconstruction or you can refer yourself in cases of delayed reconstruction or reconstruction after lumpectomy. Its your body and its your call.