Many women breast cancer patients undergoing partial or complete mastectomy desire restoration of the shape and size of their affected breast to help them feel physically and emotionally whole, balanced, feminine, attractive, and well. If a breast cancer patient with a partial or complete mastectomy chooses not to have breast reconstruction (i.e., reconstructive surgery of the breast), she can consider whether or not she wants to wear a padded brassiere, standard prosthesis, or a prosthesis customized to the size and contours of her body.
Plastic surgeons in the U.S. in 2004 performed almost 63,000 surgeries for breast reconstruction in women who either had undergone partial or complete mastectomies, suffered traumatic injuries of the breast, or had been born with (i.e., had congenital) abnormalities of the breast.[1]
Women breast cancer patients face the difficult decisions whether to have breast reconstruction performed, when to have the reconstruction performed (i.e., at the time of or following the surgery to remove the tumor and surrounding tissue), and which type of reconstructive surgery to be selected. Reconstruction of a breast can be performed with or without reconstruction of the nipple and areola (colored, circular area of skin around the nipple).
For breast cancer patients, the advantages of immediate reconstructive surgery are:[2]
Avoidance of another operation
Having a more natural-looking breast sooner
The disadvantages of immediate reconstructive surgery for breast cancer patients are:[2]
A longer surgical procedure
Extended recovery period due to more complex surgery involved
The mainstream medical community wants breast cancer patients to have a variety of surgical options for breast reconstruction, including:
Silicone implants (which consist of a sac containing sterile, synthetic gel)
Saline implants, which consist of a sac containing sterile saline (saltwater)
Tissue flap surgery
Implants:
Advantages of implants as a method of breast reconstruction are:[2,3]
A less complex operation than that of tissue flap reconstruction
More rapid recovery than that of tissue flap reconstruction
Disadvantages of implants as a method of breast reconstruction are:[2-4]
After recovery, loss of sensation in the affected breast
Relatively high rate of complications
Potential for side effects from the synthetic materials
Impermanence of the implants, resulting in eventual need for re-operation
An estimated 80% of breast cancer patients who underwent mastectomy (surgical removal of the breast) and breast reconstruction involving implants experienced complications from the implantation surgery within 4 years.[4] Complication rates from implants are high in patients whose treatment for breast cancer included mastectomy and, in some cases, local radiation therapy and/or systemic chemotherapy.
Due to complications of reconstructive surgery with implants for mastectomy patients, approximately 40% of patients need additional breast reconstruction operations within 3 years of their first reconstructive surgery.[4]
Tissue Flap Reconstruction:
For breast cancer patients, reconstruction of an affected breast using a tissue flap involves overlaying or tunneling a portion of tissue while it is still joined at one end to another part of the patients body and still nourished by its normal supply of blood vessels. A common procedure is a myocutaneous (i.e., meaning muscle and skin) flap, which involves overlaying or tunneling skin, muscle, fat, and blood vessels from the abdomen, back, or buttocks.[2,3]
Advantages of tissue flap reconstruction are:[2]
A natural-looking breast
Avoidance of side effects due to synthetic materials
Disadvantages of tissue flap reconstruction are:[2,3]
A more complex surgical procedure
Muscle weakness in the area from which the flap was taken
Scar in the area from which the flap was taken
After recovery, little sensation in the affected breast
Guidance on choices and support for breast cancer patients:
If you are a breast cancer patient who is going to undergo breast surgery, be informed about your choices about types of oncology surgery and timing and types of reconstructive surgery. In advance, discuss all your options with your healthcare team (e.g., your surgical oncologist, plastic surgeon, medical oncologist, radiation oncologist, oncology nurse, and integrative medical physician) and a breast cancer patient support group. Finding out your options, talking with other women who have faced similar issues, and taking enough time to make the decision will help you determine whether reconstructive breast surgery is right for you.
REFERENCES
1. Most breast implants rupture over time. Accessed at www.mercola.com.
2. B. Joseph. Complementary and conventional approaches to healing. In "My Healing From Breast Cancer." 1996. New Canaan, CT: Keats Publishing.
3. FDA. Breast Implant Consumer Handbook. 2004. Accessed at www.fda.gov/cdrh/breastimplants.
4. I. Rosenthal. Breast implants: Americas silent epidemic. Total Health for Longevity Magazine. 2002.
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