Q: If a woman has been diagnosed with breast cancer, what questions should she ask her physician to be sure she has the necessary information about reconstruction options at the outset of treatment?
A: As we’ve learned, women often aren’t being given their options and full information about reconstruction. For this reason it’s important—at the beginning of the treatment process—that women ask their physicians to refer them to a plastic surgeon who can help them understand all their options.
It’s critical that a plastic surgeon be part of the team because he or she is the best qualified to help the patient if a mastectomy or any other type of surgical procedure will lead to any loss or deformity of the breast. A plastic surgeon might be able to restore and reconstruct the affected breast and, in many cases, the other breast as well to ensure that the woman has the best chance for symmetry at the end of treatment.
It’s also important for women to be aware, from the outset, that if their insurance covers management of breast cancer, reconstruction is required to be covered.
And remember, this is not a cosmetic procedure. It’s reconstruction. The difference is that the goal of reconstruction is to take something abnormal and make it more normal, whereas the goal of cosmetic surgery is to take something that looks normal and make it look better.
Q: What should a patient know about the risks and the benefits of reconstructive surgery?
A: One of the important things that the patient must understand is that if she chooses to have reconstruction at the same time as the surgery to remove the cancer, the reconstruction does not significantly add to the risk of the operation. Reconstructive surgery does not increase risk significantly, and it has no impact on survival percentage—but it does help women get back to social and life events more quickly. Women who have reconstruction typically get back to work and to social situations sooner. Although some women choose to have reconstruction at a later date, doing it at the time of the mastectomy or lumpectomy eliminates the need for additional hospitalization and, most important, gets women on the road to reconstruction and restoration that much sooner.
Q: Are there any recent innovations or advances in breast reconstruction of which women should be aware?
A: We continue to develop sophisticated techniques that use autologous (the patient’s own) tissue to restore breasts—through microsurgery and without microsurgery—that can accomplish very natural and aesthetically pleasing breast reconstruction. It’s important to note, however, that at the same time we have also made advances with breast implants—in both the types of implants and the surgical procedures we use—and we’re getting even better results with implants in women who have undergone mastectomy.
Q: What should women know about what reconstructed breasts might look and feel like when compared with natural or augmented breasts?
A: It’s variable and depends on many factors, including the woman’s anatomy, how much tissue was removed to treat the cancer, what type of reconstruction she has chosen, how she heals, whether she will undergo radiation, how advanced the cancer is, and whether it’s limited to one spot or multiple spots in that breast. In most cases the expectation is not that the patient will have perfectly normal-looking breasts—there are naturally going to be some visible scars. In most cases, however, we can accomplish breasts that feel and appear natural; and, if the patient is able to have nipple-sparing mastectomy and minimal incisions, in some cases reconstructions can look like augmentations. Again, the best thing to do is to talk to a plastic surgeon, who can give the patient a realistic sense of the range of outcomes.
Q: What points might a woman consider when deciding which type of reconstructive surgery to choose?
A: One of the issues to be considered is what’s happening with the other breast. Oftentimes cancer might be on both sides, or a woman might have a strong chance of developing cancer in the other breast, so a prophylactic mastectomy might be advisable. Once a woman understands her options, another consideration might be to choose not to do implants or use her own tissue because of the particular requirements of those different surgeries, which could include multiple stages and extensive recovery time.
Q: How can patients go about selecting a qualified surgeon to perform their breast reconstruction?
A: Women can ask their breast surgeon for a referral and can ask friends or family for recommendations. It’s also a good idea to go to plasticsurgery.org to make sure that the surgeon you’re referred to is a member of the American
Society of Plastic Surgeons; this ensures that the surgeon has undergone a rigorous training program, adheres to a code of ethics, and has continuing medical education requirements that are up-to-date in all of the latest techniques.
When you initially meet with your plastic surgeon, be sure that you’re speaking the same language—that you’re on the same page about the desired result and that you understand each other. If you feel that’s not the case, get another opinion. It’s essential that you are comfortable with your doctor because reconstructions are often staged procedures over time, and there’s a lot of communication necessary between doctor and patient. It’s critical that the plastic surgeon listen to you, address any concerns, and be available to you if any issues arise along the road to reconstruction. _
Dr. Malcolm Z. Roth, MD, FACS*,* graduated with his MD degree from New York Medical College in 1982. He then completed his general surgery training at Beth Israel Medical Center and completed a residency in plastic and reconstructive surgery at the New York Hospital–Cornell University Medical Center. Dr. Roth continued his training at the Hospital for Special Surgery, where he completed a hand and microsurgery fellowship. He is currently president of the American Society of Plastic Surgeons and chief of the Division of Plastic Surgery at Albany Medical Center in New York.