When a woman is diagnosed with breast cancer, she has a decision between breast conservation and mastectomy.
Mastectomy is the removal of all breast tissue to remove the cancer, while breast conservation just removes the cancer, saving the breast.
Sometimes a woman might not have that choice because of the scope or size of the breast cancer. In those cases, a breast surgeon will perform a mastectomy with the option for breast reconstruction.
“The decision for breast reconstruction is a very personal decision for the woman,” said MedStar Franklin Square Medical Center breast surgeon, Dr. Atsuko Okabe. “I don’t think that there are specifically medical advantages for doing it, it’s really more for the woman and what we want to do for that breast cancer patient is to do whatever we can to preserve the appearance of the breast.”
There are options when it comes to breast reconstruction. The first is delayed breast reconstruction versus immediate breast reconstruction. The patient can decide to have reconstruction surgery at the same time as her mastectomy. After the breast surgeon has completed the mastectomy, a plastic surgeon will take over and perform the reconstruction surgery. In delayed breast reconstruction, the patient makes a separate visit for her reconstruction surgery.
The patient must also chose which type breast reconstruction she wants. Dr. Okabe says there are two main types.
The first option is the use of an implant. After mastectomy, the plastic surgeon will put in a tissue expander.
“I liken that to a balloon,” Dr. Okabe said. “Like a water balloon that’s placed under the muscle and gradually over time that expander is expanded to stretch the skin and when the size of the expansion matches the opposite breast, then they take out the expander and put in a permanent implant.
The other option is for the woman to use her own tissues, mostly from skin or fatty tissue, to recreate the breast.
“More often, just use skin and fatty tissue, often from the abdomen, which we call a deep flap. With that, typically, you’re not going to need an implant. So you’ve got only your own natural tissues,” she said.
For some women, surgeons are able to do a nipple sparing mastectomy. The underlying breast tissue is still removed, but the nipple and areola are preserved.
“When you do that type of reconstruction, you have a very natural appearance after a mastectomy,” Dr. Okabe said.
She said, unfortunately, that’s not always possible and the surgeon has to remove the nipple and the areola as part of the mastectomy. In that case, the woman can have nipple reconstruction and an areola tattoo at a later date.
Dr. Okabe said that breast reconstruction surgery is safe. She said that if a patient has pre-existing conditions, such as diabetes or is a smoker, those factors could impact their recovery or what type of breast reconstruction is available.