A Word from your Doctor
Breast Reconstruction after Mastectomy
By Dr. Deanna Attai

Thanks to public awareness campaigns about the importance of early detection of breast cancer, more and more women are obtaining regular mammograms, and cancers are being detected in very early stages. In fact, the majority of women presenting with a new cancer are good candidates for breast-conserving surgery, also known as lumpectomy. However, there are still times when removal of the breast is needed.

One case when breast removal is indicated is when the tumor is quite large especially compared to the size of the breast. Sometimes performing a lumpectomy in a relatively small breast would leave such a deformity that breast removal and reconstruction may be a better option. If a cancer is present just below the nipple, removal of the nipple is usually required and mastectomy is often a better option in this case. If there is more than one area of cancer in the same breast, lumpectomy is not considered to be appropriate cancer treatment. Finally, if a woman has already undergone lumpectomy with radiation therapy and develops another cancer in the same breast, lumpectomy cannot be repeated and breast removal is usually necessary.

In the past, mastectomy was the only breast cancer operation performed. After surgery, women were fitted for prosthesis so that they could wear a bra and clothes comfortably. Reconstructive surgery was considered to be unnecessary and even dangerous. We now know that breast reconstruction after a mastectomy can be a very important part of the overall recovery from cancer for both the woman and her family. While it was not felt to be important in the past, we know that the psychological impact of losing a breast to cancer may make the overall recovery process very difficult. While some women may not desire reconstruction, for those that do, there are some options available.

The first step is just to be aware that reconstruction can often be done at the same time as the mastectomy. While this results in a longer recovery time, only one anesthetic is required. A referral to a Plastic Surgeon for evaluation should be made prior to scheduling the mastectomy. The Plastic and Breast Surgeon will then work together to perform the surgery. If immediate reconstruction is not recommended or considered, it almost always can be performed at a later date.

The two basic types of reconstruction use prosthetic implants or tissue from the woman’s own body. Implant reconstruction, since it is a faster operation, may be a better choice in women who cannot undergo several hours of general anesthesia. The postoperative recovery also is usually faster. However, it can be difficult to obtain a symmetrical result when comparing the operated side to the other side, and often reduction, lift, or implant placement on the other side is necessary to obtain symmetry. Tissue reconstruction involves use of skin, fat, and muscle from either the abdomen (most common) or back to recreate a new “breast”. Because the plastic surgeon will use tissue from the woman’s own body, and not a pre-formed implant, it is easier to “mold” the tissue to more resemble the other side, and often no additional surgery to the other breast is needed for a symmetrical result. The surgery does take longer, however, and the recovery may take up to 2 months. Individual assessment of each patient by the Breast and Plastic Surgeon is necessary to decide what type of reconstruction is best in each individual case.

It used to be thought that if breast reconstruction is performed, it makes it harder to tell if a cancer has come back – we now know that detection of recurrence can be done in the presence of reconstructed tissue. In addition, federal law guarantees that reconstructive surgery for breast cancer be covered by insurance (regardless of the type of insurance program), whether done at the time of the mastectomy, or at a later date. This law also covers procedures done on the opposite breast to obtain symmetry.

As I stated earlier, the feeling of many physicians as well as patients in the past was that reconstruction was an unnecessary procedure; in fact, many patients were chastised for being “vain” for wanting reconstruction. We now are more aware of the importance for many women of feeling “whole” again after breast cancer surgery. It is important for women that do need breast removal to be aware of their options and to request these services if not initially recommended. For more information, you may visit my website at www.DeannaAttai.com.

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Dr. Deanna Attai is a Board-certified General Surgeon in Glendale. She has been in practice for nine years, and has a special interest in Breast Diseases. She strongly believes in the power of education to help women understand the changes that their bodies undergo. In addition, she feels that through education, women may be able to better cope with these changes, and become more empowered in taking control of their own health. For more information, go to www.sanarus.com or www.deannaattai.com.

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