Knowledge is paramount for patients considering breast reconstruction surgery
While up to 50% of cancer patients who have a mastectomy opt to undergo breast reconstruction surgery, a national survey on behalf of the American Society of Plastic Surgeons found that many women have not received “adequate information to evaluate how this surgery may impact them physically, financially and emotionally.”
Creating awareness is critical, said Oriana Haran, MD, a double fellowship-trained plastic and reconstructive surgeon at Mays Cancer Center at UT Health San Antonio and assistant clinical professor in the Department of Surgery at The University of Texas at San Antonio’s academic health center.
“I think it’s important for every woman out there struggling with [a new breast cancer diagnosis] to know that they’re not alone.” For some women, undergoing breast reconstruction surgery is about contour, gaining back your femininity and the sense of yourself, Haran said. “That has been proven to improve social wellness. Psychologically and physically, patients just feel better.”
Unfortunately, some women may not have adequate information about the types of breast reconstruction procedures available following the removal of the entire breast with a mastectomy or a portion of the breast tissue with a lumpectomy. In addition to being informed about the various procedures for breast reconstruction, feeling comfortable enough to discuss these options with one’s plastic and reconstructive surgeon is also important, as the surgeon can answer questions and dispel myths around breast reconstruction, Haran said.
Read on for her insights about what all women need to know about breast reconstruction.
1. Myth or fact? Implants are the only option for breast reconstruction.
Answer: Myth. Depending on their anatomy, women today have an array of options for breast reconstruction— from implants to autologous breast reconstruction using one’s own tissue to reconstruct one or both breasts.
The gold standard for breast reconstruction using a patient’s own tissue is the deep inferior epigastric perforator (DIEP) flap procedure. This surgery transfers a flap of abdominal tissue, along with its deep blood vessels, to the chest to provide both the skin and the volume needed to recreate the breast. This approach offers a durable, natural-looking outcome.
Also among the array of flap procedures using one’s own tissues for breast reconstruction is the superficial inferior epigastric artery (SIEA) flap technique. This surgery provides the advantage of preserving the underlying abdominal muscles of the patient, since it relies on the superficial vascular system above the muscle layer for the tissue that is used to recreate the breast. This technique can lower the risk of weakness in the abdominal wall compared to other flap procedures. However, it’s important to note that a good candidate for this procedure is a patient with a suitable vascular anatomy.
2. Myth or fact? Undergoing breast reconstruction using one’s own tissues means that the patient will fully regain sensation to the reconstructed breast or breasts.
Answer: Myth. While some sensation may be regained when one’s own tissues are used for the reconstruction, the reconstructed breast will not fully regain normal sensation. There are techniques to address this, such as sensate flaps where we connect the nerves. However, this is not a standard part of the procedure for most patients, and the results are inconsistent. The return of sensation exists on a very broad spectrum and is rarely complete.
3. Myth or fact? Patients undergoing a mastectomy will not be able to have future mammograms or MRI breast cancer screenings.
Answer: Myth. Some women think that if they undergo breast reconstruction, that’s going to get in the way of later screening or followup, but that’s not true. Whether we use implants or your own tissue, we can still effectively screen the area. The breast tissue and chest wall behind the reconstruction remain visible with imaging.
4. Myth or fact? Women having a mastectomy cannot breastfeed after undergoing breast reconstruction surgery.
Answer: Fact. The ability to breastfeed is lost following a mastectomy, regardless of whether reconstruction is performed. A mastectomy involves the removal of the breast tissue, which includes the glandular structures and milk ducts necessary for lactation. While reconstruction creates a new breast mound, it cannot restore the functional system for producing milk. Therefore, breastfeeding from that breast is not possible.
5. Myth or fact? Health insurance does not cover breast reconstruction procedures after having a mastectomy or lumpectomy.
Answer: Myth. Breast reconstruction is not considered cosmetic in this context. Under the Women’s Health and Cancer Rights Act, most group health insurance plans that cover mastectomies are required to also cover all stages of breast reconstruction, a provision that also applies to lumpectomies in some cases for symmetry procedures.