Plastic surgeon should be on cancer team

Breast reconstruction not same as augmentation


Ronald Peterson, Contributing writer

One of the biggest concerns for women who are about to lose a breast to cancer is, "What should I know about breast reconstruction before I make a decision?"

The question is being asked more often these days, since there was a 39 percent increase in the number of breast reconstructions in 2008. Unfortunately, most patients are not receiving adequate information, according to a report by the American Society of Plastic Surgeons.

It says that almost 70 percent of the women who had a mastectomy were not informed of all their options. As a result, most of the 79,000 women who had the procedure in 2008 did not make informed decisions.

The problem appears to be a simple one. Plastic surgeons are not brought in early enough into the process, according to the ASPS.

"Those who are diagnosed should be immediately referred to a full team of physicians that can provide breast care, and plastic surgeons need to be included as part of that treatment team," said ASPS President Dr. John Canady. The society wants to educate women through a variety of materials, ranging from information cards and online videos, to an online ad campaign and a waiting-room publication.

But is the problem really that simple? Not according to at least one breast cancer survivor.

Amy of Irvine, Calif., had a double mastectomy in 2002 when she was 30 years old. She says her plastic surgeon did not take enough time to adequately discuss her options.

"The reconstruction was not an issue at the time. Now, eight years later, I wish I made a different choice. The plastic surgeon who sold me on the 'lat flap' procedure did not inform me of the long-term consequences, and I didn't have the mindset at the time to research it myself. I now know muscles are meant to be where they are supposed to be and any movement for cosmetic purposes is totally ridiculous and stupid. One only has a short time frame to make this decision, so getting good, accurate information may be challenging but necessary for long-term physical/skeletal comfort and support," she said.

Since Amy did not need radiation treatments, she was able to have the reconstruction done at the time of her mastectomy. This was both good and bad for her.

"The benefit is to get it over with and feel like you are almost normal, but the drawback is that there is not enough time to research and really think about the future implications because you are stuck in the present trauma/drama," she said.

A good place to begin researching breast reconstruction options is the ASPS. Another Web site with a lot of information on breast reconstruction WebMD.com

Reconstruction Vs. Augmentation

Breast reconstruction is very different from breast augmentation.

While breast augmentation involves the insertion of a silicon sack under an existing breast to enlarge it, breast reconstruction involves replacing skin, breast tissue and the nipple. The ultimate goal is to restore symmetry between the two breasts. There are many types of procedures for breast reconstruction, depending on one's health, the goals of surgery, and amount of recovery time that is acceptable.

The more involved procedures carry slightly higher risks, but also greater reward in terms of aesthetic appearance.

The patient's goals, medical condition, and previous surgery will determine whether to use breast implants or flaps of tissue moved from other parts of the body. A nipple is constructed using a skin flap. The areola is then created with a medical tattoo. Some soreness, swelling and bruising will be evident for two to three weeks.

The mastectomy and breast reconstruction will leave areas of numbness and tightness where the surgery was performed and the shape of the reconstructed breast will gradually improve in months.

Recovery is normally a six-week process, but one can usually resume strenuous exercise after a few weeks. Regular breast cancer exams and screening should continue since a recurrence can be detected and treated.