Breast Reconstruction An Important Part of Healing After Breast Cancer Surgery

Women who undergo surgery to treat breast cancer may think of breast reconstruction as a cosmetic procedure—one they don’t really need for their health. But many women are shocked to learn that breast reconstruction surgery isn’t just an option for them, but mandated by law. If patients are having a mastectomy (removal of the breast) that is covered as part of their breast cancer treatment, their insurance must also cover breast reconstruction surgery under the Women’s Health and Cancer Rights Act of 1998.

While the choice to get breast reconstruction is a very personal decision, studies have shown that reconstruction after cancer surgery can lead to tremendous gains in patients’ quality of life, with benefits to sexuality, body image, and overall well-being by restoring the appearance of their breasts. However, breast reconstruction can be a complex procedure, and each patient and her circumstances are unique. That’s why it’s critical for a team of breast surgeons and plastic surgeons, along with the patient, to discuss what the right reconstruction option is early on in the process.

LISTEN: Dr. Fan discusses breast reconstruction surgery in the Medical Intel podcast.

Choosing the Right Breast Reconstruction Surgery

Women from all walks of life come to us for both breast cancer surgery and reconstruction afterward. That’s why there’s no cookie-cutter, one-size-fits-all approach to breast reconstruction.

For example, some of our patients have very active lifestyles and want to get back to their normal routines of work, exercise, and recreation right away. There are certain types of breast reconstruction surgery that can help make that happen. Other women want this to be the last breast surgery they have, and we have procedures that are tailored for that preference as well.

No two women have exactly the same expectations, goals, or needs for their breast cancer and breast reconstruction surgeries. It’s important for the whole team to examine each case individually so we can choose together what will be the best reconstruction option for each patient ahead of time.

Breast Reconstruction Options

We use three main methods for reconstructing patients’ breasts following breast cancer surgery. The first is called the oncoplastic approach. In this technique, the breast surgeon takes a small tumor out of the patient’s breast, and the plastic surgeon rearranges tissue within the breast to fill in the gap created by the tumor’s removal. We can also reduce the other breast to match the size.

Another option is prosthetic-based reconstruction. After the breast surgeon performs a mastectomy, we use a smooth breast implant or a temporary device called an expander to help reconstruct the breast. The expander is replaced later on with a smooth implant.  However, implants are not a permanent solution, they inevitably need to be replaced.

In the third reconstructive option, called autologous space reconstruction, we use the patient’s own muscle, skin, fat, and blood vessels to help recreate a natural-looking breast after a mastectomy. We typically take the tissue we need from the belly, similar to a tummy tuck, or the back, depending on where a patient may have extra tissue for the reconstructive surgeon to use.

Related reading: Why is autologous breast reconstruction better than breast implants?

We generally can complete any of these reconstructive procedures in the same operating room directly following breast cancer surgery. However, in some cases, we must perform what’s called delayed reconstruction, in which we wait until a later date to reconstruct the patient’s breast. This can be due to a number of factors, such as a patient’s:

• Breast cancer stage
• Individual preference
• Medical condition
• Need for additional treatment, such as radiation therapy

There is no particular preparation that the patient has to do ahead of her breast cancer surgery. However, the breast surgeons and plastic surgeons will meet as a team to discuss the patient’s particular needs and how to best accomplish the goals of both treatment and reconstruction.

Life After Breast Reconstruction

For many patients who undergo reconstructive surgery, the greatest hope and goal is that no one would be able to tell they ever had breast cancer when they’re clothed. Depending on the characteristics of their cancer and the particular treatments they have had, we can achieve that goal for many of our patients.

Many women are concerned about the recovery time after breast reconstruction surgery, and it depends a lot on the reconstruction method we use. Of course, each patient’s recovery is unique, but generally speaking, procedures with breast implants and expanders have a shorter recovery time, while procedures that use the patient’s own tissues have a longer recovery time. However, we have been successful in speeding up the recovery process with our multimodal pain medication pathway that we use after breast reconstruction surgery.

The Best Source for Breast Reconstruction Care

Much of our research involves the use of a protocol called enhanced recovery after surgery (ERAS), which we routinely employ. This is a holistic, patient centered approach to pain management, where the patient and the provider discuss pain prior to surgery. The goal is to use medication that targets the way the nerves fire before, during, and after surgery and limit the use of narcotics.

Our anesthesiology colleagues, including Dr. Susan Dumsha Stasiewicz who was a pioneer in the field, utilize medications during surgery that increase patients’ comfort and minimize the number of narcotics they take. We use a long acting, slow release local anesthesia block that numbs the nerves for up to 72 hours. After surgery, we use additional nonnarcotic medication to control pain.

Before we implemented ERAS protocol, autologous breast reconstruction, such as the MS-TRAM or a DIEP flap, was considered a more painful operation with a prolonged recovery course. However, with this multidisciplinary approach, we now significantly reduce patients’ hospital stays and commonly see patients only take one, two, or no narcotic tablets after surgery. These results have been submitted to a peer-reviewed journal.

Related reading: How We Reduce Pain After Plastic Surgery with the ERAS Protocol

Our team focuses not just on our patients’ breast cancer or their reconstructive process, but on the patient as a person. We work to understand each patient’s individual needs and engage with them so everyone is on the same page about the patient’s desires and expectations.

For many women, breast reconstruction is a vital part of the healing process after breast cancer surgery. Patients should make sure they know their rights and options for reconstruction from the beginning of their treatment process.