Decades ago, the most common approach to breast cancer was to perform a complete single or double mastectomy—a type of operation in which the entire breast is removed. While this approach was often effective at preventing the spread of cancer, it tended to leave significant scarring and tissue damage in its wake. Most importantly, it left women with deformed or missing breasts, making them feel like they’re lacking a crucial part of their feminine identity.
Moreover, breast reconstruction surgery was poorly understood; patients therefore usually had to wear a breast prosthesis (inserted into a special bra) after having a mastectomy. Naturally, this left many cancer survivors feeling less than confident about the appearance of their bodies. While a prosthesis can hide the missing breast or breasts when the patient is clothed, it does nothing to help her when she is unclothed.
In recent years, the situation for breast cancer patients has improved greatly. Not only are there options for reconstructing the breast after surgery, cancer therapies have become less invasive. While some patients still require a full mastectomy (or choose to have one as they wish to treat their cancer very aggressively), many can have what is known as a “lumpectomy” instead. During a lumpectomy, only the tumor is removed, rather than the entire breast. This surgery is usually combined with radiation therapy in order to destroy any cancer cells that are located outside the primary tumor. When caught early, the vast majority of breast cancers can be “cured” through these advanced treatment modalities. Five-year survival rates for stage one and stage two breast cancer patients are now approaching 100%.
Further advances in surgical techniques are allowing knowledgeable surgeons to leave patients’ nipples intact, too. In the past, it was thought that the nipples must always be removed during a mastectomy or lumpectomy as they form a part of the breast tissue, but emerging research shows that leaving the nipple in place is safe in a large percentage of breast cancer patients. This is significant because it allows for better reconstructive outcomes. Likewise, patients have been shown to feel more confident about their appearance when they are allowed to keep their nipples. Unfortunately, nipple-sparing surgical methods are still not widely known, so patients often have to do a fair bit of research in order to find a surgeon who is willing to perform this kind of operation.
If you want to have surgery that will leave your nipples in place and preserve the appearance of your breasts as much as is possible, you may wish to talk to a plastic surgeon before you have your lumpectomy or mastectomy. Sometimes plastic surgeons can refer their patients to a general surgeon who is well versed in the aesthetic aspects of performing breast surgery. Your plastic surgeon and your general surgeon will then be able to work together and come up with a plan to completely restore the appearance of your breasts while also ensuring that you remain in good health.
A Word About Prevention
As actress Angelina Jolie famously demonstrated, not all breast reconstruction surgeries must take place after cancer has already occurred. In some cases, women who believe they are at a high risk of developing breast cancer due to genetic factors can choose to have a preventative mastectomy with immediate reconstruction. This type of mastectomy, which is known as prophylactic mastectomy, can reduce the risk of developing breast cancer by approximately 90 to 95 percent. This makes it a wise choice for women with certain gene mutations or breast tissue abnormalities that often precede the development of breast cancer.
Because women who have preventative mastectomies are usually in good health at the time of their surgery, they do not have to wait to have aesthetic breast reconstruction—hence the use of the term “immediate reconstruction.” Usually, tissue expanders are put in place during mastectomy surgery, in order to gradually prepare the breast cavity to receive an implant. By using a tissue expander, your surgeon can ensure that the implant can be covered by an adequate amount of tissue; it also reduces the tension that a newly inserted implant might have on the tender breast tissue. In immediate reconstruction, however, a “pocket” is created during mastectomy surgery, then an implant is inserted directly into it. This is a one stage surgery, rather than the two stage breast reconstruction surgery that usually follows mastectomy.
One stage surgery is generally only an option when the nipple has been preserved, so make sure you locate a general surgeon who is willing to leave your nipples in place if you want to have immediate reconstruction. Note that immediate reconstruction is sometimes, but not always, possible in patients who have active breast cancer as well. Your overall health, the stage of your cancer, and how much breast tissue must be removed to treat your cancer, will all factor into whether or not you can have immediate breast reconstruction.
What is Aesthetic Breast Reconstruction Surgery?
Regardless of whether a cancer patient chooses to have a mastectomy or lumpectomy, there are a range of reconstructive options available. Aesthetic breast reconstruction is used to “rebuild” the breast (or breasts) after structural damage has occurred due to mastectomy or lumpectomy surgery. These procedures restore lost breast volume and, if the nipple has been removed, they can be adapted to include nipple reconstruction as well.
Just as it’s important to choose a skilled mastectomy or lumpectomy surgeon, choosing a highly qualified plastic surgeon to perform breast reconstruction surgery is essential. All too often, patients who choose to undergo breast reconstruction end up with breasts that have had their lost volume restored but not their overall aesthetics. These patients have breasts that are full, but they frequently have no nipples and show obvious scarring. It doesn’t have to be this way; while some scarring will almost always be present after a mastectomy or lumpectomy, it is absolutely possible to recreate a natural-looking breast. In fact, in some cases, patients can achieve the breasts they have always dreamed of via aesthetic breast reconstruction surgery. The breasts can be made fuller, perkier, and more shapely than they were prior to mastectomy or lumpectomy. This is achieved through the use of one of the surgical methods outlined below:
Implant-Based Aesthetic Breast Reconstruction
Like breast augmentation surgery, implant based breast reconstruction makes use of a saline or silicone gel implant in order to increase the volume of the breast. This method of breast reconstruction has the distinct advantage of being a relatively “low impact” surgery.
As mentioned above, implants can often be inserted during mastectomy surgery. This procedure therefore does not always add additional recovery time (on top of the time needed to heal from mastectomy or lumpectomy); the patient will recover within two to three weeks and require no future reconstruction operations. Even when implant based breast reconstruction surgery must be performed in two stages, it’s still easier on the body than flap (tissue transfer) breast reconstruction surgery. This is the case because the patient will not need to have tissue or fat removed from a second site on her body in order to rebuild the breast. The time it takes to insert implants is also much shorter than the time it takes to transfer tissue, so the patient will not have to spend a long time on the operating table. All totaled, this greatly reduces stress on the body and offers the patient a quicker, less painful recovery period.
Patients are sometimes hesitant to try implant-based breast reconstruction because they are worried that having implants will make their breasts look or feel “fake.” However, while it’s true that breast implants will not look or feel as authentic as tissue taken from your own body, modern gel implants offer a very close approximation to natural breast tissue. They contain a type of viscous silicone gel that closely resembles the density and texture of breast tissue. Modern implant placement methods, i.e., placing the implant under the muscle, also ensure a pleasing aesthetic outcome. This placement method effectively “hides” the top of the implant under muscle tissue so that the breasts still slope gradually. Breasts that have been restored expertly using implants will be hard to differentiate from natural breasts.
Flap Breast Reconstruction
During flap breast reconstruction, a plastic surgeon takes tissue from another site on the patient’s body (usually the abdomen, but the thighs, back, or buttocks are also suitable sites for tissue removal) and uses this tissue to create a “flap” of skin that will augment the breast or breasts. This flap is then filled with fat (also taken from the patient, via liposuction). This type of surgery is always a multi-step process: The patient must first recover from mastectomy and then have surgery again in order to have the “flap” created and placed. She will usually spend at least four to six weeks recovering from flap breast reconstruction.
In addition to requiring more healing time, flap breast reconstruction tends to produce more scarring. Along with scarring on the breasts, there will be scarring around the site where tissue removal was performed. It’s therefore a good idea to choose a removal site that’s located on a part of your body you don’t frequently bare. However, it’s important to understand that choosing a skilled surgeon and practicing proper wound care can greatly reduce your risk of developing noticeable scarring.
While flap breast reconstruction is more challenging than implant based breast reconstruction, it is sometimes necessary. Patients who have undergone an extensive mastectomy procedure often do not have enough skin and muscle tissue left over to allow for an implant to be inserted. Additionally, patients who have had just one breast removed often prefer flap reconstruction as it ensures that both breasts will have approximately the same texture, shape, and level of natural “droop.”
Ensuring Even Results: Approaches to Take After Single Mastectomy
As alluded to above, patients who have just one breast removed are usually very keen to make sure that their reconstructed breast closely resembles their natural breast. Fortunately, achieving this result is usually possible, so long as the plastic surgeon performing the operation is sufficiently skilled and experienced. Breast “matching” options include:
- Breast reduction surgery. Sometimes the reconstructed breast ends up being smaller than the natural breast (this is especially likely with tissue transfer procedures as some of the fat injected into the breast may be reabsorbed by the body). Patients can choose to have breast reduction surgery in order to correct this imbalance.
- Breast lift surgery. Breast lift surgery can be used to correct a natural breast that is droopier than the reconstructed breast. With breast lift surgery, the surgeon will remove the excess skin and reshape the breast into a younger, rounder shape. The breasts will also be moved into a perkier, younger position. Sagging breasts can also stretch the areolas, so a breast lift can also resize the areolas to a more natural size.
- Breast augmentation surgery. Breast augmentation surgery can be used to make both breasts larger and provide a more consistent look and feel, especially in cases where the patient wishes to have implant-based reconstruction. Because of the high variety of implants available, breast augmentation allows for an incredible degree of customization, so the patient will have options when it comes to matching the other breast. Note that breast augmentation surgery and breast lift surgery can be combined if the breasts also require lifting and reshaping in order to achieve a consistent appearance.
Breast Reconstruction: A Path to a Happier Future
Surviving cancer should never mean having to sacrifice your confidence. Research shows that women who have breast reconstruction surgery both feel better about their bodies and move on from their cancer experience more fully. Effective aesthetic breast reconstruction surgery can all but erase the signs that cancer was ever present, allowing the patient to truly put cancer in the past. For many women, breast reconstruction surgery is the final step toward achieving true freedom.
Want to learn more about aesthetic breast reconstruction? We’ll be more than happy to explain it during our free consultation sessions—just contact Aristocrat Plastic Surgery.