The majority of women who have received a breast cancer diagnosis will have surgery as a part of their treatment. But is breast reconstruction surgery a necessary procedure for every patient? Can breast cancer surgery and breast reconstruction be one procedure? This post will help you understand your options.
Understanding Breast Cancer Surgery
The prospect of breast cancer surgery is not one that most women anticipate eagerly. Although most breast cancer treatments involve surgical intervention, breast surgery may be performed for a variety of reasons:
- To diagnose a suspicious mass within the breast
- To check if cancer has spread to the lymphatic system underneath the arms
- To remove cancerous tissue within the breast, as in lumpectomy, partial mastectomy or mastectomy
The type of breast cancer surgery your doctor recommends will be based on your diagnosis and your medical history. Make sure you discuss your treatment options with your doctor so that you can fully understand the choices available to you.
Types of Breast Cancer Surgery
Breast cancer surgery – surgical intervention specifically to excise cancer from the breast – falls into two broad categories.
Lumpectomy
Lumpectomy, also called breast-conserving surgery, is a procedure that removes the cancerous mass from the breast along with as little surrounding tissue as possible. This is meant to preserve the shape and size of the breast as much as practicable, though some procedures may remove a significant portion of the breast, causing most patients to opt for breast reconstruction. Lumpectomy is usually accompanied by radiation therapy, in order to ensure all of the cancerous cells have been removed or destroyed.
Nipple-sparing Mastectomy
Nipple-sparing mastectomy is the removal of all of the breast tissue, but the skin around the breast and the nipple are left intact in preparation for breast reconstruction. In many cases, breast reconstruction is performed during the nipple-sparing mastectomy procedure.
Breast Cancer Surgery: Breast-Conserving Surgery vs. Mastectomy
It is important to take multiple factors into account when choosing between lumpectomy (breast-conserving surgery) and mastectomy. Lumpectomy combined with radiation therapy has been shown to have equally high survival rates to mastectomy, though the most effective treatment will be determined after taking the medical details of the patient and the type of cancer into account. Breast reconstruction may be an option for both types of breast cancer surgery, but patients must discuss surgical strategies with their surgeons before surgery in order to have the best possible options.
It should be noted that breast-conserving surgery will not be an option for every patient – if the patient has multiple areas where cancer is present in the same breast or if she cannot undergo radiation therapy for any reason, mastectomy may be the only appropriate treatment.
Breast Reconstruction Surgery
Breast reconstruction surgery is a viable option for the majority of breast cancer patients, and there are multiple types of reconstructive surgery options available, such as traditional implant breast reconstruction, direct-to-implant breast reconstruction, DIEP flap reconstruction surgery, Goldilocks mastectomy, or SWIM reconstruction. The options for breast reconstruction depend upon the patient’s individual circumstances.
Traditional Breast Reconstruction
Traditional breast reconstruction involves the insertion of “tissue expanders” into the chest cavity while the mastectomy is being performed. These devices allow the chest cavity walls to extend sufficiently to accommodate breast implants. The patient must visit her physician over the course of approximately two months to have the expanders evaluated and to have them filled with saline solution.
Direct-to-Implant Breast Reconstruction
Direct-to-implant, or one-stage breast reconstruction was pioneered by Dr. Lisa Cassileth, a breast cancer surgeon at Bedford Breast Center. This procedure enables women to undergo mastectomy and implant-based breast reconstruction simultaneously. Patients have the advantage of coming out of their breast cancer surgery with their breasts intact, with minimal scarring and dramatically reduced recovery time compared to traditional breast reconstruction.
DIEP Flap
DIEP flap is a breast reconstruction option that utilizes fat, skin, and blood vessels from the lower abdomen to recreate the breast after a mastectomy. This process is similar to the TRAM flap procedure, except that the DIEP flap treatment does not use muscle from the abdomen. It allows for a faster recovery than if the muscle was removed. Bedford Breast Center does not perform the DIEP flap because it involves surgery on another body area, increasing scarring and recovery time. Instead, they have pioneered two innovative methods of breast reconstruction.
Goldilocks Mastectomy
Dr. Heather Richardson, an outstanding Bedford Breast Center physician, is a co-developer of the Goldilocks mastectomy procedure. The Goldilocks Mastectomy removes cancerous tissue and reconstructs smaller breasts using the remaining healthy tissue.
This process is ideal for women who need a mastectomy but do not wish to have traditional reconstruction with implants.
SWIM Breast Reconstruction
Inspired by the Goldilocks technique, Dr. Cassileth and Dr. Richardson developed the SWIM breast reconstruction technique, which is a nipple-preserving approach that makes the results appear like a breast reduction. The SWIM technique reconstructs smaller, natural-looking breasts using healthy breast tissue.
Breast Reconstruction Considerations
The decision to have breast reconstruction is a highly personal one, and there are many factors that could influence your choice. Some patients simply do not want to endure more surgeries or prolong their recovery any more than is absolutely necessary. Some patients may not feel an emotional attachment to their breasts that compels them to have a reconstruction. Here are a few questions you should ask your doctor when deciding if a breast reconstruction would yield long-term benefits.
- I am susceptible to scarring – will that affect my results?
- How many surgical procedures will reconstruction involve?
- Will my breasts lose sensation?
- Will radiation therapy affect healing significantly?
- Am I a good candidate for one-stage reconstruction?
- Will radiation therapy delay reconstruction?
- Will I have to undergo surgery on both breasts?
- What are the risks of breast reconstruction surgery?
While women who have previously had a mastectomy may undergo breast reconstruction, the procedure is more challenging than reconstruction during or immediately post-mastectomy. Nevertheless, breast reconstruction revision may be an option whether the patient is dissatisfied with the results of a previous reconstruction or has chosen to reverse a decision to “go flat” (mastectomy with no breast reconstruction at all).
Breast Reconstruction at Bedford Breast Center
Bedford Breast Center is proud to offer the expertise of the finest breast surgeons in the world. We are committed to giving every patient the support, dedicated care, and compassion that ensures consistently positive outcomes and effective cancer remediation.
If you have questions about your breast health and would like to schedule an appointment with the team at Bedford Breast Center, please request a consultation online or call us at (310) 278-8590.