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Breast Reconstruction | Washington DC

If you or someone you care about is considering breast reconstruction, we hope this information will be helpful to you. Although not a substitute for a full office consultation with a plastic surgeon, it provides an overview of your options for post-mastectomy breast reconstruction in the Washington DC area and what you can expect in terms of surgical procedures and long-term results.

BREAST RECONSTRUCTION AFTER CANCER

Having a mastectomy for breast cancer can be a traumatic experience. We want to make sure you are aware of all the options available for restoration of the breasts and to reassure you about the positive results and benefits of breast reconstruction.

Modern breast reconstruction began in the 1960s with the development of the silicone breast implant. Four decades of research have resulted in a variety of breast reconstruction techniques and surgical procedures that are safer and more reliable than ever. With the enactment of the Women’s Health and Cancer Rights Act in 1998, health insurance companies are now required by law to provide coverage for breast reconstruction following mastectomy.

BREAST RECONSTRUCTION TECHNIQUES

There are many approaches to breast reconstruction, so a patient who desires breast reconstruction is likely to be a candidate for at least one of these techniques. Many patients will benefit from a combination. As a candidate for reconstructive breast surgery, you will want to discuss all the appropriate options fully with your plastic surgeon. Click on a link to learn more about the different options:

HOW DO I KNOW WHAT BREAST RECONSTRUCTION TECHNIQUE IS BEST FOR ME?

Most women who have had a mastectomy and are in otherwise good health are candidates for breast reconstruction. Your cancer surgeon and plastic surgeon will work together to choose the technique that will achieve the best results in terms of safety and aesthetics. Factors that influence the selection of a reconstruction technique include:

  • The type of mastectomy performed
  • Whether or not you have already had mastectomy
  • The use of radiation and/or chemotherapy
  • Your age
  • Medical history
  • Location and quality of the surgical scar
  • Quality of the chest wall skin and muscle
  • The condition of any scars on the abdominal wall and back
  • Whether or not you need opposite breast surgery for symmetry

SELECTING A PLASTIC SURGEON

Breast reconstruction following a mastectomy has been a major advance in the treatment of patients with breast cancer. With today’s mastectomy and plastic surgery techniques, almost all mastectomy patients can have breast reconstruction and enjoy the physical and psychological benefits that usually accompany this restorative procedure.

It is strongly recommended that any patient considering breast reconstruction seek a fully-trained plastic surgeon who has specialized training and significant experience in breast reconstruction for mastectomy patients. If you are considering an advanced breast reconstruction procedure such as DIEP flap, you will need to find a plastic surgeon with specific training and experience in microsurgery techniques.

Our breast reconstruction specialist Dr. Samir Rao is experienced in multiple breast reconstruction techniques, including the advanced prosthetic breast reconstruction using tissue expanders and implants, microsurgical breast reconstruction using your body’s own tissue, and oncoplastic surgery. Before joining the Center for Plastic Surgery, Dr. Rao trained alongside internationally renowned breast reconstruction surgeons at Georgetown University Hospital and completed additional training in microsurgical fellowship at the Curtis National Hand Center.

BREAST RECONSTRUCTION: THE PROCESS

For most patients, breast reconstruction will require two to three surgical procedures. The first, and most involved, procedure is the primary reconstruction of the breast mound or breast shape, which may be done in any of several ways. The second procedure usually consists of additional work on the breast shape or the placement of the permanent implant. Any procedures needed to make the opposite breast more similar to the affected breast also would be done at this time. The final step usually is the nipple/areolar reconstruction. Location of the nipple/areolar area is critical to breast appearance and is usually done after all other reconstructive stages are completed.

WHAT IS THE TIMELINE FOR RECONSTRUCTION?

Whether you undergo breast reconstruction at the same time as mastectomy, or as a separate procedure, depends on the nature of your breast cancer, your overall health, and the recommendation of your cancer surgeon. It is important, therefore, to choose a plastic surgeon who will communicate effectively and work closely with the cancer surgeon to determine the best course of treatment to achieve optimal results while prioritizing your safety and health.

Immediate Reconstruction

Patients who are aware, prior to their surgery, of the possibility of breast reconstruction often elect to have the procedure started at the time of the mastectomy, with approval from the surgeon and oncologist. About three-fourths of our patients elect to begin breast reconstruction when the mastectomy is performed. Since the general surgeon must perform a complete mastectomy and also leave sufficient remaining healthy tissue to be used in the reconstruction, your plastic surgeon and general surgeon must work closely together.

The most obvious advantage of immediate reconstruction is that it allows you to avoid an additional hospital admission. Psychologically, mastectomy patients who have immediate breast reconstruction also experience less post-mastectomy depression, because their positive body image is retained. They also have the opportunity to balance the diagnosis of breast cancer against information about the positive aspects of breast reconstruction. Mastectomy patients who begin immediate reconstruction, however, sometimes have unrealistically high expectations about the results because they cannot see what the post-mastectomy results would be without reconstruction.

Delayed Reconstruction

While patients who already have had a mastectomy cannot choose to have immediate reconstruction, they still are candidates for many of the same reconstructive techniques later on. Waiting has its own advantages. Not only is the mastectomy completely healed with delayed reconstruction, but the patient has had time to adjust psychologically, to complete any chemo or radiation therapy, to explore all the appropriate reconstruction options available and to schedule reconstructive surgery conveniently.

Oncoplastic Surgery

Oncoplastic surgery is an immediate breast reconstruction option that involves the removal of a cancerous tumor while incorporating plastic surgery techniques to create a symmetrical, aesthetically pleasing breast contour.

This can be a good option for lumpectomy candidates who would also like to make cosmetic improvements to their breasts through a breast reduction or breast lift. During the procedure, the surgeon makes incisions similar to those used in breast reduction, removing the tumor from the cancerous breast in addition to excess skin, fat and glandular tissue from both breasts to achieve smaller, shapelier breasts with improved symmetry.

Oncoplastic surgery requires a surgeon to have specific training in performing these procedures, as the techniques required vary from those used in a purely cosmetic breast procedure. Additionally, it is important to realize that oncoplastic surgery is not feasible for many breast reconstruction patients, as adequate tissue must remain to reshape the breasts.

Considerations with Radiation and Chemotherapy

Both radiation therapy and chemotherapy can influence the type and timing of breast reconstruction. Radiation therapy affects the quality of the skin and may rule out or lend itself more easily to certain reconstructive procedures. Patients who are having chemotherapy may have to postpone the start or completion of reconstructive surgery until the chemotherapy is completed.

WHAT TO EXPECT WITH RESULTS

Expectations for results in breast reconstruction will vary with each patient. Our goal is to create a soft breast that has good shape and is reasonably symmetrical with the opposite breast. This is easier to achieve for some patients than others. The results depend upon the way the individual patient heals, the type of mastectomy, the reconstruction technique chosen and the patient’s existing tissue and opposite breast. All mastectomy patients should expect to lose some sensation over the chest wall, underarm and inner arm areas. While reconstruction will not improve sensation in these areas, it should not lessen it. Most patients can expect a breast volume that approximately matches the opposite breast, although there are some limitations on the size of a reconstructed breast.

Symmetry is a primary goal in breast reconstruction, but can only be obtained in some patients by altering the opposite breast. About 30 to 40 percent of mastectomy patients will choose opposite-breast surgery in order to match the shape and volume of the reconstructed breast. This improves appearance and sense of balance and makes the fitting of clothes and dressing easier. Some patients also find that a slight degree of asymmetry is acceptable and will choose not to alter the opposite breast. Some elect not to follow through with nipple/areolar reconstruction.

Opposite Breast Surgery

Approximately 30 percent of breast reconstruction patients have surgery on the opposite breast in order to maximize symmetry. When there is a significant difference between the size of the reconstructed and the opposite breast, many women choose to have the opposite breast reduced. Opposite-Breast Reduction is done in exactly the same way as ordinary breast reduction. The primary disadvantage of opposite-breast reduction is the additional surgical procedure and the resulting scars on the reduced breast. Fortunately, breast reduction can be combined with second-stage reconstruction or nipple/areolar reconstruction.

Opposite-Breast Mastopexy: In this breast-lifting procedure, the breast volume is not altered, but the breast ptosis, or droop, is corrected by lifting the breast to give it a more youthful shape and higher position on the chest wall. This procedure is particularly helpful for mastectomy patients who have lost a significant amount of weight or who have had multiple pregnancies.

Opposite-Breast Augmentation: Some mastectomy patients, especially younger ones who are small-breasted, elect to have opposite-breast augmentation to achieve a slightly fuller breast volume that can match the reconstructed breast.

All three of these procedures – opposite-breast reduction, mastopexy and augmentation – will be discussed with you in detail prior to breast reconstruction. However, final decisions about one or more of these procedures may be delayed until the first stage of breast reconstruction has been completed, so you and your physicians can better evaluate how much asymmetry may exist.

ABOUT COMPLICATED RECONSTRUCTIONS

Almost any mastectomy patient can pursue breast reconstruction. This includes patients who have had prior radiation therapy, some other breast surgery complication or a congenital breast deformity. Each of these situations presents its own special complications, but most have solutions.

The choices of reconstruction techniques are narrowed for patients who have had prior irradiation of the skin. In these cases, a flap technique usually provides optimal results.

Patients who have non-malignant breast disease with a resulting nipple-sparing mastectomy present one of the greatest challenges for breast reconstruction, even though neither the skin nor the nipple/areolar area have been removed. An implant or a tissue expander technique often provide the best results when a nipple-sparing mastectomy has been performed.

FEES AND INSURANCE

It is required by law for health insurance policies to cover breast reconstruction after mastectomy; however, this coverage varies depending on the policy. Coverage usually includes all phases of breast reconstruction including the nipple/areolar reconstruction. Unfortunately, not all insurance companies will cover opposite-breast surgery, particularly opposite-breast augmentation and mastopexy. Most companies do cover opposite-breast reduction. Coverage and pre-approval varies with each insurance company or HMO and for different policies – even from the same company. It is important that you call your insurance provider beforehand for information on your individual insurance coverage for breast reconstruction following mastectomy.

We hope we have answered many of your questions about the options for breast reconstruction and we encourage you to talk to us about these procedures. We will do everything we can to help you make an informed decision about the ideal breast reconstruction approach for you. Please call or contact us online to schedule a consultation.

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