How to assess breast reconstruction surgery options

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If you are considering a mastectomy or breast reconstruction there is much to consider before making a decision about which procedure is right for you. Dr. Joseph Disa, a plastic surgeon at Memorial Sloan-Kettering Cancer Center provides an overview of breast reconstruction options.

How to assess breast reconstruction surgery options

Breast reconstruction options:

  • You may choose to have breast implants, or have a procedure that uses your body’s own tissue.
  • TRAM Flap is one method of using your body’s own tissue for breast reconstruction.
  • Another method combines the use of your own tissue plus an implant.
  • Implants may be what’s best if you do not have enough tissue, too much tissue or have scars.
  • It all depends on the patient as to which one is right for you, so be sure to discuss your reconstruction options with a plastic surgeon to see what is best for you.


Timing for breast reconstruction:

  • When you have the breast reconstruction surgery is also very important. Will you have it at the time of the mastectomy (immediate reconstruction) or at a later time (delayed reconstruction)?


Recovery after breast reconstruction:

  • With any surgery you should watch for complications such as infection and proper healing.
  • If using your body’s own tissue, you have to make sure that the tissue takes to your breasts.


Follow-up screenings after breast reconstruction:

  • Once you have a mastectomy you will not have mammograms.
  • The main way to screen against breast cancer after a mastectomy and breast reconstruction is through a physical exam.
  • Even with a mastectomy there is a very small chance of a recurrence. Recurrences usually appear on the skin above the reconstruction and are easily found.
For more information about breast reconstruction surgery options go to www.komen.org or call Komen for the Cure’s helpline at 1-800-IM AWARE.
Transcript

Hello, I'm Rene Syler, an ambassador for Susan G. Komen for the cure, and a woman with a very personal breast cancer story. You see, both of my parents had breast cancer and because of that, I opted for a bilateral preventive mastectomy in January of 2007. It was a very difficult choice for someone who didn't have breast cancer, but it was the right choice for me. If you have had a mastectomy or you're about to undergo a mastectomy, you might be considering breast reconstruction and if so, you're going to need some information to help you make that decision.

 

Dr. Joseph Disa from Memorial Sloan Kettering here in New York, was the plastic surgeon who helped me make my decision. Dr. Disa, thanks for joining us.

 

It's nice to see you.

 

Can you just give us a brief overview of what happens during reconstruction?

 

Sure. First of all, it depends on what type of reconstruction you have. There's two ways to do it. One way involves using breast implants, the other way involves using your body's own tissue. So that's one issue. The second issue is, when are you going to have reconstruction? At the time of the mastectomy or at some later time? Those are called immediate reconstruction at the time of the mastectomy, or delayed reconstruction if it's done later.

 

Is there one that's better than the other in terms of, you talked about the different types of reconstruction implants versus body tissue. Is that called TRAM flap?

 

Well that's one method. A TRAM flap is certainly one method. There's multiple different ways of using your own body's tissue to create a breast mount, and some of that involves just tissue only and some of it involves a combination of tissue plus an implant. And then there's ways to do it just with implants alone. And there definitely is not one way that's better than the other.

 

Is there one that has a better cosmetic outcome?

 

Not necessarily. It's individual depending on the patient. And that's where I would encourage patients to talk to the plastic surgeon to see what's best for them. For some patient, an implant may be superior and they may not be a candidate to use their own tissue because they may not have enough, they may have too much, there may be scars present that don't allow for it. And some women, an implant would be OK but it wouldn't necessarily match the shape of the natural breast and using the own body's tissue would be a much better way to match the feel and the shape of the natural breast.

 

Are there complications that you should be on the look out for?

 

Yes.

 

Are they the same with both types of surgery?

 

More or less. Whenever you do any types of surgery, you're always worried about infection. You're worried about things healing properly. If you're using your own body's tissue and you're transferring or transplanting tissue from one part of your body-- say, your lower abdomen up to the breast area to rebuild the breast-- you want to make sure that that tissue takes. And your doctor will show you what to look for and will monitor it while you're in the hospital, and once you go home you'll be instructed on things to be aware of and what to call about.

 

Now I'm looking forward, after you've been a year out from your reconstruction, a couple years out, how difficult is it to screen for new breast cancers after reconstruction? Say, an implant.

 

It's actually straightforward. Once you've had a mastectomy, you're not going to have mammograms anymore. So the main way to screen is by physical examination, and patients are taught how to self examine themselves just like they did before. Their doctors will examine them. Both the oncologist, whether it's the surgical oncologist, the medical oncologist or both, and the plastic surgeon who follows the patient will also keep an eye and screen and look out for things. It's very straightforward. It's never been shown that having breast reconstruction will impact the future development of additional breast cancer.

 

But in terms of finding a new breast cancer, I guess that wouldn't be an issue though because there would be no breast tissue left.

 

Correct. Even if you do have a mastectomy, there is a very small risk of developing what they call a recurrence, but if these occur they typically occur on the skin above the reconstruction and are easily found.

 

Dr. Disa, thanks again so much for your time. Good to see you.

 

You're welcome, Renee. It's been a pleasure to be here.

 

For more information, go to Susan G. Komen for the cure at www.komen.org, or you can call Komen for the Cure's helpline 1-800-IMAWARE. I'm aware I'm Rene Syler.

meet theexpert
  • Dr. Joseph Disa

    Dr. Joseph Disa Plastic Surgeon Dr. Joseph Disa is a plastic surgeon at Memorial Sloan-Kettering Cancer Center. He specializes in reconstruction after surgery to remove a tumor, with a focus on breast reconstruction and reconstruction of the head and neck. more about this expert »

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