BREAST RECONSTRUCTION CURRENT OPTIONS AND TREATMENTS

Breast Cancer continues to be one of the most prevalent forms of cancer for women. Currently, breast cancer will affect approximately one out of every 7 to 8 women, an increase from previous decades. There still remains no cure for breast cancer, but research is strong in that direction. Advances are made yearly in detection and diagnosis, in treatment protocols, as well as other factors and associated conditions affecting the discovery of breast cancer in a woman. Treatment involves a multitude of factors including family history, genetic components, type of breast cancer, and individual personal preferences regarding treatment options. For all these reasons, treatment of this disease is heavily individualized and consists of a concerted effort by many different specialties, including the general surgeon, oncologist, geneticist, and radiation oncologist. The reconstructive portion of treatment is performed by a plastic surgeon, and this article will touch on the various reconstructive options. When considering reconstruction after mastectomy, a woman must consider many factors. The first important question to ask should be „is reconstruction right for me?‟ Women choose breast reconstruction for many reasons, and the method of reconstruction chosen is very individualized. This depends on personal desire, physical attributes, type of breast cancer, lifestyle and psychological characteristics. No matter which method of reconstruction is chosen, it usually will entail multiple surgical procedures. Breast reconstruction can be performed at the time of mastectomy, known as immediate reconstruction, or anytime later, typically months to years, which is known as delayed reconstruction. The timing of the reconstruction depends again on individual desire, but many times is more influenced by the disease itself, i.e. whether other adjuvant treatment such as radiation or chemotherapy will be needed. Once the timing is determined, the next step is in determining which type of reconstruction is best for the individual. There are many types of reconstruction available, but all fall into one of two types. Either a portion of one‟s own body will be used, known as autologous reconstruction, or a breast implant will be used. Sometimes the two are combined. The procedures vary in complexity, recovery time and risks. Despite the method chosen, all can give a nice cosmetic result, and again choice is based on individual preference, anatomy, type of cancer and lifestyle. Probably the gold standard in reconstruction these days is the  autologous reconstruction, which is using a women's own tissue to create the breast. This is done with what is called a flap. This flap, which consists of skin, underlying fat, underlying muscle, and associated blood vessels can be taken from many different areas of the body. These are too numerous to go into detail here but these flaps can come from the abdomen (called a TRAM flap), from the back (a Latissimus Dorsi flap), or from other areas such as the buttocks region (Gluteal flaps). These flaps are either left attached to the underlying muscle, or can be completely disconnected from the muscle and placed into the chest to create the breast using microsurgical techniques. Flap or autologous reconstruction involves complex surgery, longer recovery time, affects other parts of the body and have the greatest risks. The benefits of these trade-offs are typically beautiful and very natural appearing breasts. The alternative to the autologous reconstruction uses an implant to recreate the breast mound. In certain instances this can be performed as a one time procedure, but typically this will be at least a two stage process. Following a mastectomy, there is deficient skin. The various flaps provide for this skin, otherwise we need to place a special type of implant called an expander to stretch the skin and muscle slowly. This provides the room for the second procedure where the expander is removed and a permanent implant is placed. Women have a choice of either saline implants or silicone implants as the permanent prosthesis. There has been a lot of press in the past regarding silicone implants, and unfortunately this has only confused and frightened women. Countless studies over the past 16 years have been performed, all verifying the safety of silicone implants. However there is still apprehension in some women. Talking to your plastic surgeon is the best way to get the information you need to make the proper informed choice. As mentioned earlier, reconstruction usually involves more than one procedure, and many times one of these procedures needs to address the opposite breast. Often the non-reconstructed side needs something done to it in order to achieve symmetry with the reconstructed side. This can involve a breast lift (mastopexy), a breast reduction or a breast enlargement (augmentation). Once the reconstructions are done, symmetry has been achieved and the woman is well healed, one more decision needs to be made. This is whether or not to have a nipple and areola reconstructed. Several methods are also available for this, but fall into two categories, either tattooing or flap reconstruction if an actual protruding nipple is desired. Breast reconstruction is a decision based on many factors involving many decisions and individual circumstances. In careful discussion with your plastic surgeon the best method for you can be determined. It is also very important to be aware that federal law requires insurance companies cover breast reconstruction for mastectomy following breast cancer, as well as cover procedures on the opposite breast to achieve symmetry. With the widely available options present, mastectomy alone need not be the endpoint for breast cancer. Through education and involvement in the decision making process, breast reconstruction can be a very fulfilling and satisfying option.