Reconstruction or No Reconstruction After Breast Cancer Surgery

In Breast Cancer, Recent Posts by Barbara Jacoby

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For anyone facing breast cancer surgery, one of the main issues to be decided is whether to undergo reconstruction. In my case, it was never a matter of whether or not I would have reconstruction; it was a given based upon the direction of the cancer surgeon who I would never have questioned at that time. I was very grateful that the decision was made immediately at the consultation for my double mastectomy. This allowed for me to meet with the plastic surgeon who would be present at the cancer surgery and would be placing the expanders during the same surgery thus eliminating a separate surgery later on. The next course of action had already been put into place and that made everything seem like one flowing, continuous process.

If you decide that reconstruction is in your future, do talk to your medical team and request a consultation with a plastic surgeon as soon as possible. Barbara Jacoby

Since then, the most important thing that I have learned is that if you are considering reconstruction, you need to get the plastic surgeon involved as soon as possible. For me, this allowed for a finish to the surgery that was as clean and neat as possible with the least amount of scarring. I saw the way that the scarring was after my lumpectomy when the cancer surgeon was the only one involved. That scar was rugged and very irregular. But after the double mastectomy with the cosmetic surgeon doing the closing, the majority of the scarring looks like a pink thread that is almost completely invisible except for the area under the armpits where the expanders were removed and the implants were inserted. That was a far more beautiful outcome than even I could have imagined.

So much has changed since my reconstruction was done. I did not have options. Whether I was limited because of my insurance coverage alone, I am not sure. But, I do know, for example, that tattoos were not allowed because they were concerned that the ink was poison to the body and did not want to take on that liability. There were no options offered to me like those surgeries that are now being done that use the bodies own fat in place of the breast tissue that was removed. Nipple conservation was not an option because there had not been enough research available at that time to determine whether if there were cancer cells in that area, they could be the source of a new cancer developing. And this doesn’t even begin to address such new technologies like restoring breast sensation after surgery.

However, the thing that we need to keep in mind is that each of us is so different from one another and what may be the perfect options for one person may not even be viable for another. I am grateful that I had the implants done but as there are so many other choices available now, it is so important to involve a plastic surgeon before the surgery. For instance, other treatments such as chemotherapy and radiation will have an effect on your body and need to be determined so that the best choices for reconstruction can be assessed. I have spoken to women who have had reconstruction done in other ways than just the implants and they are very pleased with their outcomes but as with any other such surgeries, the skill and reliability of the microsurgeon is of prime importance. There are women who were considering reconstruction but eventually decided against it for so many very personal reasons. And then there are those who were so scared of the outcome and all of the things that could go wrong that they never even gave it a second thought. And there are those for whom reconstruction was never an option, either by choice or not being able to have reconstruction for other reasons.

If you decide that reconstruction is in your future, do talk to your medical team and request a consultation with a plastic surgeon as soon as possible. What you think that you want and how you want your reconstruction to happen is just as important to figure out as any other part of your post-cancer journey. The type of reconstruction will definitely need to be considered. The timelines need to be scheduled just as carefully as anything else. And remember that another whole aspect of reconstruction needs to be decided if it is to include areola and nipple reconstruction.

Only you can decide what is best for you. Your decision must be your own as you will have to live with it forever. Many look at mastectomies as amputations and whether you choose to use a prosthetic afterward to replace the missing part is completely a matter of what works best for you. But, your choice should always be made sooner rather than later if you are comfortable with making that decision. But, since this decision is not a life-threatening one as are your decisions about your cancer, please don’t add the stress of making this decision to everything else if you are unsure about what you want to do. It just isn’t worth it and more than likely the right decision for you will come to you when you least expect it.

For more information regarding reconstruction options after breast cancer surgery, please click the link here and download the FREE Breast Advocate® App for assistance in enhancing your doctor/patient discussion in shared decision making.