Evolution: Breast Reconstruction After Mastectomy

“Women who want breast reconstruction after mastectomy have several options with respect to timing, type of procedure, and materials used. Here, plastic surgeon M. Whitten Wise, MD, reviews the options and discusses considerations relevant to each procedure.

“Breast cancer remains a key women’s health issue. When presented with the diagnosis of breast cancer women face the choice of lumpectomy (usually accompanied by breast radiation) versus mastectomy. And while lumpectomy rates remain high, mastectomy numbers are climbing. This is driven in part by several distinct subsets of women: those seeking to avoid radiation therapy, those looking to reduce their risk for disease recurrence, and by a dramatic increase in women seeking prophylactic mastectomy.

“Prophylactic mastectomy may be performed in the contralateral breast or prophylactically in both breasts to help prevent the development of breast cancer (especially among those patients with one of the genetic mutations predisposing women to breast cancer, such as the BRCA gene mutations).

“The majority of patients choosing mastectomy are candidates for immediate reconstruction at the time of mastectomy. This allows them to avoid additional surgeries and recovery times. It provides significant psychological benefits by allowing women to feel ‘whole,’ with reduced incidences of depression, anxiety and low self-esteem. Importantly, immediate surgery improves the aesthetic result of the reconstruction by preserving the breast skin envelope to reduce the extent of scarring and to maintain the natural breast shape. This allows the breast reconstruction to replace only the missing breast tissue under the preserved breast skin.”

Most Breast Cancer Patients Who Had Healthy Breast Removed at Peace with Decision

“More women with cancer in one breast are opting to have both breasts removed to reduce their risk of future cancer. New research shows that in the long term, most have no regrets. Mayo Clinic surveyed hundreds of women with breast cancer who had double mastectomies between 1960 and 1993 and found that nearly all would make the same choice again. The findings are published in the journal Annals of Surgical Oncology.

“The study made a surprising finding: While most women were satisfied with their decision whether they followed it with breast reconstruction or not, patients who decided against reconstructive surgery were likelier to say they would choose to have both breasts removed again. In the reconstructive surgery group, women who needed additional operations due to complications, breast implant-related issues or other reasons were likelier to regret their prophylactic mastectomy, though overall, most women with breast reconstructions were satisfied with their choices.

” ‘I think what this study does is adds some literature to the hands of the people counseling patients to say, “Whatever decision you make, you’re very likely to be happy with that in the long run, so listen to yourself, and make the decision that’s best for you,” ‘ says lead author Judy Boughey, M.D., a Mayo breast surgeon.

“Most of those who skipped reconstruction said they felt the same about themselves and their femininity in the long run as they did before their mastectomies and would make the same choices today. Many of those with reconstructive surgery also felt the same about themselves as they did before their mastectomies, but some reported more satisfaction with their appearance, higher self-esteem and feeling more feminine.”