What options for breast reconstruction are available following breast cancer treatment?

Surgical treatment of breast cancer depends on a number of factors related to each patient’s disease, but generally involves either partial or total mastectomy (removal of one or both breasts) with or without lymph node evaluation. Partial mastectomy, also known as lumpectomy or breast-conserving therapy (BCT), does not always require breast reconstruction. Certain patients pursuing BCT, however, may benefit from a combined “oncoplastic” approach where the plastic surgeon lifts or reshapes the remaining breast tissue after the lumpectomy.

Following a total mastectomy, there are two primary methods for breast reconstruction:

» Implant-based

» Autologous tissue

Implant-based reconstruction typically requires two operations. The first operation places a tissue expander at the time of mastectomy because there is often not enough healthy breast skin or tissue to accommodate permanent implants. The expander is slowly inflated over time with saline injections during clinic visits to stretch the breast skin and create a pocket for the permanent implant. Once the tissue expander reaches the desired size, a second operation is performed where the expander is removed and a permanent silicone implant is inserted.

Autologous reconstruction involves borrowing a flap of tissue (skin, fat and sometimes muscle) from another part of your body. The lower abdomen is the most commonly used donor site and results in a scar similar to those seen following cosmetic surgical procedures to remove fat and skin. The blood vessels from the donor site are reconnected to an artery and vein in your chest with microsurgery techniques to restore blood supply, and then the flap is contoured into a breast.

Techniques for breast reconstruction depend on many individual factors, and you should discuss your goals and circumstances with your surgeons to determine the best option for you. Choosing to undergo breast reconstruction should not impact your cancer treatment in any way. Some women elect to not have reconstruction after mastectomy, which is a personal decision. However, it is mandated by federal law (Women’s Health and Cancer Rights Act) for all insurance companies to provide coverage for reconstructive surgery after cancer-related mastectomies.

For more information about breast reconstruction options following breast cancer treatment, visit uvahealth.com/services/plastic-surgery/breast-reconstruction.

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Dr. John T. Stranix is a plastic surgeon with the University of Virginia Health System.

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