Breast Reconstruction Now a Vital Part of Total Treatment for Breast Cancer
- by Ahmed Abdullah, M.D.
Plastic surgery has made phenomenal advances in reconstructing the female breast after deforming cancer surgery. In fact, the question today following a mastectomy is not, "Why should she have her breast reconstructed?" but, "Why shouldn't she?"
It may seem hard to believe, but surgery for cancer of the breast began as far back as 1890. The operation was called radical mastectomy and initially involved extensive removal not only of the breast, but of the underlying muscles. Fortunately, radical mastectomy is infrequently performed today. Instead, the operation most commonly performed for breast cancer is modified radical mastectomy; it involves removal of the breast and the lymph nodes in the armpit (axilla), but preserves the underlying muscles.
You've probably read of a more conservative procedure called a quadrantectomy or lumpectomy. This has recently been found to be equally effective as rnastectomy. A lumpectomy is a more limited partial mastectomy. It still requires removal of the axillary lymph nodes and radiation treatments to the remaining breast tissue. However, thesprocedure does attempt to limit the deforming effects of surgery on the appearance of the breast.
What happens before breast surgery?
Every woman who requires surgical treatment for breast cancer should be an integral part of decision and planning for the operation.
Prior to treatment, the physicians involved with the woman's care will assign a stage of disease, depending on the size of the tumor, the presence of involved axillary lymph nodes and the potential for metastasis – the spreading of the cancer cells to other organs such as the liver or lungs. Stage 1 is the earliest stage of cancer and ha the best prognosis; Stage 4 is the most advanced disease.
Based on the cancer stage and the woman's prognosis, the general surgeon and patient together plan the breast cancer surgery - either a modified radical mastectomy with axillary lymph node removal, or a lumpectomy with axillary lymph node removal and radiation therapy to the remaining breast tissue. The surgeon should help inform and educate the patient and involve her in the decision-making process.
The decision as to the best surgical treatment option is influenced by many factors. For example, the tumor may be too large to allow a limited mastectomy, steering the surgeon and patient toward modified radical mastectomy. Additionally, the patient may not want to have radiation therapy, which is required with limited mastectomy surgery. During this planning process, the plastic surgeon's input is invaluable if the patient has decided to have her breast reconstructed. Certain technical aspects of the mastectomy can be modified to help the plastic surgeon achieve the best result possible.
How is the breast reconstructed after surgery?
Modified radical mastectomy with removal of the axillary lymph nodes effectively removes the entire breast. This results in an obvious absence of the breast, or an acquired post-mastectomy breast deformity.
As early as 1906, breast reconstruction was considered necessary for many patients who had surgery for breast cancer. The female breast is recognized in our culture as an integral part of a woman's femininity. The potentially disruptive emotional and psychological effects of a post-rnastectomy breast deformity are well-recognized and have been documented in many medical and psychiatric studies. Breast reconstruction after mastectomy can make an important contribution to quality of life. Reconstruction eliminates the need for an external prosthesis, allowing greater freedom in the election of clothing, and makes a woman more comfortable undressing in front of others.
We routinely reconstruct many parts of the body after cancer surgery, including ears, noses and lips. Most people would want a deformity of the face reconstructed, if possible. and the same sense of reconstructive needs should apply to a woman's breast. Again, the question should be, “Why shouldn’t she have her breast reconstructed?" instead of, "Why should she?" In fact, many post-mastectomy patients are more pleased with the appearance after reconstructive surgery than they were before the cancer operation - thanks to the combination of breast reconstruction and cosmetic enlargement, reduction or lifting.
Breast reconstruction presents the patient with a variety of options from which she and the plastic surgeon may select the most appropriate technique. The first choice to make is whether to use the patient's own tissue for the breast reconstruction or to use a breast implant. Unfortunately, media- and legal-driven hysteria over silicone implants have created what appears to be an almost insurmountable quantity of unsubstantiated information concerning implants. In spite of this, breast implant reconstruction continues to be a very successful technique that has greatly benefitted many women. In support of the implant manufacturers, they continue to forge ahead with tremendous technical