GOALS OF THE PATIENT
Regardless of the reason for mastectomy and reconstruction, it is important to take the time to sort out your plans, goals and expectations for reconstruction. Not every patient will elect to have reconstructive breast surgery, but every patient should consider all her breast reconstruction options. Breast reconstruction can be an important part of rebuilding a woman’s self-esteem after losing a breast to cancer.Once your team of cancer surgeons and medical oncologists agree you can
consider reconstruction, your homework must begin!
It is helpful to have a general idea about your reconstructive options.
- Choose the option that is best for you to complete your journey
- Consider all the choices, not just the ones that are local to your area–some of the best options may require travel
- Consider your long-term goals with reconstruction (aesthetics, comfort, activity, sensation, longevity of reconstruction)
- Decide whether you need to have reconstruction now, or if you can wait (immediate vs. delayed)
We have provided a downloadable guide for your convenience.
Make sure to bring your list of questions to your consultation and a note pad for notes. Ask if you may bring a significant other or friend to help record the discussion if you like. There is usually a lot of information to cover during consultation appointments.The goals of the reconstructive surgery team should always begin with following the lead from the oncology team. Your care is in the hands of a TEAM, make sure they coordinate as one on your behalf. Most, if not all breast cancer surgeons who perform mastectomy, will coordinate with a breast reconstructive surgeon to do immediate reconstruction if that is an option for you, but this is not always the best choice.
The goal of breast reconstruction is to restore the appearance of a breast after mastectomy. Although the function of the breast is often lost when it is removed for breast cancer, the appearance, shape and texture can be reconstructed to closely approximate a natural breast. The areola and nipple can also be recreated and sometimes spared. Reconstruction for many women is the piece of the journey that puts the finish to their cancer journey and helps them move forward with the rest of their life. For some patients reconstruction is purely aesthetic, for others it is about closure to the cancer journey. Make sure you take all of these points into consideration.
Recent surgical advances allow for improved and safer reconstruction than was available even ten years ago. DIEP flap, SIEA flap and TUG flap microsurgical breast as well as implants, pedicled TRAM and free TRAM reconstruction are all viable options for different patients. Although microvascular autologous (fancy words for your own tissue) reconstruction can be surgically more complex and requires an increased operating time, it does not compromise muscles which can be a huge for a survivor. We cover each of these in more detail on the CHOICES link.
Goals for reconstruction should include:
Long term results
Choosing a surgery that does not compromise your ability to do activities that you love
Breasts that are as comfortable and natural as possible
Breasts that can easily be monitored by your physicians for recurrence
Sparing muscles if at all possible
The unique history, circumstances and goals of each specific patient will help to define the choice of reconstruction method. No single technique is applicable to everyone. Although technically more complex, the potential benefits of microsurgical reconstruction (such as DIEP, SIEA and TUG flap) can be significant relative to implants or TRAM reconstruction. Some patients may be better candidates for implants, an expander or latissimus reconstruction. The reconstructive surgeon should be able to guide each individual, carefully keeping in mind the best interests of each patient, when recommending a reconstructive surgery. The reconstructive surgeon should also be willing to discuss the pros and cons of each procedure. Surgeons should not solely recommend procedures that are technically less advanced, and less demanding of the surgeon’s skills and time. Many surgeries may be easier to perform than surgeries that require advanced technology and skill, but they may also carry a higher risk of complications after surgery and risk limiting the activities of a patient post-reconstruction.
When a breast cancer survivor or BRCA+ patient is contemplating her reconstruction choices, she may ask for referrals of the surgeon’s patients who have had the same surgery. This may help the patient decide if that particular surgery is compatible with her lifestyle and her other reconstruction goals. Other important factors to consider are the surgeon’s experience with the procedure, success rate, and the surgical TEAM chosen. The benefits of your reconstruction choice should outweigh the inconvenience of travel time (if applicable) and the few weeks of recovery time invested. Unfortunately, it is possible for certain types of reconstruction to impede your active lifestyle, now and in the future. Knowledge is power. Finding out as much as you can about your choices beforehand is of the utmost importance. There is nothing worse than choosing a type of reconstruction simply because one is more prevalent than the others in the media (and perhaps the only type recommended and performed by your surgeon, then finding out afterwards there were better choices for you personally, and/or that you aren’t able to continue to do all the activities you love, unique history, circumstances and goals of each specific patient help to define the choice of a reconstruction method. No single technique is applicable to everyone. Some patients may be better candidates for implants, an expander or latissimus reconstruction. Or, for one reason or another, they choose to have implant reconstruction. Although technically more complex, the potential benefits of microsurgical reconstruction can be significant relative to implant or TRAM reconstruction.
When considering factors like chemotherapy, radiation, BRCA status (prophylactic mastectomy), physical health, body type and patient goals, it is impossible to cover all the aspects and decision making possibilities in these pages. However, all these factors play a role in the choice, timing and outcome of reconstruction. Our doctors and survivors would gladly share more specific insight if you want to contact them directly.
For more details about choices link to our Choices page or contact us direct.
MEDICAL SURGERY TEAM GOALS
The goals of the reconstructive surgery team should always begin with following the lead from the oncology team. Your care is in the hands of a TEAM, make sure they coordinate as one on your behalf. Most, if not all, breast cancer surgeons who perform mastectomy will coordinate with a breast reconstructive surgeon to perform immediate reconstruction, if that is an option. This is not always the best choice and should be discussed with your TEAM.
GOALS OF BCRC SURVIVOR / PATIENT ADVOCACY TEAM
At Breast Cancer Reconstruction Choices (BCRC), our goal is to educate and empower women facing mastectomy by providing information about breast reconstruction options. Making the commitment to investigate reconstructive options as extensively as possible can have lasting benefits for mastectomy patients. We hope to assist breast cancer survivors and BRCA+ patients considering prophylactic mastectomy in this process by providing information and encouragement. Our goal is to support each patient in their journey.
Knowledge is Power!