I Chose Breast Reconstruction

Learning to live with the new body means, most of all, learning to live with your changed breast or absence thereof. It is impossible to make sweeping statements about the reactions to these changes or the importance of breast being as we all view them differently. I, being slightly on the vain side liked having my breast, but was more than willing to give up both due to one having breast cancer in it. I enjoyed the fact that they fed my babies, how they looked in clothing and how my husband enjoyed them. But in the long run my husband was not the reason for me opting for reconstruction following my bilateral mastectomy…my decision was based on the fact that I myself wanted to have new breast reconstructed. You have the option to wait if you choose.

If you choose reconstruction of your breast, it is important to talk with women who have had this surgery. Support groups are ways of meeting such woman…both your plastic surgeon and Oncologist will have listings of support groups in your area. Ask these women about their overall satisfaction, recovery period, problems they had, and if they would go through all of it again. Also, ask about the doctor they used and if they would use them again. If the women you are talking with ask you if you want to see their new breast, say yes. Because when you see the real thing, they are different than looking at them in pictures.

You will receive a wide variety of diverse outcomes from breast reconstruction surgery. Some women will be extremely happy with the outcome, others are satisfied, while others are disappointed in the appearance of their breast, the experience with pain or chronic discomfort caused from the surgery. I had one woman complain about the sensation of construction around her upper chest. Another bitterly regretted the surgery because she said her new breast looked nothing like her original breast. And another said she could live with the way the reconstructed breast looked in clothing, but it made her I’ll to look at herself nude in a mirror because of the scars.

My thought on all of this: breast reconstruction is a “fashion accessory”. It enables you to disguise the fact that your original breast is gone. They keep your natural look in clothing. But you have to know up front, these reconstructed breasts will never look like the ones you had there originally. And they will never have the sensations of your old breast.

Breast Reconstruction is about you and what makes you feel better about yourself. It is NOT about what others want or expect you to do. Any kind of breast reconstruction means serious surgery with no guaranteed results. My Plastic Surgeon told me before I had my Bilateral Mastectomy, “Breast do not make the woman. She comes from who you are as a person. Some women have two breast, some have one, and others have none…but they are all beautiful.” This from the man who makes money fixing all the imperfections we see in ourselves.

There are a lot of minor post-breast-surgery changes that affect most women. Many seem to be the result of the auxiliary surgery that removes one or all the lymph nodes in the armpit. I had a sentinel node biopsy, which is less invasive, and generally have fewer reactions. But whichever nodule procedure you may have, an area of numbness on the back of the arm or armpit. Tightness and discomfort will occur when you raise your arm above your head. Should this or limited movement in the arm and shoulder occur, you are to consult with your doctor to schedule an appointment with a physical therapist who is experienced with working with women who have had breast surgery. Early intervention make a big difference in the outcome.

There are many different reconstruction techniques available. Your healthcare team can talk to you about the options that may be right for you, but it’s in your best interest to do your own research, too. If you know someone else who had reconstruction, you might find it helpful to talk to her about her decision process, her doctors, and her satisfaction with the results.

Just like we have vanilla and chocolate flavors for Ice Cream, there are two ‘flavors’ of reconstruction: implants and flaps.

  • Implant reconstruction: Inserting an implant that’s filled with salt water (saline), silicone gel, or a combination of the two.
  • Autologous or “flap” reconstruction: Using tissue transplanted from another part of your body (such as your belly, thigh, or back). Autologous reconstruction also may include an implant.

You also can choose whether or not to reconstruct your nipple. (In some cases, nipple-sparing mastectomy is possible, which means that your own nipple and the surrounding breast skin are preserved.)

I chose the Implant Reconstruction using tissue expanders for my reconstruction, which is often the procedure of choice by doctors and patients. This is a two-stage procedure.

In the first stage after your mastectomy, a tissue expander is placed under the muscle of the chest wall. After a two-week healing period, saline is injected into the expanders. The expansion phase continues for several weeks until the volume of the breast is achieved. Often there are imperfections and irregularities at this stage. I am told that they will look more natural after receiving the implants.

With each set of injects my muscles ache from being stretched, my back just below my shoulder blade ache, and my chest feels like there is someone sitting on it for about 48 hours. A pain pill after injections, then Tylenol for the rest of the day…all is tolerable after that. When I had the first set of injections, I was injected with 50cc in each expander…OMG! That will never happen again. It felt like the muscles were being torn apart. My neck was so stiff, I couldn’t turn my head. And my chest and back hurt so bad that I couldn’t take a deep breath. Since then each set of injections is of 25cc each. The stretching is not enough to need meds.

Stage two, at least four weeks after your last injection, the Plastic Surgeon will remove the expanders and replace them with either saline or silicone implants.

I chose the silicone implants…they tend to feel more realistic.

After the chest heals from reconstruction surgery and the position of the breast mound on the chest wall has had time to stabilize, a surgeon can reconstruct the nipple and areola. Usually, the new nipple is created by cutting and moving small pieces of skin from the reconstructed breast to the nipple site and shaping them into a new nipple. A few months after nipple reconstruction, the surgeon can re-create the areola. This is usually done using tattoo ink. However, in some cases, skin grafts may be taken from the groin or abdomen and attached to the breast to create an areola at the time of the nipple reconstruction.

Some women who do not have surgical nipple reconstruction may consider getting a realistic picture of a nipple created on the reconstructed breast from a tattoo artist who specializes in 3-D nipple tattooing.

One factor that can affect the timing of breast reconstruction is whether a woman will need radiation therapy. Radiation therapy can sometimes cause wound healing problems or infections in reconstructed breasts, so some women may prefer to delay reconstruction until after radiation therapy is completed. However, because of improvements in surgical and radiation techniques, immediate reconstruction with an implant is usually still an option for women who will need radiation therapy. Autologous tissue breast reconstruction is usually reserved for after radiation therapy, so that the breast and chest wall tissue damaged by radiation can be replaced with healthy tissue from elsewhere in the body.

Another factor is the type of breast cancer. Women with inflammatory breast cancer  usually require more extensive skin removal. This can make immediate reconstruction more challenging, so it may be recommended that reconstruction be delayed until after completion of adjuvant therapy.

Even if a woman is a candidate for immediate reconstruction, she may choose delayed reconstruction. For instance, some women prefer not to consider what type of reconstruction to have until after they have recovered from their mastectomy and subsequent adjuvant treatment. Women who delay reconstruction (or choose not to undergo the procedure at all) can use external breast prostheses, or breast forms, to give the appearance of breasts.

 

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