A woman who faces mastectomy also has to consider whether and how to reconstruct the breast that will be removed, and her options have improved in recent years.
“Immediate reconstruction, in which the reconstruction is done when the breast is removed, is the gold standard now, and it is done in most of the patients who are reconstructed,” says plastic surgeon Prashant Upadhyaya, MD, an assistant professor of surgery at Upstate. He says no longer is it common for a woman undergoing mastectomy to wake up from surgery with a flat chest.
Up to 90 percent of breast reconstructions are “immediate,” but some women have to defer reconstructive surgery for medical reasons, and some want to complete cancer treatment before considering reconstruction.
Breast reconstruction can be done using implants, or it can be “autologous,” meaning the patient’s own tissue is used to create a new breast. Either way, most health insurers are required to pay for reconstruction of both breasts after mastectomy.
An autologous reconstruction requires an extensive surgery in which tissue is either transplanted from the abdomen to the chest, or moved from the patient’s back to the chest. This appeals to patients who do not want implants containing silicone or saline in their bodies, but not every woman is a candidate for autologous reconstruction, Upadhyaya says.
A woman who opts for implants may also be able to have a surgery that leaves her nipple intact. Newer techniques involve an incision that is made away from the nipple. “It’s actually very well hidden below the breast,” Upadhyaya says. The implants are often inserted through the same incision, and “the patient wakes up with breasts completely intact.”
Although sensation won’t be the same, the surgeon says after a woman recovers from the operation, her breast may appear much as it did before.
He favors silicone gel implants. “Saline implants do not have the natural feel or the look of silicone gel implants. I offer both to patients. But I think the longevity of the results is better, and the feel of the breast is better with silicone implants.”
Implants carry the risk of infection. Upadhyaya says from 5 to 10 percent of patients with implants will face infection, which means having to remove the implants and then, months later, undergoing another reconstruction.
So which surgery provides the best outcome?
The surgeon says the answer has to be based on each individual patient’s expectations – and the realization that they may not be happy with any outcome during the post-operative period. Healing and recovery is liable to take months.
Hear an interview with Upadhyaya about breast reconstruction options