Health Take-Away: Breast reconstruction after mastectomy is a personal decision

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More than 100,000 U.S. women undergo some form of mastectomy or breast removal each year, and a growing number of them are choosing to have breast reconstruction surgery for very personal reasons, whether it's to restore their outward physical appearance or simply feel better about their own bodies.

There are several reconstruction techniques available nowadays, with the two main ones being implant reconstruction, in which the plastic surgeon inserts a round implant filled with saline (salt water) or silicone gel, and autologous or "flap reconstruction," in which the surgeon actually transplants a flap of tissue from another part of your body (usually the belly, thigh, buttocks or back) to the area of the breasts.

Losing a breast or both is a physically and emotionally stressful experience. Not only are you confronting the fears and uncertainties that come with any cancer diagnosis, you are giving up a part of your body that in many ways has defined your gender identity, your sexuality, your maternality, your physicality and your overall sense of self.

Mastectomies are one of the treatments performed on patients diagnosed with breast cancer or at genetically high risk for developing it in the future. Breast reconstruction surgery most typically is done during or shortly following a mastectomy, although some patients choose to have the reconstruction months or even years later.

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The choice of which procedure to have — and indeed, the decision to have any breast reconstruction at all — is a highly personal matter, and one that's made in close consultation with your doctors and ideally with other women who have undergone the procedure. Hearing those personal experiences can be one of the best ways to reach a decision of your own.

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Both of the surgical approaches have advantages and disadvantages. Generally speaking, implant reconstruction is an easier, less invasive surgery to perform and usually has faster, easier recovery. Flap surgery, because it involves transplanting tissue from one place to another, is more involved to perform, is more time-consuming and involves longer recovery. Over time, however, implants can be more prone to issues which may require additional procedures to correct. Flaps tend to have a more natural feel, perform better over time and usually do not need routine surveillance over the course of a lifetime. As with any surgery, it comes down to what's right for a particular patient and their individual situation.

The goal of any breast reconstruction is to restore the breast mound or mounds and achieve symmetry. The breast surgeons who perform mastectomies and the plastic surgeons who reconstruct breasts should work closely with medical oncologists, radiation oncologists and the patients themselves to develop the optimal surgical treatment and a reconstruction strategy.

It's also important to understand that while breast reconstruction rebuilds the shape of the breast, it usually doesn't restore sensation to the breast or the nipple. Over time, the skin over the reconstructed breast can become more sensitive to touch, but it will never be quite the same as it was before surgery.

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While most women choose to have some type of reconstruction, some simply do not want to have any additional surgery at all. They choose no reconstruction and don't want to be pressured by anyone to have it done. Some choose to leave the results of a mastectomy as is. Others choose breast prostheses, a wearable artificial form which gives the appearance of breasts, but without the surgery.

When it comes to choosing between surgical implants, flap reconstruction, breast prostheses or nothing at all, there really are no right or wrong answers. There's only what's right for you and the knowledge that you have many options from which to choose.

Zachary Long, D.O., is a plastic surgeon with Berkshire Medical Center.


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