Nearly 200,000 women are being diagnosed with breast cancer every year. After hearing the words, "You have breast cancer", it is easy to become overwhelmed with treatment options and choices that need to be made.
There are hundreds of questions and frequently more than one right answer. We are inviting you to explore your options, either before or after your planned mastectomy.
Breast reconstruction consists of rebuilding the breast mound, restoring its shape and size, as well as reconstructing the nipple and areola. The specific technique will depend on your preference, cancer treatment used (use of radiation therapy is especially important), your overall health, your occupation and physical activities, your body habitus, your smoking status and many other factors. Depending on clinical scenario, surgery on the opposite breast to restore symmetry (breast augmentation, i.e. enlargement, breast lift or reduction) may be needed. View this procedure in 3D here.
KNOW YOUR RIGHTS
In October of 1998, Congress passed the Women's Health and Cancer Rights Act. The act requires group health plans and health insurers that provide medical benefits covering mastectomy, to also cover the cost of reconstructive breast surgery. The coverage must include all stages of reconstruction of the diseased breast, procedures to restore and achieve symmetry on the opposite breast, and the cost of prostheses and complications of mastectomy.
IMPLANT BREAST RECONSTRUCTION
Implant reconstruction (approximately 75% of breast reconstructions in the USA are done this way) can be performed as a one-stage (rarely) or a two stage procedure. The first stage consists of the placement of a tissue expander. Since mastectomy removes not only the breast gland, but also a portion of breast skin (usually including nipple/areola complex), frequently there is not enough tissue available to cover a permanent implant (in the case there is sufficient amount of tissue available, one stage reconstruction, i.e. immediate placement of a permanent implant is performed. This scenario is more likely when a skin-sparing mastectomy is performed).
Usually, two-stage reconstruction is offered. The first stage includes placement of a tissue expander that - after successful process of tissue expansion - is replaced with a permanent implant. A tissue expander is a temporary implant with a built-in port that can be inserted after mastectomy (either immediately, i.e. during the same surgical procedure or after a period of weeks, months or even years after mastectomy - there is really no time frame within which the reconstruction process has to begin). A few weeks after the tissue expander is inserted (usually 3 weeks or so, when the incisions are healed) the process of tissue expansion begins. The patient will be asked to return to the office for a visit every other week, during which the tissue expander will be accessed and saline will be added to increase its volume. The overlying tissue will be gradually stretched until the desired volume is achieved. Depending on the size of tissue expander, initial fill volume, patient's comfort level etc., the process may take 2-4 months. After the expander is fully inflated, the second procedure will be performed - replacement of a tissue expander with permanent breast implant. Currently, silicone gel filled breast implants are used for that purpose (since several nationwide studies proved efficacy and safety of the silicone implants, they have largely replaced saline-filled devices. They provide a much more natural look and "feel" than the saline implants).
Occasionally, additional procedures may be needed to improve symmetry of reconstruction (for example: breast augmentation and/or lift of the other breast).
During your initial consultation with Dr. Majewski, the most appropriate technique will be recommended, based on your specific needs.
Before & after photos coming soon.