November 2018 Ask the Expert: Breast Reconstruction
At our November 2018 Breast Cancer 360, Difficult Decisions: Breast Reconstruction, people who attended the program had more questions than our expert had time to answer.
As an extra November Ask the Expert, Living Beyond Breast Cancer expert and 360 panelist Clara N. Lee, MD, MPP, answered questions we missed during the program about her research, breast reconstruction options and side effects.
Remember: we cannot provide diagnoses, medical consultations or specific treatment recommendations. This service is designed for educational and informational purposes only. The information is general in nature. For specific healthcare questions or concerns, consult your healthcare provider because treatment varies with individual circumstances. The content is not intended in any way to substitute for professional counseling or medical advice.
I am going to be starting a study in 2019, in which we will be collaborating with Living Beyond Breast Cancer. Please stay tuned for future updates about how to get involved.
Partial breast reconstruction, also called oncoplastic surgery, is becoming an increasingly important option for women who have deformity or asymmetry after lumpectomy with radiation. The options vary depending on your body characteristics, your goals, your health and, to some extent, what the surgeon is familiar with. I recommend asking your surgeons why they made the recommendation they did. You could also go back to the surgeon you feel most comfortable with and ask about the other two options and the pros and cons of each.
Chemo doesn’t cause necrosis per se. The main thing is to be adequately healed after reconstruction, before starting chemo.
Actually, when radiation is expected, most plastic surgeons recommend delayed reconstruction. This is because radiation generally affects the reconstructed breast, making it firmer, less natural or differently shaped. However, delayed reconstruction after radiation requires tissue transfer (flap) reconstruction. Sometimes, implant-based reconstruction is performed before radiation, especially if the patient really doesn’t want to have a flap or can’t have a flap.
Going flat is in fact the lowest-risk approach after mastectomy, in terms of complications. Most of the time, a plastic surgeon is not needed for a mastectomy, and breast surgeons/surgical oncologists are generally trained to be able to perform a mastectomy on their own. However, women who have very large breasts or very ptotic (droopy) breasts may benefit from having a plastic surgeon help with the closure to prevent dog ears. It’s unfortunate that insurance didn’t cover that.
I’m not sure there is good evidence that takes into account what women think or feel about this issue.
I don’t believe it does, but I don’t know that anyone has specifically studied this question. I don’t know of particular reason why race per se would.
Birth and pregnancy before reconstruction do not really affect options for reconstruction later. However, if you have breast reconstruction and then get pregnant/give birth, the other breast is likely to change in shape or size, or both, in a way that the reconstructed breast generally will not. You may have some asymmetry. This can generally be addressed surgically, if you desire.
They do not necessarily need to be replaced. Breast implant companies have stated in the past that the risk of a leak is 7 percent over 10 years. In other words, among 100 women with a breast implant, in 10 years, 7 will have a leak, and 93 will not. So most of the time, they do not need to be replaced for leakage. However, sometimes they need to be replaced or revised because of capsular contracture (when scar tissue forms around the implant) or malposition (when implants move out of proper position).