What to Expect After a Mastectomy
I may come off as completely ignorant with the statement I’m about to make, but I’m putting it out there. I ignorantly thought after a woman underwent a mastectomy, getting reconstructive breast surgery would be akin to getting breast augmentation. And I think it is a prevalent misconception based on the way the reconstructive process is portrayed in the media. Case in point - as I am writing this post, the news that Rita Wilson was diagnosed with breast cancer and had a double mastectomy and reconstructive surgery was made public. While the article details her breast cancer history, it does not go into depth or length about the actual breast reconstruction.
For instance - will the reconstructed breast mimic the appearance of her pre-mastectomy breasts? Will it be a long and protracted recovery? Will those implants be permanent? The truth is - breast reconstruction following a mastectomy is a much more intensive process and requires a highly skilled surgeon who will help the patient choose the best reconstruction options available. In fact, speaking with leading ABPS board-certified plastic surgeon Daniel C. Mills, II, M.D., F.A.C.S. of the Aesthetic Plastic Surgical Institute and Vice President of the American Society for Aesthetic Plastic Surgery, I was also surprised to learn that his preferred method when performing reconstructive breast surgery is to do it immediately following the general surgeon’s removal of the cancerous breast tissue. With the recent news about Angelina Jolie and her preemptive prevention of breast cancer and subsequent reconstruction, our nation's collective interest in mastectomies, the residual effect it has on a woman’s self-image and the process of reconstruction is a conversation that needs to happen. In that vein I discussed the use of breast implants after a mastectomy with Dr. Mills to get more insight into the whole breast reconstruction process.
Melissa Chapman: During a mastectomy what is done in order to prepare for future reconstruction?
Dr. Mills: The Mastectomy part should not be involved in reconstruction. The most important thing is getting the cancer out. You want there to be no barriers to the general surgeon. You want the patient to be completely cancer free. There are rare indications where you might want to stage the reconstruction, but as a general rule you let the general surgeon do the mastectomy and then a plastic surgeon can come in and do the reconstruction. It is also important to leave as much of the normal anatomy as possible. In fact there is a shift in the U.S. now to try to perform nipple sparing surgery which can be somewhat worrisome because 80% of cancers can be within 2 cm of the nipple, so you must get an intraoperative frozen section of the cut edge of the nipple evaluated for cancer during the surgery.
Melissa Chapman: How soon after a mastectomy can the reconstructive implants be placed?
Dr. Mills: The trend is to do immediate reconstruction during the same operation. After the cancer is removed by the general surgeon, the plastic surgeon would come in and place the implant which helps avoid a second anesthesia and recovery. Sometimes however, two separate procedures are performed. If the reconstruction is done as a second procedure, after the inflammation has resolved, it is standard procedure to place a reconstructive implant or expander or do a free flap procedure for breast reconstruction which employs tissues, harvested from another part of the woman’s body, to create a vascularized flap, which is equipped with its own blood vessels.
Melissa Chapman: What different materials can be used in the breast reconstruction surgery? What is the role of a tissue expander?
Dr. Mills: There are essentially three different methods that are used after a mastectomy, the first is to place a cellular dermal matrix (ADM), which is tissue that is reincorporated by the body to extend the muscle and place the implant or expander under the muscle at the time of the mastectomy. The second method is to place the tissue expander after the mastectomy has healed to stretch the local tissues. The third method is to take the patient’s own tissue from the either their back or from the abdomen to use for the reconstruction which can also be done at the same surgery as the mastectomy.
Melissa Chapman: How is the reconstruction implant procedure performed after a mastectomy? And how long is the recovery period?
Dr. Mills: If you are using tissue from the back or abdomen it makes for a larger surgery and this will increase the recovery time by a few days. Having two recoveries versus one recovery must be weighed. Doing the reconstructive surgery at the same time as the mastectomy is my preferred method which only adds one day to the recovery period of 2-3 days.
Melissa Chapman: What are the risks of breast implants and how long do they last?
Dr. Mills: Using an implant under the muscle has its own possible complications such as capsular contracture, infection of the implant and more asymmetry. Capsular contracture is increased if radiation treatments are necessary. Using your own tissue has different problems such as the flap not having good enough blood supply and dying or the aesthetic result may be less than desirable. I have always told my patients that these are not lifetime devices and they last about ten years.
Melissa Chapman: Do reconstructive implants affect the accuracy of screening for breast cancer after a mastectomy?
Dr. Mills: Since you have removed most of the breast tissue and the implant is under the muscle the screening will not be affected and a new nodule will be able to be felt. When one undergoes a standard breast augmentation the patient has some of her breast tissue to work with, but when you have done a mastectomy, the skin is stuck to the muscle - so it can’t be as good as someone who has tissue there to work with. The good news is that we are learning new techniques each and every day such as the nipple sparing and fat grafting.
At the end of the day, Dr. Mills stresses, all surgeons involved are trying to get rid of the cancer, and ultimately make a patient look better and feel more confident about herself.