Sadly, national statistics show that seven out of 10 women diagnosed with breast cancer are never told about their breast reconstruction options, despite the fact that multiple research studies have demonstrated that breast reconstruction can be critical in improving the quality of life for women with this disease.
To help raise awareness of this problem, the American Society of Plastic Surgeons and our national spokesperson, Jewel, are partnering to promote Breast Reconstruction Awareness Day Oct. 17. In light of this event, which comes midway through Breast Cancer Awareness Month, I wanted to reflect on the status of our treatment of this disease and the critical role the reconstructive surgeon plays in patient-centered care.
To me, the job of the reconstructive surgeon can be defined as making the transition from the first diagnosis of cancer back to a normal life less stressful and as painless as possible for our patients. For patients who choose lumpectomy for their surgery, the reconstructive surgeon can offer a simultaneous breast lift, augmentation or reduction that can improve the appearance of the breast in the same operation in which the cancer is removed. Treatment and reconstruction of the cancer can also be combined with surgery on the opposite breast for symmetry. Many end their treatment with their cancer removed and cosmetic enhancement of the breasts.
Multiple research studies have shown and confirmed that breast preservation with lumpectomy, when combined with appropriate postoperative radiation therapy, offers equivalent results in survival when compared with mastectomy. Knowing that the breast can be safely preserved while treating their cancer has been extremely reassuring to many patients.
The need for five to six weeks of daily radiation therapy can be daunting to many women, however. One of the most promising recent developments has been the emergence of Iort, or Intra-Operative Radiation Therapy. With this technique, a single booster dose of radiation therapy is given in the area immediately surrounding the just removed cancer at the time of the lumpectomy. Ongoing research is aimed at addressing whether the course of radiation therapy can be shortened.
For those women who choose mastectomy, there is great excitement regarding nipple sparing for those women who can safely have the breast cancer removed without disturbing the nipple or areola area. With this technique, the breast tissue is removed. But in addition to preserving the overlying skin of the breast, the areolar complex and nipple are preserved as well. The operation is then combined with an implant reconstruction or movement of the patient’s own tissue to reconstruct the breast.
In many patients who undergo bilateral mastectomy, the results can be striking. If the nipple has to be removed to treat the cancer, a skin-sparing mastectomy can be used to leave the basic architecture of the breast intact, and nipple reconstruction can then be performed as an office procedure, followed by tattooing of a new areola area. Alternatively, for those women who can’t or don’t want to have implants used in their reconstruction, the body’s own tissue, such as the abdomen in the tRAM (transverse rectus abdominus myocutaneous) flap, can be moved to reconstruct the breast. In addition to the reconstruction, the patient ends up with an abdominoplasty (or tummy tuck) as well. The abdominal flap used for breast reconstruction can also be done preserving much of the normal musculature. The use of the DIEP flap – which involves the techniques of microsurgery to move abdominal tissue to reconstruct the breast without unduly disturbing the abdominal wall musculature –has also grown in popularity.
In another exciting turn of events, there has been a great deal written recently about the role of genetic screening and the possibility of tailoring the therapy of breast cancer to the individual at the genetic level. As we continue to advance our knowledge of the human genome (the set of DNA that forms the blueprints of our anatomy and function), we can also identify certain genes that are associated with cancer, and treat the patient before the disease has progressed. For example, a mutation on the BRCA1 and BRCA2 gene sequences identifies a group of women at significantly higher risk for developing breast cancer, and currently, we recommend mastectomy to prevent development of cancer. While this has been a huge advance in our treatment of this disease, we look forward to the emergence of medical therapies that can have a similar effect in preventing cancer by being able to identify and treat women before surgery is needed.
There is so much more we can offer our patients with breast cancer who are interested in reconstruction that consultation with a qualified breast reconstructive surgeon should be an important part of their preoperative preparation. In addition, advances in the treatment of the breast cancer itself continue to increase the options available to women. I strongly recommend a team approach to treatment for women confronted with a new diagnosis.
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