Role of Reconstruction in Breast Cancer Treatment

By: Matthew J. Lynch, MD

Treating men and women with breast cancer is a collaborative process.   The team of experts includes a breast surgeon, a reconstructive surgeon, a medical oncologist and a radiation oncologist.   

Surgically, breast cancer may be treated in two ways. One method used for the early stages of the disease is to remove only the tumor—a procedure called a lumpectomy—and follow that with radiation therapy. The radiation destroys cancer cells left behind after the tumor is removed.  This is called breast conservation.  This treatment is very effective for eliminating early-stage breast cancer and minimizing the risk of it coming back. 

Even with breast conservation a reconstructive surgeon is involved to maintain a woman’s appearance.  After the tumor is removed, the reconstructive surgeon will use plastic surgery and cosmetic techniques to help maintain, and often improve, the shape and contour of the breast. These procedures are done at this stage so later, after radiation therapy there is less chance of deformity of the breast.

Other times, a mastectomy may be recommended or required.  A mastectomy is  a partial or complete removal of one or both breasts. Many women aren’t aware of the great improvements made in this procedure.  In the advent of breast cancer treatment, a mastectomy was often a radical procedure that would affect a large portion of skin on the chest and in some cases, even the chest muscle. The procedure has evolved to the point that, today much of the breast skin is left untouched and patients get a wonderful reconstructive result.

Many patients discuss with their reconstructive surgeons, and are candidates for, three different types of breast reconstruction procedures depending on the individual patient’s situation. One type of reconstructive procedure involves taking muscle, skin and fatty tissue from the upper back and using it to reconstruct the breast (latissimus dorsi myocutaneous flap). The second technique takes tissue from the lower abdomen, moves it up to the breast area and uses it to reconstruct the breast (transverse rectus abdominus myocutaneous flap).

The third option is using an implant to reconstruct the breast.  This includes using a tissue expander in the first stage of reconstruction after a mastectomy to create a breast mound.  The tissue expander has a built-in port that enables the physician—in regular office visits—to gradually add more saline solution to increase its size over time. This gradual increase in size keeps tension off the patient's incision while healing occurs. When healing is complete, the expander is removed and a permanent implant, either silicone gel or saline is inserted.

Satisfying Results

Another area of improvement is in the advanced development of breast implants.  In addition to round silicone or saline implants, used for many years—which can change shape over time—form-stablized silicone implants, just recently approved by the Food and Drug Administration, are now available and are less likely to lose their shape or ripple, and therefore maintain a more natural appearing breast.  

The results of reconstructive breast surgery can be very satisfying, and patients understand that depending on individual cancer treatment plans, breast reconstruction is accomplished in stages.  The process from start to finish may take from six months to one year.

Most patients agree it is well worth it. If you looked back at the results from procedures done 10 years ago and compare them to the results women achieve today with the new techniques available, there has been an enormous improvement. There is a much higher level of patient satisfaction - women are very pleased with the results and the exceptional care received through the process.