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“What are My Options for Breast Reconstruction after Breast Cancer Surgery?”

Many patients come in to see me after being diagnosed with breast cancer. While there are many types of breast cancer, and different modalities of treatment, one of the critical components to treating breast cancer is with surgery. This typically includes either removal of a portion of the breast, called a lumpectomy, or removal of the entire breast, called a mastectomy.

Reconstruction of the breasts can occur at the time of the breast cancer surgery called immediate reconstruction, or after other types of treatment have been administered (like chemotherapy or radiation), called delayed reconstruction. These are factors that are discussed with the patient and the other treating doctors after the diagnosis of breast cancer has been determined.

For breast reconstruction after mastectomy, the options are broken into 2 basic categories: implant reconstruction and tissue (flap) reconstruction. Sometimes the 2 modalities need to be combined to improve the overall outcome.

With implant reconstruction, this is sometimes done in more than one stage–starting with a tissue expander to help stretch the skin and accommodate the eventual breast implant. Some patients are candidates for immediate, direct to implant reconstruction, which means that they can get an implant at the time of their mastectomy. For flap or tissue reconstruction, typical places where tissue is transferred from includes the abdomen and the back.

Other procedures may be necessary down the road, including fat grafting which takes fat from the abdomen or inner thighs and transfers it up to the reconstructed breast to help improve the aesthetic outcome of the reconstruction. Also, nipple and areola reconstruction can be performed with a combination of skin rearrangement and tattoos–some of which are remarkable 3-D representations. These are almost always outpatient procedures.

After a lumpectomy, or partial breast removal, other procedures may be done to help improve the size and shape of the breast if necessary. These include fat grafting, and tissue flaps. Most patients who have a lumpectomy require radiation treatment, which must be taken into account during the discussion of breast reconstruction.

Working together as a team is an important concept for breast cancer treatment and reconstruction. If you get diagnosed with breast cancer, it is best to discuss your options with all of the treatment team members prior to proceeding to make sure that you and your entire team have a good strategy.

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