Cancer is a multidisciplinary condition. From diagnosis and treatment to recovery and emotional support, it takes a village to build the best care team. With breast cancer, there’s often an additional facet to consider: post-mastectomy breast reconstruction.
Reconstructive plastic surgery is an option for most breast cancer patients, and many will undergo the procedure to restore confidence and reclaim their bodies after extensive treatment. But the process works best with full collaboration between oncologist, breast surgeon and reconstructive surgeon, so many of today’s top hospitals are establishing the full team at the onset of diagnosis. In fact, patients at Thomas Jefferson University Hospital often meet their reconstructive surgeon on day one of their treatment.
“While the initial plan is being made, emotions are usually running high,” said Steven Copit, MD, Chief of Plastic Surgery at Thomas Jefferson University Hospital and part of the Jefferson Breast Care Center team at the Sidney Kimmel Cancer Center at Jefferson Health. “So we like to move from diagnosis to surgical plan really quickly. It’s comforting for patients. Getting them in, coordinated and expediting a treatment plan is a huge help.”
With so many types of reconstructive surgery available today, it’s important for a patient and her team to review all of their options thoroughly.
“There’s no perfect breast reconstruction—each type has its own pros and cons,” said Dr. Copit. “The key is to identify the patient’s best option.” This comes after a careful assessment of the patient’s body size and shape, breast shape and desired result. Further questions involve the estimated tissue loss during a mastectomy and a decision to remove one or both breasts.
Thanks to advancements in all types of breast reconstruction technology, even the most basic options are far from traditional.
“There has been great improvement in breast implants over the last decade,” said Dr. Copit. “Today, they’re softer and appear more natural, come in more shapes and sizes and can be implanted with less disturbance to the muscle of the chest wall.”
Advancements in the collagen mesh that holds implants in place have also improved results by controlling placement and being fully absorbed by the body.
For patients hoping for a more natural option, Dr. Copit and the reconstructive surgeons at Jefferson Health offer a cutting-edge treatment called microsurgical free-flap reconstruction, using the patient’s own tissue sourced from the abdomen.
“When using the patient’s tissue, you need expertise and training in microsurgery,” said Dr. Copit. “With more advanced training and technology, we are able to disturb less and remove less donor tissue from the abdomen.” This decreases recovery time and risk of a future hernia.
With free flap reconstruction, surgeons avoid the muscle and focus on fat and blood cells. These cells are then fused to the chest wall where they can begin to grow and cycle normally. This method is preferable for many women who undergo radiation therapy, as the tissue will replace what has been permanently damaged by the treatment.
The Value of Collaboration
According to Dr. Copit, the key to a successful reconstruction is in the collaboration between breast surgeon and reconstructive surgeon. Most mastectomies and reconstructions are done in multiple stages of the same operation. First, the cancer is removed, then spacers are inserted for prosthetics if necessary. Eventually, they will be replaced with the reconstruction, but this can happen weeks or months later.
With so many moving parts, close collaboration minimizes patient discomfort and surgery time.
“In an ideal relationship, we meet with breast surgeons to discuss the procedure, and breast surgeons design their surgery to leave a framework for us,” said Dr. Copit. “Most of the surgeons I work with have even learned to adapt breast lift incisions to minimize skin loss.”
Dr. Copit also speaks to a patient’s oncologist regularly to check for changes to a patient’s treatment plan that might affect the surgery.
Most reconstruction patients, regardless of their surgery type, can expect to be in the hospital for one to four days following their surgery. Recovery can take between four and six weeks, then the patient will be able to drive and resume normal activity.
In all, when it comes time for a conversation about reconstruction, patients shouldn’t be afraid to do their research or get a second opinion.
“The art of breast reconstruction is not about being a zealot for any one procedure, but an advocate for the patient,” said Dr. Copit.