A cancer diagnosis is devastating. Even with the tremendous advances in treatment options and positive outcomes, the diagnosis hits like the suffocating crash of a roof collapse and no oxygen tank in sight. The overwhelming implications posed to one’s financial and familial relationships, in addition to our immediate physical, emotional, and mental health, are a primary concern as life undergoes an irreversible change, even with long-term survival.
For women diagnosed with breast cancer, the devastation of the diagnosis can have increased significance. Women are faced with their immediate health and survival, but with the long-term aesthetic and bodily change this will bring. Breast cancer is the most diagnosed cancer and cancer-related cause of death for women, accounting for 30% of all cancer diagnoses among women.
Every year over 100,000 women undergo a mastectomy and over 350,000 undergo a lumpectomy. While these surgeries can significantly improve survival rates, electing either is not guaranteed. Several factors are considered when discussing post-treatment options with an oncologist or plastic surgeon ranging from the type of chemotherapy or radiation performed, to age, weight, and lifestyle choices.
Dr. Brandon Richland is a leading plastic surgeon with luxurious facilities in Southern California. Renowned for his state-of-the-art techniques and natural-looking breast reconstruction, he is one of the most sought-after experts on post-breast cancer options, including mastectomy and lumpectomy. We had the opportunity to discuss with Dr. Richland at length current breast reconstruction options and alternatives for those who choose other routes.
What determines eligibility for reconstruction?
Eligibility for breast reconstruction is determined by several key factors. The patient’s overall health, stage of breast cancer, and treatment plan play crucial roles. Women with early-stage breast cancer who don’t require radiation therapy are often good candidates. As a board-certified plastic surgeon, I also consider if the patient has any chronic medical conditions or suppressed immune systems that may impact healing. Smoking and high BMI can increase surgical risks, so these factors are also evaluated when determining eligibility.
Who are the best candidates?
The best breast reconstruction candidates are women with a positive outlook and realistic expectations. They should be in good overall health, non-smokers, and maintain a stable weight. Patients with early-stage breast cancer who haven’t required radiation therapy are often excellent candidates. Having a strong support system and the ability to cope with the emotional and physical challenges of the surgical process is also important. The best candidates communicate and express their goals clearly, and are committed to following pre- and post-operative instructions for optimal healing and results.
How is reconstruction different if the patient had a mastectomy or lumpectomy?
The main difference in breast reconstruction between mastectomy and lumpectomy patients is the amount of breast tissue removed. With a mastectomy, the entire breast is removed, requiring more extensive reconstruction procedures to recreate the breast mound. Options like implant-based reconstruction or autologous tissue flaps are commonly used for mastectomy patients.
In contrast, a lumpectomy involves removing only the cancerous portion of the breast, preserving most of the natural breast tissue. Reconstruction after a lumpectomy typically focuses on restoring the shape and symmetry of the breast, often using techniques like fat grafting or local tissue rearrangement. The reconstructive process is usually less extensive and has a shorter recovery time compared to mastectomy reconstruction.
Does a patient who has undergone a lumpectomy typically need reconstruction?
Typically, patients who undergo a lumpectomy may not require reconstruction, as the procedure aims to preserve as much of the natural breast tissue as possible. However, some patients may still opt for reconstruction if the lumpectomy results in significant asymmetry or a noticeable deformity in the breast shape. Factors like the size and location of the tumor, as well as the amount of tissue removed, can impact the need for reconstruction. In some cases, oncoplastic techniques can be used during the lumpectomy to minimize deformities and maintain breast shape, reducing the need for additional reconstructive procedures.
Ultimately, the decision to pursue reconstruction after a lumpectomy is a personal choice of the patient. I assess the individual case and guide whether reconstruction is necessary or beneficial for achieving the best aesthetic outcome.
How does weight or body type affect candidacy for reconstruction?
Weight and body type can significantly affect a patient’s candidacy for breast reconstruction. Patients with a high body mass index (BMI) or those considered obese may face increased risks of complications during and after the reconstructive surgery. Obesity can lead to slower wound healing, increased risk of infection, and potentially compromised results. I often recommend that patients maintain a stable, healthy weight before undergoing reconstruction to minimize these risks and ensure optimal outcomes. Additionally, body type can influence the available options for reconstruction. For example, patients with insufficient abdominal tissue may not be suitable candidates for autologous reconstruction using abdominal tissue flaps. In such cases, I might recommend alternative techniques like using tissue from other areas of the body or implant-based reconstruction.
What are the various options available based on physical condition?
There are several breast reconstruction options available. The choice of reconstruction technique depends on factors such as the patient’s body type, overall health, personal preferences, and my recommendation based on the patient’s circumstances. Some of the most common techniques include; implant-based reconstruction, Autologous tissue reconstruction, Deep Inferior Epigastric Perforator, Latissimus dorsi flap, Gluteal Artery Perforator flap, and fat grafting.
Do the options differ whether the patient underwent radiation or chemotherapy?
Yes, the breast reconstruction options can differ depending on whether the patient underwent radiation or chemotherapy. Radiation therapy can significantly impact the tissues and skin of the breast, making them less pliable and more prone to complications. In patients who have received radiation, autologous tissue reconstruction is often preferred over implant-based reconstruction. The transferred healthy tissue from other parts of the body can provide better healing and more natural-looking results in radiated areas.
On the other hand, chemotherapy generally does not affect the choice of reconstruction options as directly as radiation therapy. However, chemotherapy can delay the timing of reconstruction, as I would prefer to wait until the patient has completed their treatment and allowed sufficient time for recovery, to have the best result
How can these complicate the outcome or success of the surgery? Radiation and chemotherapy can complicate breast reconstruction surgery in several ways: Radiation therapy can damage the skin and tissues, leading to delayed wound healing, increased risk of infection, skin changes, and scar tissue formation. These factors can negatively impact the appearance and longevity of the reconstructed breast, especially with implant-based reconstruction. Chemotherapy on the other hand, can weaken the immune system, making patients more prone to infections during recovery. It can also cause changes in weight and body composition, affecting the symmetry of the reconstructed breast. To minimize these complications, I prefer to optimize the timing of reconstruction and ensure patients have sufficiently recovered from their treatments before surgery. Careful planning can help reduce risks and improve the overall success of the procedure.
Is it best to have reconstruction immediately? What are the pros and cons of waiting?
The choice between immediate or delayed breast reconstruction depends on many factors, including patient preference. Immediate reconstruction combines surgeries, leading to quicker recovery and better body image. However, there are risks of longer surgery and complications. Delayed reconstruction allows time for cancer treatment focus and informed choices, but requires a separate surgery. The decision should consider the patient’s individual circumstances, preferences, and treatment plan.
What are some alternatives to surgical reconstruction?
There are alternatives to surgical breast reconstruction for those who prefer non-surgical options or are not suitable candidates. For example, prosthetic breasts (breast forms) are external silicone or foam forms that provide balance and do not require surgery; custom breast prostheses are professionally fitted to match the natural breast shape and size, or 3D nipple and areola tattoos offer a realistic look without surgery. These alternatives give patients choices without additional surgeries, catering to individual needs and preferences.
About Dr. Brandon Richland
Dr. Brandon Richland is a board-certified plastic surgeon with practices in Fountain Valley, Newport Beach, and Woodland Hills, California. He specializes in natural-looking mommy makeovers, breast augmentation, body contouring, and facial rejuvenation. A graduate of UCLA and Saint Louis University School of Medicine, Dr. Richland has earned top honors throughout his career, including the prestigious Top Surgery Student award. At Richland MD and Richland Aesthetics, Dr. Richland provides a full range of advanced cosmetic procedures, including breast augmentation, lifts, tummy tucks, facelifts, and non-surgical treatments tailored to each patient’s unique needs. Committed to excellence and innovation, Dr. Richland combines state-of-the-art techniques with personalized care to help patients achieve beautiful, natural results. View his incredible before and afters @Dr.Richland on Instagram and book a consultation at https://www.richlandmd.com/. Richland MD… A Luxury Medical Spa Experience.