Breast reconstruction 101: Q&A with Dr. Lucio Pavone

October 12, 2016 | by Lucio Pavone, M.D.

There is nothing worse than feeling uncomfortable in your own body. Many women worry about how they will look and feel about themselves after a mastectomy or lumpectomy. Good news — you can have breast surgery and still feel like you when it’s done.

Breast reconstruction can restore one or both breasts to near normal shape, appearance, symmetry and size. It can also renew and restore a woman’s confidence and self-esteem. Not sure what the procedure entails and if it’s right for you?

We recently spoke with plastic and reconstructive surgeon Lucio Pavone, M.D., who provided answers to some common questions about breast reconstruction:

What are common concerns patients have about breast surgery?

When I first meet a patient, they are often preoccupied with the cancer diagnosis. As such, they often ask how undergoing breast reconstruction will impact their cancer treatment and ask questions like:

  • Will having breast reconstruction increase the chances of the cancer recurring?
  • Will having breast reconstruction affect the ability to detect a recurrence if the cancer does come back?

Patients are reassured to learn that breast reconstruction does not increase the chance of cancer recurrence, nor does it affect the ability to detect cancer recurrence. Once a patient has been educated on the options for breast reconstruction, their focus of concern shifts to how undergoing breast reconstruction will impact their life by asking:

  • What do reconstructed breasts feel like?
  • Will having breast reconstruction affect my ability to exercise?

Patients are happy to learn that once the healing process is completed, they may return to their usual activities, including exercise.

What is the goal of breast reconstruction?

Simply stated, the goal of breast reconstruction is to create an aesthetically-pleasing breast mound. With advances in breast and reconstructive breast surgical techniques, the appearance of the breast can actually be improved upon after undergoing mastectomy and reconstruction. Reconstruction of the breast also carries important psychological benefits. It not only restores form, but also returns a patient’s sense of self and femininity after undergoing a mastectomy.

What reconstructive options are available?

The options for reconstruction can be classified into two main categories: reconstruction with implants and reconstruction with the patient’s own tissue (autologous reconstruction).

  • Implant-based reconstruction involves replacing the breast tissue with a breast implant. Traditionally, this type of procedure was performed in two stages, with placement of a temporary implant at the time of mastectomy followed by a second procedure to place a permanent implant. Nowadays, a permanent implant can sometimes be placed immediately after mastectomy (direct-to-implant reconstruction).
  • Autologous reconstruction uses the patient’s own tissue to reconstruct the breast. Most commonly, the tissue is borrowed from the lower abdomen in a manner similar to a tummy tuck. Using microsurgical techniques, the blood vessels from the transferred tissue can be connected to the blood vessels at the mastectomy site so that the tissue receives nourishment and stays alive. Other donor sites include the upper thigh and buttock area.

There are advantages and disadvantages of each technique and not every patient is a candidate for both techniques. During the pre-operative consultation, the reconstructive options are reviewed with the patient and a reconstructive plan is devised which factors in the patient’s desires, patient characteristics (size, general health) and oncologic needs.

Can reconstruction happen at the time of surgery?

Most times, immediate reconstruction can take place at the time of mastectomy. For locally advanced cancers and for patients who will require radiation following mastectomy, delayed reconstruction is preferable.

What is recovery like?

Recovery is different for each individual patient and depends on many factors, including the patient’s overall health and type of reconstruction. In general, full recovery can be anticipated by 4-6 weeks. 

Do patients’ breasts look and feel natural after surgery?

The goal of breast reconstruction is to create a breast that looks and feels natural. Part of the pre-operative consultation includes a demonstration of the various types of implants, as well as typical post-operative results, so patients can make the choice that’s right for them.

How do you help patients determine if reconstruction is right for them?

Unfortunately, many breast cancer patients nationwide, are not informed about the options for reconstruction at the time of their cancer diagnosis. Of those who are informed, it is estimated that 1 in 5 patients undergo reconstruction at the time of mastectomy.

Lack of adequate education regarding reconstruction options is commonly cited as a factor contributing to the relatively low percentage of patients who undergo reconstruction. A pre-operative consultation can educate you about the process of reconstruction and the options available, so you can make an informed decision about whether reconstruction is right for you.

Learn more about breast health at Edward-Elmhurst Health.

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