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Daily Checkup: Surgery advances make breast reconstruction an option for every woman having a preventive mastectomy

An interview with Dr. Salzberg in the NEW YORK DAILY NEWS © Copyright 2015, New York Daily News, All Rights Reserved.

THE SPECIALIST

As director of integrated plastic surgery services at Mount Sinai, Dr. Andrew Salzberg specializes in breast reconstruction. He has reconstructed over 2,000 breasts in his 28-year career.

WHO’S AT RISK

Since Angelina Jolie made her preventive double mastectomy public in 2013, more and more American women are making the same choice — and advances in breast reconstruction surgery are making this option more appealing.

“Breast reconstruction is the process of creating a breast and breast mound after a mastectomy has removed breast tissue,” says Salzberg. “Every woman who has had a mastectomy is a candidate for breast reconstruction, whether she had a mastectomy 20 years ago or she is planning a future mastectomy and wants to have immediate breast reconstruction on the same day.”

Breast cancer is pervasive across American society. “One in eight women in the U.S. will have breast cancer in her lifetime,” says Salzberg. “Breast cancer is common in all ethnic groups and all walks of life. Some people are genetically positive, or predisposed to developing the disease.”

While some groups, including Ashkenazi Jewish women, are at particularly high risk of being genetically positive, people from every background can carry genes that make them much more likely to develop breast or ovarian cancer down the road.

In the past, most women who had a mastectomy did not have breast reconstruction. “Every woman who has had a mastectomy is a candidate for breast reconstruction, and we now encourage women to have immediate breast reconstruction at the time of mastectomy,” says Salzberg.

“What we’ve found is that patients who have breast reconstruction do better physically and emotionally, and there’s even some suggestion that the procedure is associated with improved longevity.”

Nationwide, only 30% of women who have mastectomies today are offered a breast reconstruction. “It’s actually New York state law that you have to offer a woman breast reconstruction if she is having a mastectomy — they must be informed that this is an option,” says Salzberg. “Unfortunately, many thousands of woman around the country have had mastectomies and never been offered a reconstruction.”

SIGNS AND SYMPTOMS

The sign that you might be a candidate for breast reconstruction is straightforward. “The only symptom is that the patient either has a defect in the breast or an absent breast,” says Salzberg. “Women who are having mastectomies or lumpectomies can all benefit from breast reconstruction, as can women who have had mastectomies in the past.”

TRADITIONAL TREATMENT

Women who are planning a future mastectomy can choose to have an immediate reconstruction as part of their planned elective surgery. “When you are meeting with your breast surgeon about the mastectomy, make an appointment to see a plastic surgeon who can take you through the options of breast reconstruction,” says Salzberg. “One big decision is whether you prefer to use your own body tissue or an implant.”

Many different factors go into the decision about what kind of reconstruction to have. “Some things we have to consider are symmetry (because we always want to match both breasts), personal choice and what we call body habitus.

“For instance, if you don’t have much body fat, you’re a better candidate for implants, but if you are heavier set, you are a better candidate for using your own tissue.” Smokers tend to have more surgical complications, because the habit decreases circulation.

Every woman should be thoroughly educated about what to expect on the day of surgery and in the recovery period. “A mastectomy plus reconstruction with implants takes about 21/2-3 hours, while reconstruction using your own tissues takes 6-8 hours,” says Salzberg.

“We get patients up and walking, eating and drinking and functioning on the same day as surgery,” he says. Most patients stay in the hospital 24-48 hours.

Patients recover from this surgery remarkably quickly. “We generally tell patients that you need one or two weeks minimum to take it easy, not lift heavy objects and not push or pull hard,” says Salzberg. “At about two weeks, patients can run, they can swim, but it really depends on the patient and their activity level. Most are sealed and healed by two weeks.”

Whether to have breast reconstruction and what type of procedure to use are always individual decisions. “You want to make the decision for yourself, not for the doctor, and not for your husband,” says Salzberg. “I’ve had patients tell me, ‘I feel great, my risk of breast cancer is gone, and I look even better than before. This is a surgery about helping women to feel whole again.”

RESEARCH BREAKTHROUGHS

In the past, mastectomy and breast reconstruction were done as two separate operations, but Salzberg pioneered a procedure that allows for mastectomy and reconstruction on the same day. “The direct to implant breast reconstruction option incorporates a sheet of collagen that we use to extend the muscle as well as skin and tissue that were donated by other patients, which allows us to do the procedure immediately — directly following the mastectomy,” says Salzberg. “This is a nipple-sparing surgery that gives an immediate, cosmetically pleasing result, and spares women months of waiting to have a second surgery, and the longer recovery time that came with it.”

QUESTIONS FOR YOUR DOCTOR

Every woman should feel empowered to ask, “Should I get genetic testing?” If you are in a high-risk group — if you have a strong family history of breast cancer or ovarian cancer, if you’ve tested positive for BRCA, if you’ve had pre-menopausal breast cancer in the past — then the question to ask is, “Am I a candidate for prophylactic mastectomy?” Follow up with, “What are the risks and benefits of the possible procedures?”

“Once the surgeon removes the tumor, it’s gone and there’s no point to living the rest of your life without a breast,” says Salzberg. “Breast reconstruction can be tailored to fit each woman’s activity level and body type, and it helps make women feel whole again.”

WHAT YOU CAN DO

Get informed.

Start your online search at the American Cancer Society (http://www.cancer.org/cancer/breastcancer) or Mount Sinai Doctors’ New York Group for Plastic Surgery (nygps.staging.wpengine.com).

Get tested.

If you have any reason to suspect that you have an elevated risk of breast cancer, talk to your doctor about genetic testing.

Don’t assume it’s too late.

Women who had mastectomies decades ago are still candidates for breast reconstruction, and the technology has improved by light years.

By the numbers:

One in eight American women will have breast cancer in her lifetime.

Only 30% of women nationwide who have mastectomies are offered breast reconstruction.

Most women are returning to normal activities within one to two weeks of breast reconstruction.

Dr. Salzberg

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