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Dr. Salzberg provides an overview of the surgical options for breast cancer removal and breast reconstruction choices faced by mastectomy patients:

Breast cancer gets a lot of attention during October’s Awareness Month, but women have this diagnosis every day, all year long. Many of them aren’t aware of their surgical options for cancer removal or breast reconstruction. I’ll provide an overview, but keep in mind that chemotherapy and/or radiation play a part in surgical treatment decisions for some women.

Many women with breast cancer can keep, or preserve, their breasts by having a lumpectomy. We remove the tumor (“lump”) and some area of surrounding healthy breast tissue. After radiation treatments, removing a tumor may leave a noticeable indentation in a breast, or the two breasts will appear asymmetrical (uneven). In those cases, we use nearby healthy breast tissue to fill in the indentation, and sometimes reduce (make smaller) the unaffected breast to match their size and shape. (Note that radiation treatments are almost always required after lumpectomy to destroy any remaining potential cancer cells.)

Mastectomy, complete removal of breast tissue, and breast reconstruction procedures have improved enormously over the decades, and can result in breasts that look very natural. In fact, a woman whose cancer is located far enough from the nipple area may be eligible for “nipple-sparing” mastectomy; the nipple is never surgically removed from the breast at all.

Breast reconstruction is most frequently performed in multiple procedures using implants, and typically takes many months to complete. After mastectomy, a deflated balloon-like device called a “tissue expander” is put in the breast and filled with salt water over three to six months until the desired size is achieved. A second surgery is required to put in the permanent implant.

To avoid this lengthy and uncomfortable expander process, and to enable a woman to wake from mastectomy with breasts in place, I developed a new method of reconstructive surgery called “Direct-to-Implant.” With this procedure, we put a permanent implant in the breast immediately following the mastectomy. Simply put, we use a specially prepared tissue material that makes a space for the implant without having to use tissue expanders. There is no months-long filling process or need for a second surgery.

Another mastectomy breast reconstruction option is microsurgery which utilizes a woman’s own skin, fat and muscle (from abdomen, buttocks, back, thigh or hip) instead of implants. This procedure is commonly referred to as a “free tissue flap.” This DIEP surgery is complex and has a longer recovery time than implants, but results in breasts that look and feel very natural.

I’d like to offer some tips for women facing cancer-related breast reconstruction:

  • Do your homework to gather information on types of mastectomy and breast reconstruction procedures and surgeons. Talk to other women about their experiences. Read discussion boards on support group websites. Find information on medical websites or journals.
  • If a surgeon says you’re not eligible for a certain type of surgery, there may be a valid reason OR it may be that he/she doesn’t perform that surgery. Find a surgeon with expertise in the procedure, and be sure to ask how many they’ve done.
  • Ask the surgeon to show you patient before-and-after photos, and not just successful cases. A skilled, confident surgeon will also show you cases that did not have ideal results, and explain why not.
  • Get a second opinion to find a procedure and surgeon that feels right for you. Insurance will usually cover a second opinion.
  • Insist on great results and do not compromise as breast reconstruction will make you whole again. If your breast or general surgeon tells you to wait until later, insist on a plastic surgery consult with a board-certified (ASPS) surgeon.

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