Plastic Surgeon Dr. Neal Hoganson Offers Advice On Choosing A Treatment Plan That’s Best For You
Each year more than 254,000 American women face breast cancer, according to the American Cancer Society. And when a woman is diagnosed, she is faced with many decisions when it comes to treatment.
“The patient goes from day one of being totally normal and healthy to having a lump or a bump to being told that they have cancer,” said plastic surgeon Neal Hoganson, MD, Scott & White Clinic – College Station. “It’s overwhelming for everybody at first.”
And for many women, part of that treatment plan includes reconstruction of the breast.
What is breast reconstruction surgery?
“A lot of [breast cancer patients] require a mastectomy,” Dr. Hoganson said. “Following a mastectomy, typically, they have options for reconstruction. And the goal of reconstruction is to recreate the aesthetic appearance of a breast after the breast tissue has been removed.”
Making the breasts look more balanced when wearing a bra, permanently regaining the shape of the breast and not having to wear and external prosthesis are also reasons that someone might choose to have breast reconstruction surgery.
But choosing to have your breast or breasts reconstructed is just the first step. Patients must also choose between having the surgery immediately after having their cancer removed or delaying reconstruction to allow for healing and psychological processing time.
Should I have reconstruction surgery immediately after having my cancer removed?
“The pros of the immediate reconstruction would be that at the time of the definitive treatment to treat the cancer, steps are being taken to reconstruct the breast and save the patient an extra operation,” Dr. Hoganson said.
But having the reconstruction surgery immediately can be a lengthy operation and may cause cell death (called necrosis), according to the ACS. More surgery would be needed to fix the problem if this occurs.
“We want to be sure that the surgery we do won’t affect the patient’s ability to have radiation or chemotherapy,” he said. “One of the down sides of immediate [reconstruction] is that the breast cancer hasn’t been fully staged. Occasionally, there is data that we get from the pathology report that changes the treatment course”
What is a nipple-sparing mastectomy?
Historically, mastectomies remove the nipple and the areola because the majority of breast cancers involve the ducts, which are connected to the nipple.
But there’s been some recent data that shows that some patients may have a choice of sparing the nipple.
“It depends upon the type of cancer, location [of the cancer], and you want to make sure that it doesn’t complicate the cancer treatment by leaving it,” Dr. Hoganson said.
If the nipple and areola have to be removed, then they can be reconstructed later with other tissues.
How do I choose the right treatment plan for me?
Dr. Hoganson said he recommends to his patients that they pick a reconstruction plan that doesn’t commit them to something that could interfere with treatment.
“The most common initial reconstruction is the placement of an expander,” he said. “The expanders can be removed or they can be plated for radiation treatment. They can even stay in for chemotherapy.”
Tissue expanders are placed under the skin where the original breast was removed to prepare the area for the placement of a permanent implant or the patient’s own tissue.
“Patients have to decide what’s right for them and talk with their doctors to pick a plan that’s going to work out best for them,” Dr. Hoganson said.
For more information about breast reconstruction surgery and helpful resources, click here or visit cancer.org.
Have you had breast reconstruction surgery? What helped you make your decision?