UC HEALTH LINE: Decision to 'Reconstruct' Personal, Emotional for Breast Cancer Survivors

Cincinnati—Breast cancer is an intense, varied journey for every woman. For many, the challenges of that quest do not end when they are deemed “cancer-free.”

“Many patients—especially young survivors—are frustrated by the appearance of their breasts after cancer surgery but find the idea of a permanent prosthesis (implants) unappealing,” explains Jesse Taylor, MD, a University of Cincinnati (UC) plastic surgeon who specializes in microsurgical reconstructive surgery at University Hospital.

“I always encourage my patients to think seriously about how much surgery they can handle,” he adds. “Reconstruction is another major surgery that requires recovery time and carries some risks.”

According to American Society of Plastic Surgeons statistics, more than 106,000 women chose to have breast reconstruction last year—a 25 percent increase from 2000.

Reconstruction techniques have advanced, allowing specially trained surgeons to do muscle-sparing reconstructive surgery using the patient’s own tissue which, according to Taylor, is more appealing to patients.

“Using the patient’s own tissue allows us to create a more natural breast—both in appearance and feeling,” says Taylor. “Accepting implants can be psychologically challenging because you’re introducing a foreign element, something that your body will naturally resist.”

Taylor says no woman should feel like she has to live with physical disfigurement after breast cancer surgery with the safe, modern reconstruction techniques available today.

He specializes in a microsurgical reconstruction procedure known as the DIEP (deep inferior epigastric perforator) where he creates a new breast using the patient’s own tissue and fat. During the procedure, Taylor surgically reattaches tiny blood vessels from the transplanted tissue to the chest wall.

Traditional breast reconstruction uses TRAM (transverse rectus abdominis muscle) flaps where entire pieces of muscle, skin and fat are moved up from the lower stomach into the chest cavity to form a breast. The procedure can lead to abdominal hernias, loss of abdominal muscle control and fat necrosis, a condition where the skin continues to live but the underlying fat dies and forms a firm mass. The masses, in turn, lead to cancer scares and more biopsies.

The DIEP flap procedure spares the muscle, reducing the risk for complications associated with TRAM flap surgery, improving the tissue’s blood supply and retaining abdominal muscles. The result is a more natural breast, both in feeling and appearance. 

Taylor cautions women to consider several things when making a decision about reconstruction:

• Implants are much safer than in the past, but require maintenance. When you get breast implants, it is a lifetime commitment. Because an implant is recognized by the immune system as foreign, the body may try to reject it and lead to a higher risk of infection. Women who choose implants should have them regularly checked by a plastic surgeon.

• No type of reconstruction will restore your breast to its precancerous state. With microsurgical reconstruction, some patients may benefit from partial sensation in the breast, but this will not restore sensual arousal from stimulation.

• Muscle-sparing reconstruction is not guaranteed to work. Although microsurgical reconstruction is preferable in terms of look and feel, there is still a risk that the revascularization will not be successful and the harvested tissue could die.

• If you do choose to reconstruct, most insurance plans will cover the cost of surgery. The 1998 Federal Breast Reconstruction Law guarantees certain medical coverage rights to breast cancer patients who opt to have reconstructive surgery. Contact your insurance provider for more information.  

For more information on breast reconstruction options at UC, visit www.cosmeticsurgeryuc.com. Appointments with Taylor can be made by calling (513) 475-8881.