Sunday, November 19, 2006

Age Not An Exclusion Criterion for Breast Reconstruction

Breast Reconstruction in Older Women: Should Age Be an Exclusion Criterion?

Plastic & Reconstructive Surgery. 118(1):16-22, July 2006.
Bowman, Cameron C. M.D.; Lennox, Peter A. M.D.; Clugston, Patricia A. M.D. +; Courtemanche, Douglas J. M.D., M.S.

Abstract:
Background: At present, breast reconstruction is undertaken by fewer than 10 percent of breast cancer patients undergoing mastectomy. Even though the benefits are numerous, this finding is even more notable among older women. Traditionally, women older than the age of 60 have been offered implant reconstruction or no reconstruction at all in hopes of minimizing potential morbidity. This practice may be due to a number of factors including a lack of patient education and information, as well as physician/surgeon bias regarding the safety or relevance of breast reconstruction in older women.

Methods: The authors undertook a retrospective study in which they surveyed 75 women (age range, 60 to 77 years) from two surgeons' practices who underwent various forms of breast reconstruction over the past 8 years. Type of reconstruction, recovery time, and complication rate were correlated with patient satisfaction, general health, and quality of life.

Results: An 81 percent response rate was obtained, yielding an average age of 66.6 years over a 3.8-year period. The overall rate of complications requiring operative intervention was 20.5 percent. When asked whether age should be a determining factor for breast reconstruction, more than 90 percent felt that it should not be. Only 16.1 percent of patients who had a delayed reconstruction stated that the option of breast reconstruction was presented to them at the time of their diagnosis, although 100 percent felt that it should have been. A significantly poorer physical health score was found among patients who experienced a complication, and lower mental health scores correlated with women who were less satisfied with their outcome.

Conclusions: The authors believe that all types of reconstruction should be an option for women older than 60 years of age and that age as an isolated factor should not deter physicians from offering these women the option of breast reconstruction.

******

Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including the DIEP flap procedure. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.

******

Saturday, November 18, 2006

One-Third of Breast Cancer Patients Unhappy with Outcome of Lumpectomy

Women with breast cancer often undergo a lumpectomy and radiation to save their breasts and avoid the need for additional reconstructive surgery. However, approximately one-third of all patients are unhappy with how their breasts look after undergoing breast conservation therapy and many would consider reconstruction, according to a study presented today at the American Society of Plastic Surgeons (ASPS) Plastic Surgery 2006 conference in San Francisco.

“I have patients walking into my office saying lumpectomy was supposed to save their breast but what’s left doesn’t look like a breast to them,” said Howard Wang, ASPS Member Surgeon and co-author of the study. “Conservation is believed to be an acceptable way of saving a woman’s breast. But many of these women are coming to plastic surgeons for help, saying it isn’t so.”

In the study, 28 percent of the breast cancer patients stated they were dissatisfied with the cosmetic result of their lumpectomy. Of those patients, 46 percent stated their physical appearance was worse or much worse after the surgery and were considering reconstruction. Only nine percent of patients who were satisfied with the outcome, however, would consider reconstruction if it were offered.

Approximately 26 percent of patients were unhappy with their physical appearance after the lumpectomy but had an improved sense of body image. Plastic surgeons believe this disparity occurred because many patients felt relieved to be free of the cancer, leading them to feel better about their bodies even though they were not happy with how their breasts looked.

According to the American Cancer Society, almost 213,000 women will be diagnosed with breast cancer this year. Almost 58,000 women underwent breast reconstruction surgery in 2005, according to ASPS.

“Patients should know their options and understand that just because they undergo a lumpectomy to save their breast does not mean they will be happy with the cosmetic outcome,” said Dr. Wang. “Oncologists need to work with patients to help them understand the potential physical outcomes and refer them to a board-certified plastic surgeon to consider all of their choices.”

For referrals to ASPS Member Surgeons certified by the American Board of Plastic Surgery, call 888-4-PLASTIC (475-2784) or visit www.plasticsurgery.org where you can also learn more about cosmetic and reconstructive plastic surgery.

The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. With more than 6,000 members, the society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

******

Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including the DIEP flap procedure. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.

******

Breast Reconstruction Not as Safe For Obese Patients

Significantly obese women may wish to consider delaying breast reconstruction following mastectomy until they achieve a healthier body weight. According to findings presented today at the American Society of Plastic Surgeons (ASPS) Plastic Surgery 2006 conference in San Francisco, women who are significantly obese are at higher risk for complications and have a lower satisfaction rate than do normal and overweight patients.

“Just because someone is overweight doesn’t mean they should not be entitled to undergo breast reconstruction after mastectomy,” said Elisabeth Beahm, MD, ASPS Member Surgeon, author of the study, and associate professor at M. D. Anderson Cancer Center. “Feeling ‘whole’ can be an integral part of recovery from cancer, yet significant concerns have been
raised about the wisdom of doing breast reconstruction in very obese patients due to a high complication rate.”

The current retrospective study found that patients with a BMI greater than 35 demonstrated significantly increased complication rates for all types of breast reconstruction, from implants to flaps. The complication rate approached 100 percent for morbidly obese patients with a BMI over 40.

“We investigated whether plastic surgeons can safely perform breast reconstruction for these patients or if we would be depriving them reconstruction simply because of empiric concerns for their weight,” said Dr. Beahm. “We found that significantly obese patients, those having a BMI of 35 or higher, had a higher risk for complications. Our experience suggests that in many cases it may be more prudent to delay breast reconstruction until the patient has lost weight.”

The most frequent complications for obese patients were fluid collections and infection at both the reconstructive site and the flap donor site. When the flap was harvested from the abdominal area, weakness and deformity of the abdominal wall such as hernia and bulge was much more common than in normal weight patients.

“While it’s very difficult to tell a patient she needs to wait for breast reconstruction, patient safety is our primary concern,” said Dr. Beahm. “We must not compromise the oncologic imperative in breast cancer. Each case must be individualized. Morbidly obese patients need to work with their plastic surgeons and carefully assess risk factors. Patients may be best served by deferring breast reconstruction until they have achieved and maintained a lower BMI through exercise and nutrition.”

For referrals to ASPS Member Surgeons certified by the American Board of Plastic Surgery, call 888-4-PLASTIC (475-2784) or visit www.plasticsurgery.org where you can also learn more about cosmetic and reconstructive plastic surgery.
The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. With more than 6,000 members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

******

Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including the DIEP flap procedure. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.

******

Breast Implants Do Not Cause Breast Cancer Recurrence In Mastectomy Patients

Early Detection and Treatment Not Hindered, Says Study Presented at American Society of Plastic Surgeons Annual Meeting

Women interested in immediate breast reconstruction after mastectomy should not worry that their implants could cause, hinder detection of, or affect treatment of cancer recurrence, according to a study presented today at the American Society of Plastic Surgeons (ASPS) Plastic Surgery 2005 conference in Chicago.

“For women contemplating immediate breast reconstruction, there is a lot of information being presented to them. As plastic surgeons, we want to help our patients feel better about their bodies without risking their safety and long-term health,” said Andrea Pusic, MD, ASPS Member Surgeon and co-author of the study. “It is important for us to provide them with hard facts that show an implant does not increase the chance that their cancer could recur, delay the diagnosis of a recurrence or affect the outcome.”

In the study, 309 women who had immediate breast reconstruction with an implant were compared, on the basis of age and stage of disease, to a group of 309 women who had mastectomy without reconstruction. The incidence of local breast cancer recurrence in reconstructed patients (6.8 percent) was not significantly different from non-reconstructed patients (8.1 percent). In addition, the implants did not hinder early detection of recurrence. Ninety-five percent of recurrences were initially detected by physical examination of the breast during regular check-ups with their plastic surgeon or oncologist. Five percent of recurrences were detected through a computer-assisted tomography (CT) or bone scan.

The treatment for recurrence was not affected by the implants and did not generally require removal of the implants. In the study, only three of the 21 patients who experienced a recurrence had their implants removed after treatment, and two of those patients specifically requested their implants be removed for personal reasons.

“We are pleased to report that treating breast cancer recurrence rarely requires the removal of patients’ implants,” said Dr. Pusic. “This is reassuring information for women who choose to have implant-based breast reconstruction.”

In 2004, almost 63,000 women had breast reconstruction after mastectomy, according to ASPS statistics. The American Cancer Society estimates 211,240 new cases of invasive breast cancer will occur in 2005 among women in the United States and more than 40,000 women will die from the disease.

The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. With more than 5,800 Member Surgeons, the society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

******

******

Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including DIEP flap reconstruction. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.

******

Immediate Breast Reconstruction After Mastectomy is Safe, ASPS Study Says

Debunking the myth that women with locally advanced breast cancer must wait until after chemotherapy to have their breast reconstructed, a study presented today at the ASPS/PSEF/ASMS 71st Annual Scientific Meeting in San Antonio found that immediate free flap reconstruction for women with breast cancer is safe and psychologically beneficial.

The study, which followed 170 patients with locally advanced breast cancer, found that immediate reconstruction did not delay post-operative chemotherapy, prolong recovery or hinder the diagnosis of local cancer reoccurrence.

"Losing a breast is traumatic," said ASPS Member James Watson, MD, and participating surgeon in the study. "As a board-certified plastic surgeon, I wanted to ensure that immediate breast reconstruction was safe for my patients and would make the healing process easier. The findings in this study will allow women to start healing sooner psychologically, knowing that their decision will not impede their physical progress against breast cancer."

The paper states that women participating in the study were pleased with their immediate reconstruction experience, indicating an immeasurable emotional benefit patients gain by having the reconstruction right away.

According to the findings, the majority of patients were either satisfied or very satisfied with their reconstruction and, if they had to, would have it done immediately after their mastectomy again. Also, the majority of women agreed they would recommend immediate reconstruction to a friend or colleague.

Through the study, Dr. Watson found that immediate free flap reconstruction - where a section of muscle, fat and skin are removed from the abdomen, buttocks or thigh regions and reattached in the breast using microsurgical techniques - resulted in similar complications and delays of post-operative chemotherapy to patients who delayed reconstruction. The most common postponement for patients was waiting for the wound to heal. However, the maximum delay was only three weeks, which did not have significant oncological impact on their post-operative therapy.

Also, while there were local reoccurrences of the cancer, physicians were able to diagnose the cancer's return quickly, resulting in no delay for additional treatment. Most local reoccurrences were located at the mastectomy scar or in the mastectomy flaps, which could be diagnosed by a physical exam and biopsy.

"An added benefit to reconstructing the breast immediately is that it's easier for the oncology surgeon to complete the mastectomy. Often, the breast cancer is so large or involves so much skin that the surgeon has to remove additional skin in the region, making it difficult to reserve enough tissue to close the wound," stated Dr. Watson. "With immediate reconstruction, the oncologic surgeon can eliminate more breast skin to ensure the cancer is removed and use the skin from the free flap procedure to close the wound."

Last year, more than 190,000 women were diagnosed with breast cancer. More than 80,000 women opted for breast reconstruction following a mastectomy, according to ASPS 2001 statistics.

Access to breast reconstruction following a mastectomy has increased due to the passage of the Women's Health and Cancer Rights Act 1998, proudly supported by ASPS, which mandated insurance coverage for breast reconstruction and the alteration of the opposite breast for symmetry for women who have undergone a mastectomy.

"With the finding that reconstruction right after mastectomy is safe, women can maximize their opportunity to not only heal physically but also psychologically right away," said Dr. Watson. "Before, women had to wrestle with their changed body image after losing a breast while physically recovering from their battle with cancer. Now, they don't have to delay the psychological healing process of beating breast cancer and celebrating that victory."

ASPS, founded in 1931, is the largest plastic surgery organization in the world and the foremost authority on cosmetic and reconstructive plastic surgery. ASPS represents physicians certified by The American Board of Plastic Surgery (ABPS) or The Royal College of Physicians and Surgeons of Canada. For referrals to ABPS-certified plastic surgeons in your area and to learn more about cosmetic and reconstructive plastic surgery, call the ASPS at (888) 4-PLASTIC (1-888-475-2784) or visit www.plasticsurgery.org.

******

Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including DIEP flap reconstruction. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.

******

Breast Reconstruction Helps Cancer Patients Return to Normalcy, According to the American Society of Plastic Surgeons

"It's only a part of my body, not my life," said Lola Sawyers when she was diagnosed with breast cancer in October 1997. The diagnosis was not a shock to Sawyers as her mother had breast cancer.

Lynette Dilbert, whose sister died from breast cancer, was determined not to let the disease take over her life when she was diagnosed in August 2000. "I'm in charge of what I decide," explained Dilbert about her treatment.

Just eight months after Judy Tanner's husband died from a brain tumor in June 1998, she found a lump on her right breast while dressing. Devastated by her husband's death, the diagnosis of breast cancer was hard to bear, but like Sawyers and Dilbert, Tanner would not let the disease take her life.

Through research and discussions with physicians and breast cancer survivors, these women made a firm decision - after mastectomy they would undergo breast reconstruction.

This year, more than 175,000 women in the U.S. will be diagnosed with breast cancer. However, if diagnosed and treated the survival rate is greater than 90 percent. For those women, whose treatment includes either partial or full mastectomy, advances in breast reconstruction and breakthrough legislation helps make this devastating news easier to bear.

"Strength and determination are simple words, yet they are strong terms that truly describe Lola, Lynette and Judy," said American Society of Plastic Surgeons President Walter Erhardt, MD, Albany, Ga., about his patients. "Choosing breast reconstruction is a big decision when facing this life-altering disease, but as any plastic surgeon can tell you, after breast reconstruction, survivors have a renewed sense of self-esteem and confidence.

"After breast reconstruction, no one can tell I had cancer," explained Dilbert. Tanner noted that she felt like a whole woman again. "I'm looking better than I did before," she said. "Even my co-workers have noticed a positive change in me."

Nearly 79,000 breast reconstruction procedures were performed last year, a 166 percent increase since 1992. The passage of the Women's Health and Cancer Rights Act of 1998 has aided this increase. The law mandates insurance coverage for breast reconstruction and the alteration of the opposite breast for symmetry for women who have undergone mastectomy. The law applies to women with group health insurance or a health insurance plan purchased through a health insurance company.

Discussion about breast reconstruction can start immediately after diagnosis. Typically, plastic surgeons make recommendations based upon the patient's age, health, anatomy, tissues and goals. The most common procedures include skin expansion followed by the use of implants, or flap reconstruction.

"Breast reconstruction gives patients the ability to feel whole again," said Dr. Erhardt. "As a plastic surgeon it's rewarding to see my patients develop a renewed confidence and love of life."

When confronted with breast cancer, Sawyers, who is known as the lemonade lady in her community because she's taken life's lemons and made lemonade, reminds woman to look at all the options. "Make reconstruction a personal choice based on what you believe and what you know," she says. "Let the final decision be yours."

"Loosing a breast is not the end of the world," said Dilbert who is active in her community's breast cancer advocacy programs. "I constantly remind women to schedule their mammograms."

Tanner strongly advises women to ask questions when choosing reconstruction. "Find out all you can about the surgeon's credentials, talk to other patients and do your homework," she reminds.

ASPS, founded in 1931, is the largest plastic surgery organization in the world and the foremost authority on cosmetic and reconstructive plastic surgery. ASPS represents physicians certified by The American Board of Plastic Surgery (ABPS) or The Royal College of Physicians and Surgeons of Canada. For referrals to ABPS-certified plastic surgeons in your area and to learn more about cosmetic and reconstructive plastic surgery, call the ASPS at (888) 4-PLASTIC (1-888-475-2784) or visit www.plasticsurgery.org.

******

Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including the DIEP flap procedure. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.

******

Breast Cancer and Reconstruction: Exploring the Options, Procedures and Perceptions

By Lisa Barclay

Breast cancer. It is the leading cancer diagnosed in women in America. This year, it will affect the lives of more than 180,000 women for the first time – and end the lives of 40,000 more. Thanks to proactive efforts like National Breast Cancer Awareness Month celebrated in October, the disease doesn't automatically mean a death sentence. However, the impact breast cancer has on the lives of its victims is arguably life altering – and not easily erased.

In this article, we will share the experiences of five women who have survived the disease, as well as the expertise of several American Society of Plastic Surgeons (ASPS) members who specialize in breast reconstruction after breast cancer. It is our hope that the information presented in this article will serve as a valuable resource in your journey through breast cancer treatment and recovery.

A Diagnosis of Cancer

Fear. Shock. Denial. These are just a few of the emotions women experience upon learning they have breast cancer. Jayne Siebold, of Hinsdale, Ill., was 49 when she was diagnosed with the disease and explains her initial reaction to the news. "When the doctor confirmed it was cancer, I remember thinking, 'They can't be talking about me, this must be a mistake.' Then the fear kicked in."

Barbara Taylor of Dallas went into physical shock. "Everyone I had ever known or heard of who had the disease died from it. So the fear I experienced initially was completely overwhelming, virtually crippling."

When Sue Kocsis of Omaha, Neb., was diagnosed she was 34 years old and the mother of three little girls. "The entire process was extremely overwhelming. It took visits to five different physicians before the cancer was actually diagnosed, so in the beginning I was relieved to know just what I was dealing with – but felt a tremendous amount of anger toward the doctors who kept telling me it was just fibrocystic disease and nothing to worry about."

The treatment of breast cancer involves a physical change to the body. As a result, it can have a profound psychological impact. "A woman's breasts are deeply rooted in her sense of femininity...her role as mother and nurturer, " says Jack Bruner, M.D., of Sacramento, Calif. "Therefore, facing the loss of one or both breasts can be very traumatic." Dr. Bruner recommends that every women diagnosed with breast cancer request information about reconstructive options from their general surgeon and seek the opinions of several plastic surgeons prior to surgery.

Reconstructive Solutions

Almost any woman who loses her breast to cancer can have it rebuilt through reconstructive surgery. And discussion about reconstruction can start immediately after diagnosis. Ideally, you'll want your breast surgeon and your plastic surgeon to work together to develop a strategy that will put you in the best possible condition for reconstruction.

There are several reconstructive options available after mastectomy. Typically, your plastic surgeon will make a recommendation based upon your age, health, anatomy, tissues and goals. The most common procedures include skin expansion followed by the use of implants or flap reconstruction.

Flap reconstruction is a more complex procedure than skin expansion. Scars will be left at both the tissue donor site and at the reconstructed site, and recovery time is longer than with an implant. However, when the breast is reconstructed with one's own tissue, the results are generally more natural and concerns related to implants are non-existent. Recovery times for both procedures range from six months to one year, or longer, depending on individual circumstances.

Skin Expansion

This common technique combines skin expansion and subsequent insertion of an implant. Following mastectomy, your plastic surgeon will insert a balloon expander beneath the skin and chest muscle. Through a tiny valve mechanism buried beneath the skin, he or she will periodically inject a salt-water solution to gradually fill the expander over several weeks or months. After the skin over the breast area has been sufficiently stretched, the expander is removed in a second operation and a more permanent implant – either saline or silicone – will be inserted. Some expanders are designed to be left in place as the final implant. The nipple and dark skin surrounding it – called the areola – are reconstructed in a subsequent procedure.

Flap Reconstruction

An alternative approach to implant reconstruction involves creation of a skin flap using tissue taken from other parts of the body, such as the abdomen, back or buttocks. In one type of flap surgery, the tissue remains attached to its original site, retaining its blood supply. The flap, consisting of skin, fat and muscle with its blood supply, are tunneled beneath the skin to the chest, creating a pocket for an implant or, in some cases, creating the breast mound itself without need for an implant. Another flap technique uses tissue that is surgically removed from the abdomen, thighs or buttocks and then transplanted to the chest by reconnecting the blood vessels to new ones in that region.

Making the Choice

Breast cancer affects women differently depending on their age, marital status and self-image, as does their attitudes about reconstruction. No matter how they feel about it, Glenn Davis, M.D., of Raleigh, N.C., stresses that "every woman should be afforded the choice of undergoing reconstruction as part of her breast cancer treatment, and provided adequate facts to make an informed decision.

Unfortunately, many women are not given the option or the information they need to make an informed decision about reconstruction. According to Christine Horner-Taylor, M.D., of Edgewook, Ky., the women who don't undergo reconstruction procedures after losing a breast to mastectomy have many reasons for doing so. "Many women have told me the reason they didn't have breast reconstruction was because their general surgeon didn't recommend it or didn't mention that it could be done at the same time as the mastectomy. If the women are older, their surgeon may have decided they don't really need to go through it," she says.

Other reasons women pass on reconstruction include their unwillingness to have any more surgery than is absolutely necessary and an inability to weigh all the options available while they're struggling to cope with a diagnosis of cancer.

When Reconstruction May Not Be an Option

Not all women are good candidates for breast reconstruction. According to Dr. Horner-Taylor, "Women who have had a mastectomy or Lumpectomy with radiation are typically not strong candidates for skin expansion reconstruction. Radiation changes the characteristics of skin tissue, causing a variety of complications ranging from excessive scar tissue development, to blood supply and overall healing problems."

Dr. Davis feels that while radiation does present some difficult challenges, it doesn't automatically rule out the possibility of reconstruction. "While each circumstance is different, I strongly believe that if there is enough good tissue to work with, reconstruction remains a viable option for most women," he says.

Dr. Bruner notes that patients that are emotionally unstable should probably postpone reconstruction. "Coping with the reality of breast cancer is an extremely overwhelming process. If a woman cannot understand the risks and limitations of reconstruction prior to her mastectomy surgery, I would recommend she wait."

Managing Misconceptions

Misconceptions abound regarding breast cancer reconstruction. "Most misconceptions are fueled by a lack of information," says Dr. Bruner.

Common misconceptions include having to wait up to one year to safely undergo reconstruction, reconstruction makes it difficult to identify cancer if it recurs, and reconstruction interferes with cancer treatments, such as chemotherapy.

"Wrong on all counts," says Dr. Horner-Taylor. "Reconstruction can take place immediately following mastectomy with little complication. In the case of implants, reconstruction may take longer if the patient has to undergo chemotherapy, but otherwise doesn't interfere with the process."

Managing Expectations

Managing patient expectations is one of the most important aspects of breast cancer reconstruction. It is important for women to remember that the goal of reconstruction is improvement, not perfection. "Be sure to discuss your expectations candidly with your plastic surgeon, and expect nothing less than total honesty from him or her in return," says Dr. Horner-Taylor. "It's always smart to get the opinions of several plastic surgeons before moving ahead."

To ensure reconstructive surgery has the desired outcome, breast symmetry procedures – surgery to the other breast – is usually also part of the reconstructive process. "Symmetry procedures either reduce, lift or reshape the remaining breast to ensure a better match to the reconstructed breast," says Dr. Bruner. He goes on to note that symmetry procedures can be an ongoing process, with periodic adjustments necessary to correct the affects of the aging process. ASPS is currently pushing for legislation to ensure women have access to symmetry procedures as part of their reconstruction treatment after breast cancer.

Dolores Glover, Siebold and Kocsis all decided to undergo reconstruction procedures – Siebold at the same time as her mastectomy, Glover 10 years later and Kocsis one year later. Glover and Siebold opted for skin expansion with implants. Kocsis decided to go with flap reconstruction.

"Breast reconstruction was the number one motivation that got me through the most difficult times of my treatment," says Siebold. "The breast reconstruction, although excellent, will never look or feel the same as a natural breast. However, not having to stuff my bra with fillers is a great relief, and I truly feel like a complete woman again."

Glover was never given the option of reconstruction at the time her cancer was diagnosed and her mastectomy performed. She was 38. "I was so busy being a mom to my two children and a wife that I didn't think about reconstruction initially. I also didn't want to endure any more pain or surgery, although my oncologist strongly recommended it," she says. However, every time she caught a glimpse of herself in the mirror, she was reminded of her disfigurement. "I felt deformed, and that feeling never went away until I had reconstruction. I eventually did use a prosthesis, but still wasn't happy with the results." Ten years after her mastectomy, Glover finally decided to have breast reconstruction. "I'm glad I had it done. It helped me to find closure and feel normal again."

For Kocsis, breast reconstruction was a completely mind restorative process. "The day I had my reconstructive surgery was the day I took my life back," she says. She first learned about flap reconstruction through a local support group and decided to undergo the procedure one year after her diagnosis. "I liked the idea of using natural tissue for the reconstruction, and once I made the decision to have surgery, I actually looked forward to having it done." The reconstruction was a success and Kocsis is thrilled with her results. "I really feel great about my decision and the end result. In fact, my family and I celebrate the date of my surgery every year as my re-birthday." Kocsis is now active in public education efforts for breast cancer and reconstruction, writing articles, conducting interviews and giving presentations.

Davis decided not to undergo reconstruction, although she was prepared to go through with it until the day before her mastectomy. "I just decided that I didn't want to be under anesthesia or on the operating table that long," she says. And five years later, she's confident she made the right decision. "It was more important to me to focus on treating the cancer. My breasts are not that important to me, they don't define who I am as a person."

Making An Informed Decision

The decision to undergo breast reconstruction is an intensely personal one. All of the ASPS members interviewed for this article agree that the decision should be made by the patient, not by treating physicians. "It really is a quality of life issue," says Dr. Davis. "And it doesn't matter how old the patient is or if they're married or single. All women should have the option, if they want it."

The most important tool available to women coping with breast cancer is information. "Women need to get as much information as they can, from doctors, cancer organizations, support groups and other women," says Dr. Bruner. "And they shouldn't be afraid to ask the tough questions, as many as necessary to increase their comfort level with their treatment and aid in their recovery process."

To learn more about your breast reconstruction options CLICK HERE.

For more information about breast cancer, call any of the following toll-free numbers:

American Cancer Society
1-800-ACS-2345

Cancer Care, Inc.
1-800-813-HOPE

Cancer Research Foundation of America
1-800-227-2732

National Alliance of Breast Cancer Organizations (NABCO)
1-800-719-9154

National Cancer Institute's Cancer Information Service
1-800-4-CANCER

Y-ME National Breast Cancer Organization
1-800-221-2141


******

Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including the DIEP flap procedure. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.

******