A Breast Reconstruction Surgeon’s Thoughts On What You Should Know 

Did you know that one in every 29 South Africans will be diagnosed with breast cancer during their lifetimes? It also happens to be the most prevalent cancer in South Africa. These are some scary statistics, but the good news is that breast cancer is treatable when detected early. There are also countless treatment options and breast reconstruction options available.

Early detection

It used to be recommended that women undergo annual screening mammograms from the age of 40. However, data from recent studies has increased this to 50 years old in Europe and Canada. At present, South Africa doesn’t have guidelines for screening for breast cancer. Women who have an increased risk (a strong family history of breast cancer suggesting a genetic link) should have screening from a younger age.

A mammogram is an x-ray of the breast tissue that can result in the detection of breast cancer up to two years before a tumour can be felt by you or your physician. Regular mammograms play a key role in early detection.

All women can do a self-examination on a monthly basis. Signs that you should keep an eye out for include a lump in the breast or underarm area, as well as skin irritation or dimpling. Lesser known symptoms include nipple pain or the nipple suddenly turning inwards, and unusual nipple discharge and swelling of all or part of the breast. If you notice anything out of the ordinary, book an appointment with your physician. 

Treatment options

The initial treatment of breast cancer typically involves surgery. The desired outcome of surgery is the removal of the cancer while conserving normal breast tissue. Since this isn’t always a possibility, you may require a mastectomy. A mastectomy involves removal of the affected breast tissue.

You may also need to undergo radiation either before or after surgery. This involves using high-energy x-rays to shrink tumours and to destroy cancerous cells. Chemotherapy is also often used to kill cancer cells. This involves patients being given a combination of drugs in pill format or via injection. Your oncologist will advise you on whether the above treatments are beneficial and will help you decide what is best for you.

A useful tip: if chemo is in your treatment plan, consider having eyebrow tattooing prior to starting.

Life after a mastectomy

Regardless of your age or relationship status, it’s difficult to predict how you’ll feel after a mastectomy. Since breasts are considered one of the hallmarks of becoming a woman, it’s perfectly normal to feel intense grief and anxiety after losing a breast. Breasts play a significant role in a woman’s sexuality, and you may have used your breasts to feed your babies. You’ll experience a plethora of emotions when faced with losing your breast. The good news is that there are many good options available today, should you choose to undergo breast reconstruction. Click here to hear Liza’s story

Important questions to ask yourself

It’s vital that you spend some time thinking over all the options available to you, to ensure that you make a decision best suited to your lifestyle. Here are some helpful questions to ask yourself and to discuss with your doctor:

  • Am I a suitable candidate for breast reconstruction?
  • Is it possible to have reconstruction done at the same time as my mastectomy?
  • Will reconstruction interfere with chemotherapy and/or radiation therapy?
  • How important is rebuilding the breast to me personally?
  • Could I live with a breast that I can put on and take off?
  • Am I mentally and physically prepared for more surgery, if I were to opt for delayed reconstruction?
  • What types of reconstruction are available to me, and what are the costs associated with each type?
  • How much discomfort or pain will I feel?
  • Will my medical aid cover it?
  • What type of reconstruction does my doctor think is best suited to me?
  • How long will I need to be in hospital for?
  • Will the reconstructed breast match my other breast?
  • What problems may arise from having a breast reconstruction? Are there any risks involved?
  • How long will the breast reconstruction last?
What are my options?

There are several options available to women who have had a mastectomy, and while most women typically choose to have some form of reconstruction, many choose to go flat. ‘Going flat’ or ‘living flat’ refers to the decision not to undergo reconstruction or use prosthesis. This is the safest option if you have any health issues that may put you at risk if you had to undergo another surgery. Many women who do not have access to medical aid or adequate funds to cover the cost of breast reconstruction may also choose to go flat.

Often, women who don’t have the option of breast reconstruction opt for a prosthesis or a ‘breast form’ to help them feel more confident and look more balanced without surgery. The quickest way to fill the space where your breast once was is by using a breast form. They come in many shapes and sizes, and you can slip your breast form into a specially designed bra or attach it to your breast using an adhesive patch. The adhesive patches typically last for about a week and you can replace them as needed. Chat to your physician about your prostheses options and to find out where you can purchase these.

A 2014 study found that roughly 56% of women opted for a breast reconstruction after undergoing a mastectomy.

There are several breast reconstruction options that you can choose from, depending on your needs and preferences. You can either opt for an implant reconstruction, or an autologous or ‘flap’ reconstruction.

Implant Reconstruction

An implant reconstruction involves inserting an implant that contains saline, a silicone gel, or a combination of the two underneath the pectoral chest muscle. The duration of the procedure and the recovery period is less than that of a flap reconstruction. Although this option involves shorter surgery than a flap reconstruction, it may require more than one procedure. Both saline and silicone implants have a limited lifespan. This means you’ll need to undergo more surgery, either to replace the implant or revise the reconstruction in the future. This option is often the best for slim women who have small breasts, as they rarely have enough extra tissue on their backs, bellies, thighs, or bottoms to form a good breast shape when undergoing flap reconstruction.

Autologous or ‘flap’ reconstruction

Autologous or ‘flap’ reconstruction uses tissue from another part of your body, such as your belly, thighs, or back. This means that there will be at least two areas of the body that are healing at the same time. This option is becoming more popular, especially for women looking for a natural alternative to implants. Many women also like that the procedure often results in a smoother, flatter tummy. It’s a bit like having a mini tummy tuck at the same time! This form of reconstruction typically lasts a lifetime, however, the duration of the surgery and the recovery time is longer than that of an implant reconstruction.

With the above in mind, the reconstruction method that’s best suited to you (if any) depends on a number of factors. Make sure that you are given all the options and that you’ve allowed yourself the opportunity to be informed, empowered, and to decide what will best suit you.

Dr Rory Dower is a plastic surgeon who has completed 2 international fellowships. He’s super-specialized in breast reconstruction, and offers the full spectrum of reconstructive options to women who have been diagnosed with breast cancer.