Surgery After Cancer: Breast Reconstruction Considerations

Publication: Austin Medical Times
October 01, 2018

Advances in breast cancer treatment have resulted in impressive survival rates – for example, to nearly 100 percent for stage 1 breast cancer, according to the American Cancer Society. But even that significant progress does not mask the understandable uncertainty newly diagnosed women face. The top immediate concerns for many of my patients are: fear of chemotherapy and potentially losing their breasts with mastectomy.

All forms of breast cancer treatment – chemotherapy, surgical techniques, and radiation – continue to improve as experience and research reveal new breakthroughs and innovations. That in turn can present patients with more options that can more closely align with what matters to them during and especially after treatment.

Ridding our patients of cancer is priority one. Obviously. But it’s not the only priority. With breast cancer, physical scars intersect with emotional and psychological wounds. Surgery to remove cancer is more straightforward. Clinical considerations lead the way, but breast preservation and physical appearance are taken into account. Advanced techniques like hidden scar or nipple sparing surgery are possible options for some patients.

Ultimately, whether a patient undergoes a mastectomy, lumpectomy, or lymph node surgery, and whether in combination with chemotherapy and/or radiation, is all about making the patient cancer free.

Decisions about follow-up reconstructive surgery blend medical with deeply personal concerns. For some women, the desire to look and feel as “normal” as possible – as they define normal for themselves – post-cancer is vitally important. The range of options includes saline and silicone implants, a variety of forms of flap surgeries which use back, buttock, or abdomen tissue to reconstruct breasts, with nipple reconstruction and/or tattooing available to complete the process in some cases.

Some women opt for proactive surgery on the opposite, non-cancerous breast for symmetry, while others choose a form of reconstructive surgery, but postpone it. The need for follow up radiation treatment can impact the recommended timing.

In contrast to the array of proactive options is the choice of declining reconstructive surgery altogether. Some women do not want to endure still more medical procedures following the ordeal of cancer treatment. Others choose to “go flat” for many reasons such as concerns about possible complications from surgery, or lifestyle priorities, like having to miss more time with young children or family, or being able to exercise and maintain an active lifestyle.

For every breast cancer patient confronting these decisions, it is important to get complete information from your medical teams about all options. We encourage patients to weigh their decision carefully. That means asking yourself difficult questions about what matters regarding your physical appearance – when you are dressed or undressed.

Every survivor wants to live their best life after cancer. But the way every survivor does that will not be the same. My colleagues once treated an 81-year-old patient who insisted on breast reconstruction surgery – a controversial choice perhaps, but it was her choice. We also see much younger patients who say no to more surgery following mastectomies.

The swirl of clinical, emotional, and lifestyle circumstances comprises an inherently unique and individual decision-making opportunity for women who have had breast cancer surgery. Our pledge is to fully inform our patients about the risks and benefits, and to support them in whatever choice they make.

Heather King, M.D., FACS, is a breast surgical oncologist at Texas Breast Specialists – Austin, a part of Texas Oncology, located at 901 W. 38th Street, Suite 300, in Austin, Texas.


This story originally appeared in the Austin Medical Times.