Oct. 19 is Breast Reconstruction Awareness (BRA) Day in Canada - an initiative to promote education, awareness and access for women who may wish to consider post-mastectomy breast reconstruction. It is a collaborative effort that includes plastic surgeons specializing in breast surgery, plastic surgery nurse specialists, the Canadian Breast Cancer Foundation, Canadian Society of Plastic Surgeons, medical device industry representatives and breast cancer support groups. Dr. Mitchell Brown is one of the plastic surgeons driving events for BRA Day in Toronto. Here he answers some basic questions about reconstruction.
How soon can I begin the reconstruction process after I have completed my breast cancer treatment? I have heard that in some cases it can be performed in conjunction with a mastectomy, is that a possibility?
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| Dr. Mitchell H. Brown Plastic and Reconstructive Surgeon, Women's College Hospital |
Breast reconstruction can be performed at the same time as a mastectomy. This is called immediate breast reconstruction. Candidates for immediate reconstruction are generally women who are having prophylactic (preventative) mastectomy or are having mastectomy for low-grade, non-invasive disease such as DCIS. In some cases, women with invasive disease may also be candidates for immediate reconstruction.
Breast reconstruction that is performed following the mastectomy is termed delayed reconstruction. This type of plan is best suited for women who prefer to focus initially on the treatment of their disease and then consider reconstruction at a later date.
Both forms of reconstruction are generally quite successful and all options of reconstruction are available to women whether it is being performed as an immediate or as a delayed procedure.
I have heard of many different types of reconstruction, which do you recommended for younger women? Does having a single or bilateral mastectomy make a difference in what you would recommend?
There are various options for breast reconstruction. Autogenous reconstruction is the term used when reconstruction is performed using your own body's tissue. Most commonly, this tissue comes from the lower abdomen in a procedure known as a TRAM flap or DIEP flap. Occasionally tissue may be taken from the back or less commonly other areas such as the buttock or inner thigh.
Alloplastic reconstruction is the term used when reconstruction is performed using a breast implant. Traditionally this is done as a two stage procedure in which a tissue expander (stretching device) is inserted in order to stretch the skin, and then a second procedure is performed to replace the tissue expander with a permanent breast implant. Recent advances have allowed us to offer many women the ability to undergo implant reconstruction in a single stage. Although this is not for every patient, it is often an excellent choice for younger women and patients having prophylactic mastectomy.
Does ongoing treatment for my breast cancer affect my reconstruction options?
Ideally, it is best to perform breast reconstruction following the completion of all adjuvant therapy. In some cases, however, this is not possible and a woman may have adjuvant therapy following their reconstruction. Reconstruction does not negatively impact on any adjuvant therapy that is required.
How long is the recovery time? What type of care will I need to do at home?
The recovery from reconstructive surgery is dependent upon the type of reconstruction that is performed. For larger procedures such as the TRAM flap or DIEP flap, most women take approximately 2 weeks to return to daily non-physical activity and 6 weeks to resume all physical activity. Implant reconstruction is generally a faster recovery with most women feeling comfortable within the first few days and then returning to full activity within a month.
How soon will I be able to resume exercising?
For most people recovery occurs over the first 2 weeks. In order to resume a full exercise routine you must wait 4-6 weeks following surgery.
How will my reconstructed breast feel to the touch?
Although your surgeon will do their best to restore a normal shape to the breast, a reconstructed breast will not have normal sensation. This can be variable from patient to patient. Some women report regaining significant sensation in their reconstructed breast while other patients describe a fairly persistent numb feeling.
What is the average cost of a reconstruction? Does insurance cover it?
Breast reconstruction is covered entirely by the provincial health insurance plan in Ontario. Occasionally there may be costs associated with a balancing procedure of the opposite breast, but in many cases, this balancing procedure can also be covered.
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