Having to undergo a mastectomy procedure is unquestionably traumatising for any woman. Despite that in many cases it is life-saving, we have seen many women’s overall self-image shattered, leaving as much of a bodily and emotional scar, as well as sense of “incompleteness”. Considering that most of the mastectomy patients we have treated at the Cosmetic Surgery Cyprus clinic lost their confidence in their body image as well as their self-image months after surgery, it was our duty to do our very best to help them regain their self confidence and feel whole again.
Is Breast Reconstruction the Right Choice ?
Deciding whether to have a breast reconstruction or not is a very personal decision and a delicate matter for any woman who has experienced mastectomy. This is a choice that will definitely have long-term implications, so don’t rush, take your time to digest things and above all, accept your new condition before taking huge strides forward. If you do decide to go through another surgery, this time to have your breast(s) rebuilt, you should be aware that there are two ways of doing that:
- Implant Reconstruction – This technique uses saline or silicone implant to create a breast shape.
- Autologous or Flap Reconstruction – It involves ‘borrowing’ tissue from other parts of the body to rebuild your breast.
Sometimes, both techniques may be used to give your new breast a more natural, ‘as it used to be’ aspect depending on the size of the area affected by mastectomy.
However, do bear in mind that reconstruction is not a must. You might choose to wear a prosthetic breast, which is nothing more than a pop-in breast form you can easily put in your bra and go for a reconstruction at a later stage. Nevertheless, a reconstruction done earlier on or even immediately after mastectomy can have a better aesthetic results. Although if are not psychologically prepared to go through another surgical procedure immediately after such a traumatizing event, having your breast rebuilt later is an option.
Whatever you decide, it is best that you consult your oncologist and plastic surgeon to find the optimal solution in your particular case. We can arrange for a consultation with Dr. Bugra whose 25-year experience in plastic surgery and world-wide reputation as an esteemed cosmetic surgeon specialising in post-mastectomy breast reconstruction and augmentation, amongst other areas, can be all you need to make a decision that you can be sure you won’t regret in many years to come. Initial consultation can be by photograph if the patient is not living in Cyprus, or does not visit regularly.
That being said, registering on breast cancer forums and talking to women like you who have already had their breast or breasts rebuilt would also be an enlightening experience, giving you a broader understanding. Because nothing compares to another patient’s perspective, getting first-hand information right from the horse’s mouth and even photo sharing will definitely give you a boost and some comfort.
Here are a few facts you may wish to consider while you’re still pondering about whether or not to have a breast reconstruction:
1. How important is having a permanent breast reconstruction to you ?
Some women prefer using a prosthetic support (an artificial breast shape) rather than having their breasts rebuilt. By comparison, most women believe that having their breasts re-built is a more convenient solution as it is permanent and does not involve extra caution while caring about a prosthetic breast.
2. If mastectomy is to be performed on one of your breasts, how important is it that both of your breasts have the same appearance in a bra or bathing suit ?
Usually, after mastectomy women want their breasts to have a natural and balanced appearance in a bra, bathing suit or in low cut clothes. Here is where the plastic surgeon’s talent can work magic on the female body. Although the difference between the re-built breast and the healthy one is noticeable when you’re naked, it still resembles your natural breast ‘as it used to be’ while wearing a bra or bathing suit.
3. Will breast reconstruction involve several procedures ?
This depends on the case. If you do decide to go through with this, it is advisable that you consult your plastic surgeon to establish what needs to be done both on a short and long-term basis. For instance, if your breasts are naturally large, the reconstruction could create a smaller breast. In this case, to preserve a balanced, naturally-looking appearance of both of your breasts and make you regain your self-confidence, the reconstruction procedure could be a reduction and or breastlift performed on the breast that was not affected by mastectomy. At a later stage, to improve your body-image you may choose to have a nipple tattooed on the rebuilt breast.
4. How important is to you to be able to resume your usual routine soon after surgery ?
The majority of women who choose not to have a reconstruction of their breasts are able to resume their usual activities sooner after mastectomy compared with women who opt for breast reconstruction.
5. Do you have a physically challenging job ?
If the answer is ‘yes’, regaining flexibility immediately after surgery is of crucial importance to you. This is why it is crucial the breast reconstruction surgery is performed only by top expert cosmetic surgeons with lots of experience in that particular type of surgery. We have treated many patients that came to our clinic with a sensation of discomfort due to implants inappropriately introduced under or placed over the chest muscle, which have become harder in time, leading to a complication known as capsular contracture.
At Cosmetic Surgery Cyprus we always try to stay ahead of our times and look into the most advanced technologies and latest equipment that can help produce a safer, more natural looking result, and the least invasive procedures. This is why Dr. Bugra uses the most recent techniques, such as DIEP and SIEA flaps to reduce the risks in any flap surgery by removing only the tissue needed to re-make the breast and preserving the donor’s muscular structure.
6. Concerned about the cost of the surgery ?
In general, breast reconstruction is covered by most of the health insurance schemes. Insurers are bound by law to cover breast reconstruction as well if they cover mastectomy. In this case, you may need to provide any supporting documentation from your surgeon that breast reconstruction is required post mastectomy, Dr Bugra and Cosmetic Surgery Cyprus are happy to help you with the necessary documentation.
7. Did you undergo a lumpectomy procedure which affected your breast appearance ?
Numerous women undergoing lumpectomy are satisfied with the way their breasts look afterwards and do not opt for a reconstruction. However, if you had a significant part of the tissue removed, you may wish to have your breast rebuilt. Researchers suggest that 10%-30% of the women who have had a lumpectomy are not happy with the appearance of their breasts after the procedure. Furthermore, in only a few years post lumpectomy, the breast may lose much of its natural shape especially after radiation therapy. Most often the treated breast is smaller compared to the healthy breast. In this case, reconstruction may be the ideal option with a reshaping surgery on the opposite breast(a reduction or breast lift).
8. Do you have diabetes, circulatory or bleeding disorders ?
These are likely to impact your ability to heal, which is another issue not to be overlooked in your decision making. Also, if you are a heavy smoker or frequently consume alcohol, you should again carefully weigh the option of having a breast reconstruction.
Important Note: Gifted as any plastic surgeon may be, he can only reshape or recreate the shape of your breasts but not restore sensation in the tissue and nipple. In time, you may regain sensation in the rebuilt breast, but it will not feel the same.
When to Have a Breast Reconstruction ?
Depending on your overall health condition (the cancer stage you’ve been diagnosed with), you may have a breast reconstruction:
- Immediately after mastectomy (Immediate Reconstruction) – The onco surgeon removes the breast affected by cancer and the plastic surgeon immediately intervenes rebuilding the shape of your breast by removing tissue from another part of your body or by inserting an implant. Immediate reconstruction may not be an option if further treatment post mastectomy, such as chemotherapy or radiation therapy is required. Depending on your particular case, your surgeon may recommend either delaying the procedure till the treatment is over or having your breast only partially rebuilt.
- After mastectomy, lumpectomy, radiation therapy or chemotherapy (Delayed Reconstruction) – Chemotherapy and radiation therapy can affect the size, colour, texture and appearance of the rebuilt breast. Especially in case of implant reconstructions, radiation therapy can have a harmful effect. If the cancer reached the lymph nodes, radiation therapy after surgery is required. A lot of surgeons recommend having a breast reconstruction after chemo or radiation therapy (6 to 12 months later).
- Staged reconstruction, involving partial reconstruction during mastectomy (Delayed-Immediate Reconstruction) – With this particular type of reconstruction, Dr. Bugra places an ordinary breast implant or a tissue expander (depending on the case) under the preserved breast skin and chest muscle after the removal of the tumor. A tissue expander is nothing else than a balloon-like device that keeps the skin stretched to form a ‘pocket’ for the rebuilt breast under the skin. This procedure is particularly recommended if you need to follow radiation therapy or chemotherapy. Throughout the therapy, the expander may be inflated or deflated based on the physician’s decision in order for radiation therapy to better target the area of the breast affected by cancer. About 4 to 6 months after completion of the treatment, the expander is removed and replaced with a flap taken from a healthy area of the body.
Generally, stage I and stage II diagnosed breast cancer patients do not require radiation therapy after mastectomy and can easily have immediate reconstruction. The situation is different with stage III and IV patients who do need chemo or radiation therapy after mastectomy or lumpectomy, in which case they may qualify for staged or a delayed reconstruction procedures.
Becoming whole again is an important and a lifetime decision, which is why seeking specialist advice is the best way to identify the option that can have the best outcome in your case. Be an informed patient, share and exchange ideas with other women like you and strategically use that information in your decision making.
However, if you do need more help to decide which procedure is best for you and/or have concerns or questions regarding the outcome of the breast reconstruction surgery (i.e. breast symmetry, position/angle, size of breasts, feel, etc.), how to maintain the pleasing result of the surgery or any other aspect of the overall process, Dr. Bugra and everybody at Cosmetic Surgery Cyprus is here for you. Just gives us a call or contact us via email and allow us to become your companions in turning a page in your book of life, leaving all the sad memories behind and embracing the new positive future you!