11 Things You Need to Know About Breast Cancer Treatment and Reconstruction

Every woman with a breast cancer diagnosis faces a myriad of decisions, to the point that it often feels completely overwhelming. We want to help as you consider information that will support you in your process.

To that end, board certified plastic surgeon Dr. Aboutanous recently sat down with her colleague, breast surgical oncologist Kandace McGuire, MD, and members of the support group Here for the Girls for a virtual tea and talk. Here’s what we learned from their very informative discussion.

1. Prompt cancer treatment is important—but it is not an emergency. Pause to make the best decisions.

Receiving a breast cancer diagnosis will feel like an emergency; you will naturally want to do whatever you can to eliminate the cancer right away. However, you will have a lot of important, personal decisions and it is best to slow down enough to make the right choices.

As Dr. McGuire counsels patients, “Realize this breast cancer did not start yesterday, and it does not need to be operated on tomorrow. You have some time to figure out what you want to do rather than rushing into things and doing something you may later regret, whether that’s doing too much or too little or choosing a surgery that isn’t perfect for you.”

Staying calm and fully understanding your choices will help you find the best path forward. Start off on the right foot by meeting with a qualified breast oncologist and reconstructive plastic surgeon, even gathering second opinions as needed. Consider bringing a trusted friend or family member with you to your appointments as well—they can help ensure you retain all the information that is being shared and support you in trying times.

2. Second opinions are a good thing!

No good doctor will be upset with you if you seek a second opinion. They should understand if you wish to confirm any aspects of your diagnosis or treatment plan. Even if another oncologist or plastic surgeon provides the same general opinion, sometimes they will explain things differently, or you will feel more comfortable with them.

But stick with your doctors through the process if at all reasonable.

Once you identify your medical team, it is wise to stick with them. Even if you have a complication, that may not be a reason to immediately switch doctors. Your reconstructive surgeon has learned about your physiology, has familiarity with your treatment history, and is often most qualified to correct any issues.

All that said, if a doctor is making you uncomfortable, you can and should make a change. Your medical team should help you feel supported throughout the process.

3. You are not alone: women who have gone through this already are here for you.

Across the country, there are breast cancer support groups ready to offer invaluable support and information throughout the process. Many of these women will also be willing to show you their results after lumpectomy, mastectomy, and reconstruction and explain the choices they made. Here in the Richmond, Virginia area, we recommend speaking with Here for the Girls.

But don’t rely on Google. And it is okay to cut off people who want to tell you horror stories!

If you only look online for support and information, you will get a more negative slant. This is because women who have successfully overcome breast cancer are much less likely to participate in online forums, while those that have had issues often need to seek more comfort and help from others. Photos of complications also get far more “press” and will present a scary picture when, in actuality, the majority of women have a very good experience with breast cancer treatment and reconstruction.

You may also occasionally encounter someone who wants to tell you a “horror story” of someone who had a bad experience with treatment or reconstruction. Women dealing with breast cancer do not need to take on the baggage of these rare occurrences and added stress can even hamper your ability to fight cancer and heal afterward. Rest assured that you will most likely be among the majority of women who have a good experience.

4. If you need to have a mastectomy, do consider reconstruction.

Even if you want to have as little surgery as possible, we encourage all women to seriously consider breast reconstruction. You’ll be looking at yourself in the mirror long after the cancer is gone, and most women love the normalcy breast reconstruction brings to their lives versus using prosthetics.

Considering your reconstruction options early can also improve your reconstruction experience and results because it allows your oncologist and plastic surgeon to coordinate and develop an ideal treatment plan. For example, if you know you need radiation, your doctors can make a plan for what skin will be available and schedule insertion of a tissue expander to hold space for a future implant.

Don’t fear that speaking with a reconstructive surgeon creates an obligation to move forward. They will be happy to talk about being “on the fence” and go over all the pros and cons. The choice is 100% personal and yours alone to make.

If you are unsure about breast reconstruction, here are a few important questions to ask:

• Will a given choice “burn any bridges” and limit your options?

• What happens if you choose not to have reconstruction now and later decide you would like to do so?

There are rare times when reconstruction isn’t a good idea, but your oncologist will let you know if this is the case. For example, if you have a kind of breast cancer that requires extensive radiation and surgical treatment (inflammatory breast cancer is one example), reconstruction will not be considered until a future date.

5. Surgery is not always the first step—many patients have systemic treatment prior to surgery.

Many women receiving a breast cancer diagnosis express an eagerness to have the cancer immediately removed via surgery. However, lumpectomy is only appropriate when a doctor can get around the entire breast cancer mass and for approximately 25% of patients, a better path is to have systemic treatment prior to any surgery. This allows your oncologist to actively try shrinking the cancer prior to surgery, which can reduce trauma to the breast and improve your results.

6. Lumpectomy is almost always followed by radiation treatment.

Nearly every woman who gets a lumpectomy will need radiation. In contrast, women who have a full mastectomy often can avoid radiation treatment. That said, in the rare cases when mastectomy is used to treat a 5cm or larger tumor or when lymph nodes are involved, your oncologist will require radiation to reduce the chances of the cancer returning.

7. You might have to avoid MRIs for a time.

Often, the breast cancer treatment and reconstruction process involve devices that have small amounts of metal in them. For example, surgical steel clips may be used to mark a cavity for radiation during treatment, while needle biopsies may involve a titanium clip. Breast tissue expanders also have a small metal piece. As such, you can not have an MRI when this is the case. The good news is the metal components of these tools are not substantive enough to set off alarms in airports.

8. Breast tissue expanders aren’t natural-feeling, but they are important.

Expanders do the important job of holding the shape of the breast during treatment and allowing your plastic surgeon to shape the skin for better breast reconstruction results. However, they are very different from actual breast implants: they are much firmer and don’t feel natural or comfortable. Later, you’ll get softer implants—or have autologous reconstruction.

9. Today, you should need a really good reason not to have a nipple-sparing mastectomy.

It used to be that nipple-sparing mastectomy was uncommon, but advancements in treatment and surgical techniques have made it a viable choice for most women. (Angelina Jolie also helped bring awareness to the procedure!) The procedure is very safe when properly done, and you will then have one less step in reconstruction.

Note that nipple-sparing mastectomy is for appearance. In most cases, nipple sensation won’t be preserved. If your doctor expresses reservations due to the location or nature of your cancer, a “nipple” can later be created from surrounding skin with color added via tattooing.

10. You’ll need to protect delicate skin during the healing process.

During the first 3-4 months, your post-mastectomy and post-reconstruction skin will be very tender. Dr. Aboutanos tells her patients to remember their healing tissues are as tender as a baby’s skin. Extra caution is also required because sensation in these areas will be lessened. You may not realize if you are getting burned while spending a few minutes in the sun or realize if a hot pad or cold pack is harming your skin. Avoid applying excessive heat or cold and always protect yourself fully from the sun with an SPF rated garment.

11. You might feel free to go braless after reconstruction. And many women never wear an underwire bra again.

After your reconstructed breasts have healed, many women find their new breasts need less support and enjoy going braless more often. Some women even choose to not have dimensional nipple reconstruction to avoid show-through. Many women also never wear an underwire bra again—in addition to no longer needing the extra lift an underwire can provide, they are prone to rubbing against tender post-reconstruction skin.

Have more questions about breast reconstruction?

We encourage you to watch the full recording of our Virtual Tea & Talk on YouTube; we’ll also be offering more Q&A content here on our blog in the coming months.

If you are in the Richmond, Virginia area and would like to speak in person about breast reconstruction, Dr. Aboutanos would love to meet with you and go over your options. Contact us today to schedule an appointment.