9 More Things You Need to Know About Breast Cancer & Breast Reconstruction
Dr. Sharline Aboutanos and her colleague, Breast Surgical Oncologist Kandace McGuire, MD, held a virtual tea with the support group Here for the Girls to share valuable, in-depth information with women facing a breast cancer diagnosis. Their rich and varied conversation provided so much enlightening information that we wanted to make it available for all to reference in a series of blog posts.
Read part one of this two-part series, 11 Things You Need to Know About Breast Cancer Treatment and Reconstruction. Now, we’ll continue our deep-dive into the subject of breast cancer and reconstruction!
1. Changing breast size to your liking can be part of the process, so discuss it early.
While no one wants to go through breast cancer treatment and reconstruction, you can get one benefit out of the process: reshaped breasts. Whether you’ve always wished for smaller or larger breasts, never liked their overall shape, or wished for them to sit higher on the chest, a breast reconstruction surgeon with experience in breast aesthetics can help you achieve an updated shape after mastectomy or even lumpectomy:
Breast lift or breast reduction after lumpectomy is a great way to smooth out and resolve post-procedure unevenness.
Breast reconstruction can offer an opportunity for augmentation if you would like larger breasts; insurance doesn’t require you to have the same size of breasts.
Breast asymmetry correction is often a natural part of the breast reconstruction plan. While no two breasts are ever exactly even, women who have dealt with a cup size or more of asymmetry can see improvement. And, if you only have cancer in one breast, insurance should still cover the treatment of the opposite (non-breast cancer side). The goal is to look good in your clothing and to make sure both breasts are close enough in size that bras will fit well.
It’s best to discuss your appearance goals early in the process, and bring them up with both your surgical oncologist and breast reconstruction surgeon. We promise they won’t judge you for being concerned about aesthetics during breast cancer treatment. Any good doctor will be glad to provide you with insights that can inform your treatment plan!
2. Nipple-sparing mastectomy ≠ preservation of nipple sensation.
If your oncologist believes a mastectomy is required, it is most important to thoroughly remove all potentially cancerous breast tissue. Unfortunately, this means the nerve endings leading to and from the nipple will be damaged in the process, even if you are having a nipple-sparing mastectomy. (While there are new, experimental techniques being tried on some patients, they are not yet widely available, or a proven-safe choice.)
You may wonder, then, “How can my nipples be spared without leaving breast cancer cells behind?”—and even question if nipple-sparing mastectomy is a good idea. While we will try to preserve the nipple, it is not guaranteed going into surgery. The breast cancer surgeon tests the back of the nipple in the operating room at the time of surgery to confirm that there are no malignant cells there.
3. Lymphedema is unpleasant, but there have been advancements and your doctors will do their best to help.
If you need a mastectomy, your doctors will also have to consider your lymph nodes. This is because the lymph nodes catch cancer and other infections and often become involved when it comes to breast cancer.
Removing lymph nodes always includes some risk of lymphedema. What is lymphedema, exactly? Most commonly, patients experience swelling in the affected arms which creates pain and discomfort.
Unfortunately, having lymph node surgery increases the chance you will experience lymphedema, but there are steps your doctors can take to help.
Sentinel lymph node biopsy can help us spare the lymph nodes and reduce the risk of lymphedema from something like 20%+ to below 5%.
If we feel it is safe to be conservative and can remove few lymph nodes, the remaining lymph nodes will likely reroute.
Another important factor is preventing infection throughout the treatment process.
Moving and physical therapy can also help reduce the risk of lymphedema.
Lymphedema of the breast can also happen with larger breasted women, especially when a tumor is located in the upper outer area of breast. Because you can’t exercise your breasts, your medical team will help you understand how to use compression garments and massage to mitigate the condition.
There is additional hope on the horizon. Surgical treatment of lymphedema is in the research stages; for example, doctors are testing lymph vessel to lymph vessel bypass and other techniques.
4. Drains aren’t as awful as they sound.
Many patients cringe at the thought of post-mastectomy surgical drains—we admit, the idea can sound rather unpleasant. However, drains serve several important purposes and will help you heal more quickly, so think of drains as your friends rather than enemies. Here are some of the main benefits of post-surgical drains:
Fluid won’t be able to accumulate in and put pressure on healing tissues
Drains decrease incidence of secondary infections
They help your doctors monitor healing; as accumulated fluid amounts decrease over time, you’ll also get a sense of progress towards healing.
Expect to have at least one drain per side after a mastectomy; they will somewhat limit your activity while they are in place, but all the benefits are worth a few weeks of inconvenience.
5. Pain management advancements will make your post-operative experience better.
Concern about overuse of opioids plus advances in pain management techniques have come together to help breast reconstruction patients have a better, less painful recovery. Today, instead of prescribing substantial amounts of post-operative pain reliever, doctors focus on preventing the pain response in the first place. They do this via regional nerve blocks and by using multimodal analgesia in the surgical process. These techniques help lessen unpleasant side effects of common painkillers, including nausea and constipation
6. Don’t write off silicone breast implants until you have all the facts.
It’s understandable for any woman dealing with breast cancer to want to steer clear of any potential added risks, and many think silicone implants are less safe than saline implants. However, there are some important facts you need to know:
Even saline implants have a silicone shell.
During the years they were taken off the market in the United States, silicone breast implants underwent numerous advancements, and today’s versions are completely different from past versions which were more likely to rupture and leak.
Silicone-filled implants are now made of cohesive gel or an even firmer form of silicone, so in the very unlikely event of a shell rupture, the filling will not migrate out into your body.
Silicone implants feel more natural, as the material is closer in texture to real breast tissue than saline fill, which is water.
Many women who got saline implants for their original augmentation procedure have chosen to switch to silicone for all of these reasons and are happier with them.
Given all of the above, don’t be surprised if your breast reconstruction surgeon advocated for silicone implants. That said, some women still prefer saline implants for various reasons and a full range of choices is available to you.
7. No matter what implants you choose, future implant surgery is likely.
Implants are not designed to last forever; you may need to have them replaced later for a number of reasons.
While breast implants typically last for a decade or longer, they are not considered to be “lifetime” devices. It is a good idea to have them checked yearly.
Over time and with age, many women want to change their implant size.
Sometimes implants need to be removed for reasons that are completely separate from the implants themselves, such as due to infection or another complication of breast surgery. Additionally, radiation can make it more likely you will experience capsular contracture.
Rarely, there are other systemic health reasons that cause women to have their implants removed.
If you do end up having physical problems with your reconstructive breast implants, your insurance should cover treating the issues.
8. Between breast cancer treatment and reconstruction, some patients will need two or three operations.
Many patients hope for “everything” to be done in one surgery, especially if they have been reading online about the option for simultaneous breast reconstruction. While this is an ideal we reach for, in some cases the course of treatment will require two or three surgeries to most effectively treat breast cancer before staging out reconstruction for ideal results. If you need three or more surgeries, the last few are likely to be quite minor.
9.Choose what makes you happy, even if it is quirky.
Many patients get creative when it comes to aesthetic details of breast reconstruction. For example, some women are now requesting artistic nipple-areolar tattooing instead of having the artist attempt a perfect trompe-l’œil effect. You can show your love of your breasts with heart-shaped “areolas” or give yourself stars. If you’ve always hated nipple show-through and wear thick bras to hide them, you can plan to reduce your nipples’ size—or go against the popular tide and not choose a nipple-sparing mastectomy procedure. What’s most important is that you do what feels right to you! Your medical team should support you 100% with personalization as long as the choices will be medically safe.
Want to learn more about breast reconstruction?
We encourage you to watch the full recording of our Virtual Tea & Talk on YouTube; we think you’ll find the conversation comforting and information. If you are in the Richmond, Virginia area and seeking an experienced breast reconstruction surgeon, Dr. Aboutanos would love to meet with you and go over your options. Contact us today to schedule an appointment.