Why would I need reconstruction if I decide on having or have had a partial mastectomy?
Understanding your reconstructive options when you are considering or have had a partial mastiectomy (or lumpectomy) is important. Partial mastectomy and lumpectomy are considered “breast-sparing surgery” or “breast conservation surgery” (see Figure 1) because there is an attempt to save as much healthy breast tissue as possible while removing the breast cancer. These procedures are best for treating early stage (I & II) tumors or smaller tumors. The best candidates for this procedure are women with small tumors and larger breasts. Virtually all patients who have one of these procedures will need radiation therapy after surgery. For some patients the removal of breast tissue may leave an indentation, such as a large dimple, in your breast. This indention may not be seen until after your radiation treatment. Also the breast with the breast cancer may become smaller with the removal of the cancer and after radiation. Malposition of the nipple/areola may also occur. Some patients with very small tumors and larger breasts may not have cosmetic consequences from the tumor removal and may not need reconstructive surgery. Therefore, it is important to have a discussion with your breast surgeon to discuss the cosmetic consequences of the tumor removal to your breast appearance.
What reconstructive procedures are available to me if I am having a partial mastectomy?
To prevent these cosmetic changes such as the indentions, significant size differences and nipple/ areola malpositions, a plastic surgeon may be able to “re-arrange” or rotate the tissue that is remaining in your breast at the time of the cancer removal. Often candidates for this technique are women with larger breasts (C or D cup) and smaller tumors. These techniques may leave you with a smaller breast or further scars on your breast. These procedures are referred to as oncoplastic surgery. The oncoplastic techniques utilized by your plastic surgeon often employ incision patterns and techniques traditionally used in cosmetic procedures such as breast lifts (mastopexy) and breast reduction surgery. If these procedures are performed, a “symmetry” or “balancing” procedure to your other breast not affected by cancer may be necessary to match the reconstructed breast. Your breast may also change (ie shrink or tighten) as a result of the radiation therapy.
If you are a women with a smaller breast and do not have enough breast tissue to “re-arrange” or rotate into the area where the cancer was removed you may need to recruit tissue from another part of your body to fill in the defect if your tumor was of significant size. Most commonly local tissue under your armpit along your chest wall can be recruited (local tissue flaps) or tissue from your back (latissimus dorsi flap) can be rotated to fill the space where the tumor was removed. These techniques will leave further scarring along your chest under your armpit and on your back. Therefore it is important for women with smaller breasts and larger tumors to consider the cosmetic consequences of breast conservation because often a full breast reconstruction after a mastectomy can result in a better cosmetic outcome.
What if I have already had a partial mastectomy and have a deformity after radiation or volume asymmetry between my breasts?
If reconstruction is not an option at the time of your cancer surgery, or you have already had a partial mastectomy and as a result have an indentation in your breast, delayed reconstructive options may be used. Because radiation my shrink or tighten your skin, local tissue flaps or the latissimus dorsi flap can be used to fill in the indentation. This may result in you having a “patch” of skin on your breast in the area of the scar where your partial mastectomy was performed. Often your plastic surgeon will also want to assure that your cancer doctors have cleared you from surgery and you are far enough out from your radiation therapy (usually 6 months-1 year) that you have healed enough to have another surgery. In addition, for smaller indentions a technique known as fat grafting (see section on fat grafting) where fat is removed from another part of your body and injected into the depression may be an option. Reconstructive procedures are often more difficult to perform and have a higher risk for complications after radiation therapy.
If you have significant volume difference between your breasts as a result of the partial mastectomy and radiation, your physican may also recommend a symmetry procedure to be performed on the breast that didn’t have the cancer to make the breasts more symmetric rather than performing surgery on the radiated breast.
Questions to Ask Your Cancer Surgeon and Plastic Surgeon
- Would I be a candidate for reconstruction at the time of my partial mastectomy?
- What are the options I have for reconstruction based on my tumor size and breast size?
- What complications are associated with the procedures?
- How will radiation affect my reconstruction?
- Will I need something done to my breast that does not have cancer?