The road to reconstruction.
When a woman is diagnosed with breast cancer, it is not just a series of words that are in some way connected to the body she calls hers; it is a journey. Unfortunately, it is a journey that she has not chosen, but that will subject her to appointments, to operations, to invasive questions, and to a complete change from the self she recognized.
Our breast reconstruction team aims to change that experience. Our team has developed excellent relationships with general surgeons as part of our regional breast reconstruction program at Cambridge Memorial Hospital (CMH), so breast cancer treatment and reconstructive plans are seamlessly coordinated with each patient’s medical team. This team-oriented medical synergy is The Cosmetic Surgery Clinic’s goal for breast reconstruction surgery. Along with our partners at the Cambridge Memorial Hospital, we are home to a regional breast reconstruction program that serves patients from all over Southwestern Ontario. Drs. Chesney, Ma and Shenker are all experienced in the latest breast reconstruction techniques, including the DIEP flap technique, which requires specialized microsurgical skills that are not found in all clinics or hospitals. Our team offers a wide range of advanced options for patients seeking to better understand their breast reconstruction choices for life after breast cancer.
The Basics.
One of the first steps in making decisions about whether or not to pursue breast reconstruction surgery, is to understand all of the options that are available — including not having reconstructive surgery. Once a patient understands all of her options, our surgical specialists will provide details about the range of surgical options available. We will help patients understand how to navigate the broad range of decisions about breast reconstruction they will need to make.
The Surgical Options.
In terms of the surgical options available, one option is immediate breast reconstruction. A women can go into surgery to have the cancerous breast removed, and come out of that same surgery with a brand new breast, not having to wait months or years in between surgeries.
Immediate breast reconstruction involves one (or more) of our plastic surgeons from the early stages, working closely with the general surgeon who does the cancer resection.
The second type of reconstructive surgery available is a delayed breast reconstruction. This type of reconstructive surgery is a separate operation from the cancer resection. For a variety of reasons, it may be scheduled months or years after the original mastectomy. Sometimes a delayed reconstruction is done because a woman did not know immediate reconstruction was an option.
The Techniques.
With every breast reconstruction surgery, the goal of our specialized breast reconstruction surgeons is to create new breasts that have a similar size, shape and symmetry in comparison to the natural breasts. Our surgeons achieve this through various methods, including using skin and fat taken from another part of your body (called an autologous flap technique). Alternatively, a new breast can be created using a traditional breast implant technique, known as prosthetic reconstruction.
Breast reconstruction using skin and fat.
In autologous flap breast reconstruction, a breast is fashioned with skin and fat tissue (and, on occasion, muscle) from elsewhere on the body. Generally, the “donor” sites are the abdomen, the upper back, the inner thigh or the buttocks. The tissue is shaped into a breast mound and tends to look and feel more natural than a breast implant. The surgeons from The Cosmetic Surgery Clinic are also trained in microsurgical techniques, which means they can connect arteries and veins that are only a few millimeters in diameter. They use these techniques when doing the DIEP flap technique. The DIEP (deep inferior epigastric artery perforator) utilizes fat and skin tissue from the abdomen, but spares the abdominal muscles, which generally shortens the patient’s overall recovery time, and minimizes the chances of abdominal wall weakness and bulging.
Breast reconstruction using implants.
When deciding on how to create the new breast, women, along with their surgeons, may choose to use a breast implant for a multitude of reasons. Some patients lack sufficient amounts of fat for use in another part of the body; others simply prefer the look and feel of an implant, or don’t have the luxury of having sufficient time to recover from an autologous tissue reconstruction.
If a woman decides to opt for the use of a breast implant, there are two variations of the reconstructive process that she may undergo. The direct-to-implant reconstruction is a one-step technique that involves the surgeon creating a pocket for the implant using the pectoral muscle and an acellular tissue matrix. This option is only available for immediate breast reconstructions.
The second option, in the case of a delayed reconstruction, is to utilize a tissue expander to stretch the skin to create space to ultimately house the implant. This option does require a second surgery to replace the expander, but is appropriate for patients with less elastic skin, or those who can’t support the immediate placement of a breast implant. The tissue expander – which resembles a partially filled implant – is gradually filled over time by the surgeon until the appropriate size is achieved and the skin can support the chosen implant.
The process of going through the breast cancer and reconstruction journey is a complex one, with many options to weigh and many decisions to make. Drs. Chesney, Ma and Shenker want to encourage all patients who may have questions or want to know more about their options to talk to their family doctors, their general surgeons, and their oncologists. Ask for a referral to see our team at the Cosmetic Surgery Clinic and the Cambridge Memorial Hospital.
