Mastectomy Education
Many women eligible for breast reconstruction following cancer surgery are not being informed of their options. All women should know their options. It’s time to close the loop on breast cancer.
Studies have revealed:
- Eighty-nine percent of women want to see breast reconstruction surgery results before undergoing cancer treatment.
- Less than a quarter (23 percent) of women know the wide range of breast reconstruction options available.
- Only 22 percent of women are familiar with the quality of outcomes that can be expected.
- Only 19 percent of women understand that the timing of their treatment for breast cancer and the timing of their decision to undergo reconstruction greatly impacts their options and results.
* The American Society of Plastic Surgeons (ASPS) is pleased to provide trusted
breast reconstruction educational information developed by ASPS Member Surgeons.
http://www.breastreconusa.org/education/breast-reconstruction-quick-facts/
BREAST EDUCATION
Mastectomy is the surgical removal of one or both breast, including the nipple and areola. Women who are advised to have mastectomy instead of lumpectomy are women who have:
- Had radiation to the breast
- Multiple tumors in the breast occupying several quadrants of the breast
- Extensive DCIS that occupies a large area of the breast tissue
- A large tumor compared to breast volume
- A strong family history of breast cancer or who test positive for certain genetic mutations like BRCA1 and BRCA2
- Those that wish to avoid radiation
- Those who do not mind loss of nipple sensation in order to avoid future mammographic or MRI surveillance.
NOTE: Nipple Sparing Mastectomies are a new option available for many women which can often preserve the entire nipple, making breast reconstruction less detectable than ever before.
Your physician will guide you in deciding which mastectomy to have, but as always, you should be an active part of any decisions that directly affect your treatment. Your surgeon should explain all the options to you in full, listening carefully to your questions and addressing every one of your concerns.
There are several types of mastectomies:
Total simple mastectomy – This is removal of the breast, nipple and areola. No lymph nodes from the axillae are taken. Recovery from this procedure, if no reconstruction is done at the same time, is usually one to two weeks. Hospitalization varies; for some it may be an outpatient procedure and other patients may require an overnight stay.
Modified radical mastectomy – This procedure is removal of the breast, nipple and areola as well as axillary node dissection. Recovery, when surgery is done without reconstruction, is usually two to three weeks.
Skin sparing mastectomy – This is the removal of the breast, nipple and areola, keeping the outer skin of the breast intact. It is a special method of performing a mastectomy that allows for a good cosmetic outcome when combined with a reconstruction done at the same time. A tissue expander may also be placed as a space holder for later reconstruction.
Nipple sparing mastectomy – A newer technique, this kind of mastectomy is reserved for a smaller number of women with tumors that are not near the nipple areola area. Your surgeon will make an incision on the outer side of the breast or around the edge of the areola and hollow out the breast, removing the areola and keeping the nipple intact. This method involves simultaneous reconstruction. Sometimes the completed reconstruction is done at the same time and in other cases, a tissue expander is inserted as a space holder for later reconstruction.
Nipple and areola sparing mastectomy – In this newer procedure, your surgeon will make the incision on the side of your breast or in some cases, around the edge of the areola. The breast will be hollowed out and reconstruction is performed at the same time. In some cases, a tissue expander may be placed as a space holder for later reconstruction
Scar sparing mastectomy – This is a fairly new form of surgery which was developed at Johns Hopkins Medicine, as well as other major cancer centers. The affected breast is hollowed out. Whether done as skin sparing, nipple sparing, areola sparing or a combination, one goal of this surgery is to minimize the surgical incisions that are visible. It is not uncommon for an entire mastectomy procedure to be performed through an opening that is less than two inches in length.
Preventive/prophylactic mastectomy – Prophylactic mastectomy is a surgery designed to remove one or both breasts in order to dramatically reduce the risk of developing breast cancer. Women who test positive for certain genetic mutations like BRCA1 and BRCA2, or who have a strong family history of breast cancer, may elect to do this kind of surgery. They may also elect to have their ovaries removed at the same time. Genetic counseling may help to confirm or eliminate any nagging suspicion about family history.
With preventive mastectomy, no lymph nodes need to be removed, since there is no evidence of cancer. For preventive purposes, you should have a mammogram performed within 90 days of the procedure to ensure that the breast tissue being removed is healthy. Women can undergo simultaneous reconstruction of any kind after mastectomy; there is no medical need to delay reconstruction. All forms of mastectomy listed above are options, excluding modified radical mastectomy. This is a complicated decision and requires the guidance of breast cancer specialists who can explain all the potential risks and complications of taking this extraordinary step.
Did you know…..There are options. There are an increasingly large number of breast implant options to choose from? Material, shape, size, and profile all contribute to how your reconstructed breasts will look, and you can work closely with your surgeon to choose the best options for a natural result.
Did you know…. You don’t have to make a decision right away. Immediate or delayed breast reconstruction can both be safe and successful. Immediate breast reconstruction is performed at the same time as the mastectomy, with breast skin often preserved for a more natural look. For some women, the emotional healing process is somewhat easier when they do not have wait to see their new breasts. On the other hand, delayed breast reconstruction can offer women more time as they explore their options and make these decisions, for women who need radiation therapy in the following a mastectomy.
Did you know…. Breast reconstruction doesn’t always mean implants! You can have beautiful and natural-looking breast reconstruction that doesn’t require the placement of saline or silicone breast implants. DIEP breast reconstruction rebuilds the breast using tissue and blood vessels (but no muscle) from the lower belly, giving you a tummy tuck and reconstruction at the same time. The latissimus dorsi flap, involves using muscle, fat, skin, and blood vessels from the upper back to build a natural-looking breast mound without implants. What works best for you will be depend on your natural anatomy and desired results.
Did you know…. Breast reconstruction can aid in the emotional recovery after mastectomy.
Did you know…. Insurance companies must cover breast reconstruction. Affording high-quality care is of utmost importance to many women with breast cancer. It can sometimes feel daunting to navigate the insurance process, especially if you are unsure of your rights. Contact your insurance company to know what your plan covers.