Almost 200,000 women are diagnosed with breast cancer each year, with over 40,000 dying from the disease annually. Many of the survivors undergo mastectomies—the removal of one or both breasts—a procedure which can be devastating to a woman’s self-image and self-esteem.one procedure which helps to minimize the psychosocial aspect of such a surgery is breast reconstruction, sometimes performed at the time of the mastectomy. A study to evaluate the psychosocial outcomes and body image of mastectomy reconstruction patients has shown ongoing benefits to women in self-esteem, body image and general well-being two years after undergoing the procedure. However, not everyone is made aware of the option for reconstruction.
A study by Dr. Caprice Greenberg from Brigham and Women's Hospital in Boston found that many women who have had a mastectomy failed to receive information about breast reconstruction. He found that younger women, more educated women, and women who were Caucasian were most likely to receive discussion about breast reconstruction. Doctors apparently unconsciously discriminated against older women, less educated patients, and women of minority races.
According to a recent report published by the American Society of Plastic Surgeons, a staggering 7 out of 10 women facing breast cancer are never told of their options. An additional study released at the 2010 American Society of Breast Surgeons (ASPS) Annual Meeting reported that 4 of 5 women do not receive breast reconstruction after mastectomy despite legislation passed more than 10 years ago requiring insurance companies to cover the cost. The results of these studies indicate how important it is for women to get as much information as possible prior to treatment.
Some of the more common breast reconstruction options being used today are:
Nipple-Sparing Mastectomy: In this instance, all visible breast tissue is removed beneath the nipple, which is spared. This type of surgery is normally available if the cancer is located at least 2-4 cm away from the nipple, which decreases the likelihood that the nipple is involved. This means there are strict criteria to qualify for the procedure, but it is being performed with more regularity.
DIEP Flap: This employs both skin and the fatty tissue from the patient’s abdomen, resulting in a bit of a tummy tuck along with the breast reconstruction. Without interfering with the abdominal muscles, the patient’s own tissue and skin is removed and used to reconstruct a more natural-feeling, soft breast.
SIEA Flap: Similar to the DIEP Flap, but utilizes a different blood flow to reconstruct the breast.
SGAP Flap: This procedure employs both skin and the fatty tissue from the patient’s gluteal area. When a patient does not have excess abdominal fat to do a DIEP Flap, they can perform the same type of surgery utilizing tissue from the buttocks/upper hip area.
IGAP Flap: Same as the SGAP but utilizing skin and tissue from the lower hip and buttocks.
TUG Flap: The tissue and skin for reconstruction comes from the inner portion of the thigh, near the groin crease. Helps to avoid abdominal scars, but can only be used for small to medium-sized breasts due to the amount of flesh available in the area.
There are additional reconstruction options, utilizing other methods, available. You should discuss all options with your oncologist and surgeon before making any final decisions.
“Health is increasingly a shared responsibility between the physician and the patient,” says Dr. Cary Presant, HealthNews columnist. He recommends that as a patient you must ask important questions and take control of your future health. Asking not only the physician or surgeon, but also the nurse, nurse practitioner or physician's assistant who is helping the doctor, is extremely important. In addition, it is important to research the treatment or surgical procedure which has been suggested. Good sources are websites which can be reviewed to provide advice and further questions for your physician and the medical staff, and non-profits such as the American Cancer Society and Susan G. Komen Breast Cancer Foundation.
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