HER2+ Early-Stage Breast Cancer

Reconstruction

Whether to have breast reconstruction is a decision only you can make. Your breasts may play a crucial role in your personal sense of femininity and sexuality. You may be eager to replace the breast(s) you lost with implants or prostheses to feel more like your pre-cancer self. You may prefer what’s referred to as “going flat,” which means no breast prosthesis, enhancement or additional surgery. Bottom line, it’s your body and your choice, so learn as much as you can about your options and think about what will make you most comfortable.

If you are having a mastectomy or lumpectomy, your doctor will likely discuss possible breast reconstruction, which involves additional surgeries to restore or reshape one or both breasts. Reconstructive surgery is often performed, or at least started, during a mastectomy or can be delayed for a few months or even years. It may be done during or after a lumpectomy if the surgery will cause the affected breast to look significantly different from the other after the tumor is removed.

Flap reconstruction involves recreating the breast using a flap of tissue, usually with skin, fat, possibly muscle and blood vessels from elsewhere in your body. Various techniques are available depending on the tumor’s size and location, size of your breasts, your body type, activities you enjoy, whether your breast has been radiated in the past and your preferences regarding appearance. Flap procedures should be performed by an experienced plastic surgeon who specializes in breast reconstruction.

Implant-based reconstruction, using silicone or saline implants, initially requires less extensive surgery than tissue flap procedures. The overlying chest wall muscle and skin may be stretched by inserting a tissue expander under the muscle to accommodate the implant. The expander is gradually inflated with fluid injections through the skin until the desired size is reached. In some cases, the implant is placed on top of the chest wall muscle but underneath the skin.

Non-surgical options, such as a breast prosthesis, are also available. Made from artificial materials, the prosthesis is designed to provide a natural, symmetrical appearance when you’re dressed. You must wait until you’re healed from cancer surgery to be fitted for a prosthesis. One type is worn inside the hidden pocket of a mastectomy bra. Another type attaches to your body with a special adhesive, although this approach may not be recommended after chest wall radiation.

Mastectomy bras are available in many styles and colors. Some health insurance providers will cover the costs of both a prosthesis and mastectomy bras if you provide a prescription from your oncologist or oncology surgeon. Call your insurer beforehand to verify which mastectomy-related products are covered and the documentation required for reimbursement.

As you weigh your options, consider the following:

  • Breasts are not essential organs for life, though they may play a crucial role in your personal sense of femininity and sexuality.
  • Your plastic surgeon will work with you to set expectations for what your new or reconstructed breasts will look like. Keep in mind that even with reconstruction, your breast(s) will not look or feel exactly as they did before or have the same sensation.
  • Many advocacy groups offer peer counseling, so you can ask questions of women who’ve had different reconstruction procedures. It’s helpful to hear how and why others made the decisions they did and the benefits and challenges they’ve had as a result. Ask your nurse/patient navigator for referrals, and use the resources in the back of this guide.

Do your research, then choose the path that is right for you.

Questions to Ask Your Doctor

Deciding how to proceed before having any surgery allows your plastic surgeon to collaborate with your breast cancer surgeon during your mastectomy. To feel informed enough to make a decision, discuss your options with your doctors. These questions will get you started.

  • Can I get this first stage of reconstruction done at the time of mastectomy?
  • How soon will I be able to return to work or other important activities?
  • If drains are necessary, how long will they stay in?
  • Will the healing period required for breast reconstruction delay chemotherapy or interfere with post-mastectomy radiation?
  • Am I a candidate for nipple- and areola-sparing mastectomy? Can you tell me more about nipple reconstruction and areola tattooing?
  • Can you refer me to a peer-to-peer organization so I can learn about other women’s experiences?

Breast Reconstruction Options

Breast Reconstruction Techniques
There are two surgical methods for flap surgery. A pedicled flap is one in which the muscle is the carrier of the blood supply. A free flap contains one or two blood vessels that are attached to blood vessels in the breast area. Types of flap surgeries are listed below.
 
DIEP: deep inferior epigastric perforator flap
SIEA: superficial inferior epigastric artery flap
TRAM: transverse rectus abdominis muscle flap
LSGAP: lateral septocutaneous perforating branches of the superior gluteal artery perforator flap
SGAP: superior gluteal artery perforator flap
TUG: transverse upper gracilis flap

 

DIEP Flap Breast Reconstruction

 

Expander Implant
Implants may be used for breast reconstruction. With this option, a tissue expander is inserted at the time of the breast cancer surgery. The expander slowly expands breast tissue, and a permanent implant is inserted in a second operation.

 

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