Navigating breast cancer or a genetic predisposition to it can be overwhelming. Empowering women to remain the captains of their own ships, my goal as a plastic surgeon is to provide advanced breast reconstruction options that make them feel confident and whole in their skin. Depending on a patient’s unique circumstance, preference and in consultation with her treatment team, these options may include implant-based reconstruction, natural breast reconstruction (such as the DIEP flap procedure, which uses a patient’s own abdominal tissue) or an aesthetic flat closure (in which the tissues of the chest are closed as smoothly as possible without an implant or added natural tissue).
Meeting with a plastic surgeon as early as possible in the treatment journey allows patients to familiarize with what type of surgeries are available in order to make the most informed decision. Very few women are able to decide upon their exact breast reconstruction in one day. Often it takes hearing about the available options, thinking about them, researching them and talking to friends or family members first, which is completely understandable. If breast reconstruction does turn out to be part of a woman’s journey to feeling whole again, then it’s my privilege to be part of it.
Upon the initial meeting, which can be conducted via a telehealth consult video for patients outside of the Austin area, we discuss the patient’s unique situation, candidacy and goals. Doing so allows us to build an initial framework for breast reconstruction that we can populate with details over time. Some of the factors that can affect reconstruction candidacy and timing include a patient’s need for chemotherapy or radiation and their medical health.
When developing a plan for breast reconstruction, we don’t want to make any decisions that could interfere with cancer treatment – which is the priority. While chemotherapy may be performed before or after a mastectomy or lumpectomy, radiation is always performed after breast surgery. Two common treatment sequence examples involving radiation include: mastectomy, chemotherapy and radiation, or chemotherapy, mastectomy and radiation. As radiation can significantly and permanently alter a woman’s skin or tissue, women who will be undergoing radiation therapy are generally advised against implant-based reconstruction. To avoid any complications that could delay chemotherapy or radiation, such as an infection or a wound not healing in a timely way, reconstructive surgery is almost always performed after cancer treatment is complete. Optimal timing for breast reconstruction is discussed during each of my detailed consultations, but more information on immediate reconstruction (performed after a mastectomy/lumpectomy) or delayed reconstruction (performed as its own surgery), can be found here: drpotter.com/breast-reconstruction-timing/
In addition to cancer treatment, candidacy considerations for DIEP flap reconstruction include whether a woman is able to physically or personally undergo the six- to eight-hour procedure, three- to five-day hospital stay and four- to eight-week recovery time. Women with a history of pulmonary embolism or deep venous thrombosis (DVT) will also need special blood work to determine if it’s an appropriate option.
An additional factor that we discuss during the consultation is scarring, because every skin type has its own way of healing. Together, we look at whether a history of hypertrophic or keloid scarring complications is present and we discuss what the scars will look like over time. The goal is to ensure our patients are educated and know what to expect. For example, if hyper- or hypo-pigmentation may be a factor, we can discuss potential laser therapy treatment in the future, depending on personal preference.
While breast reconstruction cannot change a cancer diagnosis, it can give patients a chance to think about what they want their future to look like and provide them with choices that are theirs to make. To help patients understand where breast reconstruction fits into the broader picture, the sooner that a patient begins searching for and meeting with plastic surgeons, the better. With a variety of factors and circumstances to consider, please don’t hesitate to contact us with any questions or inquiries along the way.