Breast reconstruction know your options
Posted on 15 November 2011
When you’re facing breast cancer, knowing your options for breast reconstructive surgery gives you a meaningful boost for both physical and emotional healing.
Words Robyn von Geusau, Helen Wills Photographs Diaan de Beer, Roger de la Harpe
For many women, their breasts are the symbols of their femininity. Most women would find it difficult – if not impossible – to imagine life without them. The good news: mastectomy need not be the final word when it comes to breast cancer. Thanks to ongoing advances in breast reconstructive surgery, there are now several options available, all of which can help patients to regain their former shape and self-image. ‘After a patient has been referred to me by a breast surgeon, I chat to her about her choices,’ says Dr Shane Barker, a plastic and reconstructive surgeon at Mediclinic Constantiaberg. Depending on the circumstances, she could opt for an immediate reconstruction (done at the same time as the mastectomy) or a delayed one. ‘All patients are different,’ advises Dr Barker, ‘and you have to tailor the reconstruction to the nature of the disease, the general health and lifestyle of the patient, her history, body type and, of course, personal choice,’ advises Dr Barker. Apart from choosing when to have the reconstruction, you can also go either the prosthetic (using manufactured implants) or autologous (using tissue from other areas of your body like your back, below the breast, thigh, buttock or lower abdominal area) route.
Although the length of recovery depends on each individual patient, physical recovery usually takes between 10 days to two weeks. ‘Emotional recovery takes a lifetime,’ says Dr Chetan Patel, a plastic and reconstructive surgeon at Mediclinic Sandton. ‘Every breast-cancer survivor should attend a support group. You need empathy from those who are going through it themselves, or who’ve been there.’ During reconstructive surgery, the patient is taken into the operating theatre in which a breast surgeon, oncologist and reconstructive surgeon are present. Working in unison, they complete the mastectomy and perform the reconstruction.
Dr Barker explains how a two-stage immediate breast reconstruction with prostheses works: ‘Because skin and breast tissue is removed during a mastectomy, there is often not enough to work with for a new breast, so we implant a temporary tissue expander. This slowly expands the skin envelope.’ The breast ‘grows’ thanks to a nifty injection dome through which saline solution is injected once a week for a few weeks. The skin gradually stretches and, once the breast has reached the desired size, the expander is removed and replaced with a permanent implant. ‘We may have to make a minor adjustment to the other breast,’ explains Dr Barker, ‘so that both look equal.’ Once the breast has ‘settled’, a nipple is created using skin from either a toe or an ear. The patient can also choose to have an aereola tattooed onto her skin to finish off the procedure and give her newly reconstructed breasts an even more natural look. ‘It just completes it,’ adds Dr Barker.
‘I didn’t want to look unbalanced.’
Nadine Foster, 54
When Nadine Foster learned she had breast cancer, she knew she wanted a full rather than a partial mastectomy. She had lost her beloved sister to the disease, and Nadine was very clear about the way forward.
‘I was angry with that breast: I wanted it off my body,’ she says. ‘I discussed my reconstruction in depth with Dr Barker, who pointed out all the options to me.’ Nadine says her decision to have a breast reconstructed was based on practical rather than emotional reasons. ‘I didn’t feel that I’d lose my femininity when I lost my breast. Rather, because I’m an active person – I swim and am always on the move – I didn’t want to feel or look unbalanced.’ Not only is Nadine able to wear fitted clothing, she is once again full of zest and energy. ‘The surgery helped me move forwards and onwards,’ she concludes. ‘I can do everything I used to do.’ Nadine has these words of advice for other women who may be considering reconstructive surgery: ‘Do what feels right for you, and make sure you have all the information available to you before making a decision.’
ASK YOUR doctor
• What are my options?
• What are the risks and complications of each surgery?
• Will this interfere with my cancer treatment?
• Can I see before-and-after photographs of other patients?
• When can I resume normal activities?
• How long will the procedure take?
• What are the costs involved?
NOW OR LATER?
• Having immediate reconstruction means you only have one operation and recovery period, it helps you preserve a positive body image and you avoid the experience of having one or no breasts.
• The benefits of delayed reconstruction are that you have more time to consider different surgery options, to focus on your recovery from cancer and to rebuild your strength.