Significant advances have been made in the management of breast cancer over the last 20 years. Improvements in diagnostic techniques and protocols have resulted in progressively earlier detection of breast cancer, which is the most important factor mitigating towards effective treatment and potential cure. Women who carefully follow recommendations for regular breast self exams, periodic breast exams by their gynecologist or family physician and routine screening mammography, benefit from potential diagnosis of early or ‘minimal’ breast cancer and are then eligible for breast conservation treatment. However, for those less fortunate women whose breast cancer is more advanced at the time of initial diagnosis or for whom breast conservation treatment is not appropriate, a modified radical mastectomy may be the optimal treatment. In these situations, post-mastectomy breast reconstruction may represent an excellent therapueutic option.
Although a wide variety of post-mastectomy breast reconstruction techniques exist, they can be broadly divided into two categories: autogenous and prosthetic. Autogenous breast reconstruction involves the use of a patient’s own tissue to reconstruct a breast mound, whereas prosthetic reconstruction involves the use of tissue expanders and implants for breast mound reconstruction. These surgeries can be performed either immediately following mastectomy as part of the same procedure (ie. immediate post-mastectomy breast reconstruction, or at a subsequent time delayed post-mastectomy breast reconstruction’). When performed as an immediate post-mastectomy procedure, patients benefit from the preservation of a greater variety of treatment options and may be eligible for a ‘skin sparing mastectomy’. Following breast mound reconstruction and the completion of any additional necessary breast cancer treatments, such as radiation and/or chemotherapy, patients complete their breast reconstruction in several additional stages including a possible ‘balancing’ procedure on the opposite breast, nipple reconstruction and nipple/areolar tattooing. Due to the many factors affecting the choices in breast reconstruction as well as the variety of reconstructive techniques available, it is not possible to appropriately outline them all in this forum.
Many patients express concern regarding the potential cost of breast reconstructive surgery. However, Federal Legislation adopted in 1998, known as the ‘Women’s Health Care Rights Act’ mandates health insurance coverage for breast reconstruction following mastectomy, including opposite breast ‘balancing’ procedures performed to regain symmetry. This law represents a clear societal commitment to minimize the suffering and disability that can result from mastectomy. Therefore, any woman diagnosed with breast cancer, for whom mastectomy is the recommended treatment, owes it to herself to schedule a consultation with a qualified, experienced plastic surgeon certified by the by the American Board of Plastic Surgery (ABPS). After reviewing prior treatment records, performing a complete history and physical examination and discussing your unique individual concerns, your plastic surgeon can than outline a breast reconstruction plan that is most appropriate for you.
As a board certified plastic surgeon with over 15 years of clinical practice experience and member of the American Society of Plastic Surgeons (ASPS) and American Society of Aesthetic Plastic Surgery (ASAPS-The Mark of Distinction in Cosmetic Plastic Surgery®), Dr. Robert Kimmel welcomes the opportunity to provide breast reconstruction for women who have undergone or who are about to undergo mastectomy. In many situations, breast reconstruction is the key to minimize the physical and psychological trauma that can frequently accompany the loss of a breast. In this way, women are able to more rapidly return to a happy productive lifestyle.