questions to consider before undergoing breast reconstruction
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By Cristiane Ueno, MD
What is your primary motivation? I’ve had patients tell me, “Since I have cancer, I should gain something out of it and get bigger breasts after the mastectomy,” or “I am too old, and I should not think about looking pretty.” Other patients just want to feel normal again, and they don’t want to undergo further surgery – they are just happy to be alive. Breast reconstruction can help you feel like you didn’t lose everything and improve your self-esteem, sexuality, quality of life and body image depending on your motivation. If restoring your breast to near normal shape will help you feel like yourself again, find a board-certified plastic surgeon. Our goal is to give you a breast shape that allows you to feel whole again.
Getting a breast cancer diagnosis is scary and overwhelming. There is a
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lot to process and you may find yourself wondering the following:
• Should I have a mastectomy or double mastectomy? • Should I have breast-conserving surgery (also known as a partial mastectomy)? • Should I undergo chemotherapy or radiation therapy? • What will happen to me after the diagnosis? Breast reconstruction itself can be an overwhelming prospect to consider in terms of what the procedure entails. Your initial thought might be to get a double mastectomy and remove both breasts to avoid dealing with breast cancer ever again. As board-certified plastic surgeons, our goal is to make you aware of every option, so you feel empowered to make an informed decision. Here are five questions to consider before undergoing the procedure. ASPS member Cristiane Ueno, MD, FACS, practices at Kaiser Permanente Washington. Dr. Ueno came to the United States from Brazil where she had completed her plastic surgery residency. She has specialized in treating breast cancer patients since her early years in Brazil and is board certified in surgery and plastic surgery (both in Brazil and the United States).
Which type of reconstruction is best for you? There are many different types of breast reconstruction. You and your plastic surgeon will discuss all options available for treatment based on your breast cancer, expectations, associated medical conditions, emotional health and the decision that makes you most comfortable. You can use your own tissue, an implant or even a combination of your own tissue and an implant. Talk to your breast surgeon and plastic surgeon, discuss your options and take time to consider the pros and cons of each procedure before deciding which type of reconstruction is best for you. Review expectations, risks and complications carefully with your plastic surgeon to assure you are speaking the same language. Ask questions if you don’t understand certain words or if the information is not clear to you.
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How is your health? A medical condition can limit your options and prevent you from undergoing the procedure. Consider your physical health. Will cancer and/or other associated medical conditions affect your ability to heal or withstand further treatment after reconstruction? Be sure to discuss your health concerns and all medical conditions with your plastic surgeon. Ultimately, it is your decision, in conjunction with your physician, to determine if you are a candidate for breast reconstruction.
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What is your preferred timing for breast reconstruction? Don’t worry if you had a mastectomy days, weeks, months or even years ago. There is no specific timeline. You can always consult a plastic surgeon and discuss breast reconstruction before or after your mastectomy, and in some cases, before or after breast-conserving surgery. You can undergo immediate reconstruction – which reduces the number of anesthetics required to complete reconstruction – or postpone it to focus on your cancer treatment. You are entitled to choose your priorities and change your mind on when you want to have it done.
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What is covered by your insurance plan? The Women’s Health and Cancer Rights Act (WHCRA), signed into law in October 1998, provides protections to women who choose to have breast reconstruction after a mastectomy and includes all stages of breast reconstruction, surgery of the other breast to produce a symmetrical appearance, any external breast prostheses needed before or during reconstruction and treatment of physical complications of all stages of mastectomy – including lymphedema. In most cases, WHCRA will protect you and help you with breast reconstruction coverage. Be sure to ask your team about it. PSN: BREAST RECONSTRUCTION 2019 l
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