Truths and myths about breast reconstruction

Breast Cancer Awareness Month often talks about prevention, but rarely mentions what to do when the disease has already occurred or when the breast has already been removed. Breast cancer in women is one of the most common cancers today, and it is extremely worrying that the cancer is occurring at younger and younger ages, sometimes even in girls under 20, especially in cases where one of the female family members has also suffered from breast cancer.

We conducted an interview with our doctor , Dr. Dink Bagatin, specifically on the topic of breast reconstruction and mastectomy, where we asked him to answer all the most common questions collected by patients.

• Why do so many women still not decide to undergo surgical reconstruction? What are their fears?

What we do know is that 1 in 8 women in the US will develop breast cancer in their lifetime, of which only 23% of women are aware of the wide range of reconstructive options available to them.

Our primary goal must be to increase patient knowledge about breast cancer and the possibilities of reconstruction after surgery. We must help women understand what their options are.

What is important here are stories of hope, courage, and the possibilities of reconstruction from the perspectives of patients and doctors, and I am referring to the experiences of patients, but also of doctors who perform breast reconstruction.

Ignorance is still the main reason why so few women choose to have breast reconstruction after breast cancer. I’m sure there are also prejudices surrounding the reconstruction procedure itself.

Most often, a woman, after such a serious illness, does not want to undergo any additional procedures.

Reconstruction also sometimes seems overly complicated and may not give women the results they want. I know a woman who just wants the disease to go away and feels like she’s too tired to do anything after it’s healed.

• Are there any myths about reconstruction that you would like to dispel?

Yes, of course, there are several! The first myth is that breast reconstruction can only be done after a mastectomy (removal of the entire breast), which is not true.

It can be done at the same time as the mastectomy, which is recommended in situations where it is possible. Of course, this is not possible in all cases and may partly depend on the therapy planned after the procedure. But patients should have this information.

Another myth I would mention is that breast implants are the only option for breast reconstruction. The truth is they didn’t.

It is important to know that they are one of the options, but that in addition to this option, there is also a combination of implants and your own tissue, as well as reconstruction with your own tissue from the back, abdomen, buttocks, or upper thigh.

Furthermore, it is a myth that breast reconstruction is not an option when radiation is part of breast cancer treatment.

In this case, breast reconstruction is often recommended later to reduce the risk of complications. I would also like to mention the myth that a reconstructed breast must look unnatural.

This may be the case with some reconstructions, as well as with patients who want an artificial ‘augmented’ look. Reconstruction with one’s own tissue may in some cases give a more natural look.

• How far have we progressed in this area? Is this process carried out in the same way today as it was before? 10 years?

Progress is always present here, as well as in the world, in terms of using all the advanced techniques that are also used by others, and which have proven to be good in breast reconstruction.

The goal of reconstruction is to restore a similar appearance to the normal shape, appearance, and size after breast removal. The techniques themselves have improved, as have the materials used. I believe that in Croatia we are at the same level as, say, in the USA.

• In what ways is breast reconstruction performed? Can you briefly describe the process?

Breast reconstruction usually involves multiple procedures performed in stages; it can begin at the time of mastectomy or can be postponed until a later time.

It is divided into two types – breast reconstruction based on implants and reconstruction based on one’s own living tissue (flaps). In the first case, with implants, the first step is a mastectomy, that is, the removal of all breast tissue, and then breast reconstruction is immediately performed with an implant that replaces the lost breast tissue.

In the next act, the breast is further refined, more precisely, a new nipple is created, more volume is added in terms of fat grafting and the like.

Another option is to take your own living tissue from one region of the body and use that tissue for breast reconstruction.

We are talking about the option of reconstruction with your own tissue, which can also be combined with an implant.

• Is there an expiration date for implants?

It is recommended that implants be replaced after 10 to 15 years. However, if everything is in order and the patients have no problems with them, which we determine during regular check-ups, they can be left in for a longer period of time.

• If the patient has one breast removed, do you have to perform surgical procedures on the other, healthy breast to make the breasts look the same?

Of course, it is always recommended that the appropriate type of correction be performed on the other breast.

This can be a lift , a lift and reduction , or a lift and augmentation of the other breast. It all depends on the extent of the asymmetry of the breasts after reconstruction of the diseased breast.

• Are there any patients you would turn down for breast reconstruction surgery? Who is a good candidate for reconstruction?

Most patients are good candidates for reconstruction, the only question is what is the best technique for their reconstruction.

Who is not a good candidate? I would like to mention here that smoking reduces circulation in the remaining breast tissue and significantly increases the possibility of complications by 2 to 3 times or more.

• When should I undergo the procedure? How long should it take after a mastectomy?

It would be best to undergo the procedure immediately after the mastectomy, but of course this is not always possible.

The reason why the procedure is sometimes performed after a while is due to additional therapy that needs to be taken after surgery, such as breast radiation or advanced breast disease.

• What are the risks associated with breast reconstruction surgery?

As with any other procedure, standard or more complicated, there are certain risks.

After the reconstruction, infection or capsular contraction can occur (in the case of reconstruction with an implant), which means that a strong scar forms around the implant, which deforms the breast, making it very hard and painful.

Then a capsule needs to be made and the implant replaced. Also, after reconstruction with your own tissue, it can deteriorate due to poor circulation. Scars can sometimes be more pronounced.

• What changes do you see in women after reconstruction? To what extent does it affect their psychological health?

After reconstruction, women are truly happy with themselves. They have a breast, even though they have had cancer, and that breast, most often, looks similar to the natural one.

It is important that women do not feel a sense of loss, nor a painful reminder that they had cancer. Reconstruction achieves a result similar to the appearance they had before the disease. The goal of reconstruction is to achieve the most natural and beautiful appearance possible, or the appearance that women want.