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The Life-Changing World of Breast Reconstruction Surgery

The Life-Changing World of Breast Reconstruction Surgery featured image
PLUME CREATIVE/ GETTY IMAGES
This article first appeared in the Fall 2024 issue of New Beauty. Click here to subscribe

Every cosmetic surgery procedure should place you at the core of decision-making and design, but there’s one procedure that takes this as gospel. With so much on the line, a breast reconstruction is a delicate balance between the oncologist’s guidance, the plastic surgeon’s artistic eye, and, most critically, what the patient needs to feel whole again.

Featured Experts

Before Making a Choice

How a mastectomy is performed can also influence the outcome of a reconstruction, says Eugene, OR plastic surgeon Mark L. Jewell, MD. “It is vital for patients to carefully pick the general surgeon for their mastectomy,” he explains. “Unless a patient and her plastic surgeon have a general surgeon who understands that tissue flaps have to be thick enough to have adequate blood supply, tissue necrosis will occur and the reconstruction will be doomed. If radiation can be avoided, there will be a far better outcome. Radiation irrevocably damages normal tissues and causes failure of the reconstruction.”

Newton Centre, MA plastic surgeon Joseph A. Russo, MD, says that patients’ options for reconstruction are also shaped by their choices during treatment. “In the past, mastectomies were favored over a lumpectomy with radiation,” he explains. “But, with study, we’ve found that there is no difference in mortality or recurrence of cancer if you have a lumpectomy with radiation versus a total mastectomy.” Careful selection of a plastic surgeon with expertise in breast reconstruction can help minimize complications and maximize positive results.

The Options

“Essentially, there’s implant-based reconstruction and tissue-based reconstruction, using the patient’s own soft tissue using flaps from different parts of the body,” explains Wichita, KS plastic surgeon Amy M. Sprole, MD. “In some ways, a tissue-based reconstruction can look more natural, as it uses the patient’s own tissue,” Dr. Russo says. “That being said, implant reconstruction is a simpler surgery and it can also be performed at the same time as the mastectomy if the patient prefers.”

Outside of these options, women who have undergone a mastectomy can also “go flat.” Tucson, AZ, plastic surgeon Raman C. Mahabir, MD, explains that “going flat” is actually a very challenging operation. “A true flat aesthetic closure must smooth the extra skin, lumps and bumps and any unevenness leftover from a mastectomy.”

No decision can be made without a full understanding of the patient’s specific case of cancer. “Every part of reconstruction is a huge decision, including whether or not the patient chooses to do one side or both, or to do nipple sparing or not,” explains Dr. Mahabir. “Those decisions are certainly based on the cancer itself, but also on what the patient feels. Fear of future cancer can be a significant factor in decision-making.”

Up to 50 percent of cancer patients who have undergone a mastectomy elect to have a reconstruction surgery.

SOURCE: JAMA Surgery

Not Your Mother’s Breast Reconstruction

Preferences for implant-based reconstruction versus tissue-based surgery have shifted over the past few decades as techniques and technology have improved. “When I began doing breast reconstruction 25 years ago, I did a lot of tissue-based surgery,” explains Concord, CA plastic surgeon Eric Mariotti, MD. “However, with skin-sparing mastectomies and more implant choices and techniques to put the implants above the muscle, I switched almost exclusively to implant-based reconstruction. The surgery and recovery are often easier, and in many instances, I find the results to look better.”

“When the implant is placed in the natural space where the breasts had been rather than under the muscle, we see a really nice satisfaction rate,” adds Dr. Sprole. “This option also looks incredibly natural.” However, that doesn’t mean tissue-based reconstruction is unpopular. “It’s a much more complex surgery because you’re also doing a tummy tuck, carving that fat out and sculpting it into the shape of a natural breast,” Dr. Mahabir explains. “But, in my opinion, the positives make it the gold standard of breast reconstruction. When you gain weight, your breasts get bigger. They age with your body. You never have to worry about a rupture, a leak or a replacement, much less capsular contracture.”

Solving Common Problems

It isn’t just the techniques that have been updated, though. Breast reconstruction using implants has also seen material changes. “Implants will always be part of breast reconstruction,” Dr. Mahabir adds. “What might change, however, is what the implants are made of.”

In fact, it’s those changes that have allowed new techniques, like placing the implant above the muscle, possible. Previously, capsular contracture, where a ‘capsule’ of scar tissue forms around the implant, made under-muscle methods the most popular. “There was a reason we were placing implants under the muscle,” Dr. Sprole says. “The rate of capsular contracture was much lower in this method. But, with the development of what’s called a dermal matrix, where the implant is wrapped in tissues, we’ve been able to reduce that risk significantly.”

Additionally, innovations in breast implant construction have allowed patients to have more options with less complications. Natrelle, for example, has developed a gummy gel textured implant that remains in one piece in the event of a rupture, wrapped in a protective, medial-grade silicone shell that’s made to last.


Look for the pink ribbon on your favorite beauty products during the month of October to support breast cancer awareness and research.


Take Your Time

While some patients may want to begin reconstruction right away, it’s important to know that taking your time is often a good thing. “Patients who have immediate reconstruction at the same time their mastectomy is performed are often less satisfied with the overall result,” Dr. Mahabir says. “In that case, they’re going to sleep with their own breasts and waking up with a surgical result, and that difference can be jarring.”

Dr. Sprole says that in her practice, immediate breast reconstruction is a two-stage process to allow for necessary tissue expansion and healing. This way, she can ensure the best outcome without leaving patients with nothing for any length of time. “Patients wake up with a tissue expander in,” she explains. “That time used to be dreaded, but the shift to placing the implant above the muscle has made my patients’ recovery less painful.”

In 2024, an estimated 313,510 people will be diagnosed with breast cancer in the U.S.

SOURCE: Breast Cancer Research Foundation Data

Your Perfect Fit

Alongside these advances in technology and techniques, patient expectations have also risen. “Compared with the expectations of breast reconstruction just a couple of decades ago, today’s patient prefers not to look like she even had a mastectomy,” Dr. Mariotti explains. “In order to accomplish this, we, as plastic surgeons, must strive to deliver the most natural-appearing results we can.”

Helping to deliver those results are brands like Natrelle, whose huge catalogue of breast implant options is curated for each patient. Considering height, chest wall width, your side profile and the volume of implants, Natrelle offers a range of suitable options that include 3 different gummy gels. From natural-touch to a fuller cohesive gummy gel, these silicone gel implants are designed to remain in one piece in the event of a rupture.

Maximizing patient satisfaction is always the goal for an aesthetic procedure. But, there’s a lot on the line with breast reconstruction. “The emotional impact of losing part or all of the breasts shouldn’t be understated,” Dr. Russo says. “This is a vital part of how women see themselves, and restoring that sense of confidence is ultimately the goal.”

The median age for women who undergo breast reconstruction is 53 years old.

SOURCE: JAMA Surgery

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