You may be facing the loss of one or both breasts - and this leads to yet another decision to make: breast reconstruction, external breast prosthesis, or nothing at all? This is a very personal choice, and your decision may depend on several factors. Talking to your doctor and with breast cancer survivors can help you make the choice that will be right for you.
Your Medical Situation Affects Timing and Options
Once you are diagnosed with breast cancer, you will need surgery, and possibly chemotherapy, radiation, or both. Knowing your diagnosis and understanding your treatment options will help you decide between plastic surgery and using a prosthesis.
Immediate reconstruction, done right after a skin-sparing mastectomy, is considered to give the most pleasing aesthetic results. If you have early-stage breast cancer, you can opt for immediate reconstruction or none at all. Instead of reconstruction, you can use external breast prosthesis, or go braless - whichever you are most comfortable with. Studies have shown that immediate reconstruction does not delay detection of chest wall recurrence (CWR). In cases where CWR did occur, it was related to distant metastatic disease.
If you know that you will need radiation after your mastectomy to help prevent a recurrence, you may be a good candidate for delayed reconstruction. An immediate autologous reconstruction or a permanent breast implant would interfere with the radiation treatments. In that case, it is best to have delayed reconstruction, or have an unfilled tissue expander implanted just in case, or no reconstruction.
If you smoke, you may not be a good candidate for breast reconstruction. Smoking causes your blood vessels to become narrow, and since reconstruction can involve reconnecting arteries, constricted blood vessels can cause reconstruction to fail.
Personal Preferences Are Important to Your Decision
Perhaps your medical situation leaves the door open to immediate or delayed reconstruction, as well as an external breast prosthesis, and going natural. If so, your personal preferences will most likely guide your decision.
I met Ellen at church soon after I was diagnosed. Ellen, married and the mother of two grown daughters, discussed her options with her husband. "It didn't really make any difference for us," she said, "I didn't want more surgery, so I use a prosthesis now, and I'm happy with it!" In her book "It's Not About the Hair," author Debra Jarvis talked about choosing to have an implant because she felt that she was "too lazy to use a prosthesis."
Other people don't mind having breast reconstruction along with a mastectomy, but there are those of us that just want quicker surgery and less anesthesia. Sometimes a woman prefers to have a mastectomy only, and defer her decision about reconstruction until she has learned more about her diagnosis or until she has fully recovered from additional treatments.
Lifestyle Can Influence Surgical Choices
Breast cancer never comes at a good time in your life. You may be married, single, or somewhere in between, when you are diagnosed with cancer. Some women are diagnosed while they are pregnant, raising a family, or after their kids have gone off to college.
Paula was a young career woman in my support group, was engaged to be married, when she was diagnosed. Determined to save her breast, she agreed to have chemo before surgery, hoping to shrink her tumor. After several treatments and trying different drugs, she was able to have a lumpectomy. Anne, a friend at church, was a newly divorced mother of young boys when she discovered her lump and had a double mastectomy with no reconstruction and no prostheses. "I didn't have time," she said, "The kids needed me for everything right then. I had surgery, chemo, and did the best I could." She wears colorful ethnic fashions that are not form-fitting, and now looks splendid and healthy. Lani, my Facebook Fan, had a mastectomy while pregnant, and could not have reconstruction right away. "I had made it clear before surgery that was my goal - to have reconstruction. It helped that I knew before the surgery that I would be meeting with a (plastic) surgeon within the next few weeks or so." Meanwhile, she wears a mastectomy bra and prosthesis, and is looking forward to breast reconstruction, as well as the end of treatments.
How might your choice affect your intimate life, now and in the future? Is your shape an important part of that relationship, or is it secondary? Would a prosthesis come between you - or would it make no difference? Have this discussion before you make a decision, so you can avoid surprises later.
Finances Can Impact Your Choices
In the United States, Federal law protects your right to symmetry - insurance will help pay for breast reconstruction or a prosthesis and mastectomy bras. Just like getting a wig during chemo, you'll need a prescription for a breast prosthesis. If you file an insurance claim for external breast prosthesis, they may refuse to cover breast reconstruction at a later date - so check first! Medicare and Medicaid can be used to pay for some of these expenses - if you are eligible. Keep good medical and financial records - many of these costs may be tax deductible.
Make a Balanced Decision
The most important goal of surgery for breast cancer is to remove the disease. While keeping your health and survival in mind, also consider these things: your medical situation, personal preferences, lifestyle, and finances. Try to think in terms of six to 10 years into your future. What are your hopes, dreams, and goals for those years? What are your priorities? Let your decision be a very personal one that would satisfy you in as many respects as possible.
What Happens After Treatment For Breast Cancer? American Cancer Society. Last Revised: 05/13/2009.
Breast Reconstruction After Mastectomy. American Cancer Society. Last Revised: 09/30/2008.
Options and considerations in the timing of breast reconstruction after mastectomy. Preya Ananthakrishnan and Armand Lucas. Cleveland Clinic Journal Of Medicine Volume 75, Supplement 1 March 2008.