What is the best breast reconstruction option?
A difficult decision that faces a breast cancer patient who is interested in breast restoration is determining the type of surgery and the type of reconstruction. These two are usually related as the type of mastectomy: total or partial, one side or both sides, determines the available options for breast reconstruction. During consultation I am often asked about the best breast reconstruction option and my answer always is: the best option is the one that preserves the breast!
Despite advancement and refinement of surgical techniques, a reconstructed breast may look identical and sometimes better than the natural breast, but it does not feel the same as a natural breast. This is largely due to the fact that a reconstructed breast has minimal sensation. I always tell my patients that nothing can replace their natural breasts.
Breast preservation or conservation means that the breast surgeon only removes the part of the breast that contains the tumor while preserving the rest of the breast. This type of surgery is called “lumpectomy” or “partial mastectomy” and it is typically followed by radiation therapy. Not every patient is a good candidate for breast conservation and this option should be discussed with the breast surgeon. Reconstruction following lumpectomy is usually performed a week later after the final pathology results confirm that the tumor was completely removed. The type of reconstruction depends on several factors including the size of the breast and size and location of the tumor removed. The goal of surgery is to fill the void or cavity created by the lumpectomy, by either re-arranging the breast tissue or by bringing in tissue from somewhere else. The end result is an intact breast structure that withstands the scarring forces of radiation.
Tissue re-arrangement is performed in patients with large droopy breasts and it results in a smaller and lifted breast. A patient who prefers to preserve the same shape of her breast can be a candidate for a procedure that recruits skin and fat from the back carried on a strip of muscle, called the latissimus dorsi muscle, and delivered to the breast through the armpit. This tissue is shaped in the same dimensions of the missing breast tissue and is buried under the breast skin to fill the cavity. This procedure preserves the majority of the muscle and minimizes dissection in the back area and therefore potential complications.