Breast Reconstruction after Mastectomy

This is Weekly Dose of Wellness brought to you by MemorialCare Health System. Here's Deborah Howell.

Melanie Cole (Host): Many women face the decision of choosing to have breast reconstruction after a mastectomy. This is Melanie Cole, sitting in today for Deborah Howell, and my guest is Dr. Eugene Elliott. He's a cosmetic and reconstructive surgeon at Orange Coast Memorial Medical Center. Welcome to the show, Dr. Elliott. So tell us, what is breast reconstructive surgery and how is it different than when somebody hears breast augmentation?

Eugene Elliott, MD: Breast reconstruction is essentially restoring the breast shape as well as possible after a mastectomy. And the way it differs from conventional cosmetic augmentation is with augmentation, you're starting breast tissue remains and you're just enhancing the patient's intrinsic breast tissue.

Melanie Cole (Host): No woman wants to get that diagnosis of cancer or have to consider a mastectomy, but Dr. Elliott, is reconstructive surgery something that you would think about before you decide whether or not to have that mastectomy? How do you make that decision?

Eugene Elliott, MD: Well, it's very important that the patient, as you said, no one wants a diagnosis of breast cancer, but it's important that the patient have a frank discussion with her doctors regarding her options for breast reconstruction. And the patient should not go forward with a mastectomy without thorough knowledge of what her options are regarding breast reconstruction.

Melanie Cole (Host): Okay, so she talks with you, talks with her doctor. Are there certain things that you want women to do at the time of the mastectomy to assist with achieving the best aesthetic results, something that losing weight or getting stronger, anything that you would like them to do?

Eugene Elliott, MD: Well, just in general, we want a patient in as good health as possible. So a patient should take care of themselves, take vitamins, be in the best physical condition because surgery has risks. And if you're in better shape, you're going to be able to withstand the risks of surgery much better. Other than that, there's no special preparation except having a very good understanding of what's going to happen, knowing the risks, knowing the complications, having realistic expectations. So all these factor in.

Melanie Cole (Host): Okay. What are some of the limitations of breast reconstruction? Are there some women who, after a mastectomy, it's just not an option?

Eugene Elliott, MD: In general, breast reconstruction is limited in the sense that when a mastectomy is performed, there's removal. The therapeutic goal of a mastectomy is to remove the breast tissue so the patient is healthy again. And then you're left with skin, and muscle, and the breast tissue is gone. So you have to reconstruct a breast out of the remaining tissues, and that can be quite difficult. There aren't any true limitations except the patient's general health because doing breast reconstruction does add time, surgical time and anesthesia, and calls for additional surgical procedures. So all these factors are very important.

Melanie Cole (Host): Dr. Elliott, tell us what's going on in the recent advances that help women to achieve better breast reconstruction results.

Eugene Elliott, MD: Well, if you look at the history of breast mastectomy for breast cancer, it started out with what were called radical mastectomies where a lot of skin was removed. Then it evolved into what was called skin-sparing mastectomy, which helped. And now the most recent advances in mastectomies is, when indicated, performing what are called nipple-sparing mastectomies. So that really helps the ability to reconstruct. On the reconstructive side, most plastic surgeons use what are called acellular dermal matrix. That's a material we use under the skin to help improve the cosmesis of reconstruction. So all these advances are helping us get better results with our reconstructions.

Melanie Cole (Host): Tell us about some of the implants. When you're reconstructing that tissue, as you said, it's very difficult. And women have heard a lot about different types of implants and reconstruction material. Tell us a little bit about that.

Eugene Elliott, MD: Well, basically, a patient with the implant type of reconstruction, a patient has the choice of either saline or silicone. Those are the general categories. But within those choices, there are many different shapes, sizes, contours, that can be used and would be appropriately chosen by the surgeon to get the best possible result. I don't want to fail to mention the fact that there is a different type of reconstruction called autologous reconstruction, which involves using the patient's own tissues. But these are very long surgeries. They're usually performed by a team of surgeons and commonly performed in a university center. So nationally, the most common form of reconstruction does involve breast implants.

Melanie Cole (Host): And so when this happens, what can a woman expect after surgery? Is there swelling? When do they look normal, as it were?

Eugene Elliott, MD: Well, breast reconstruction with implants involves at least two stages of surgery. So it's a journey. And usually we perform what's called an immediate reconstruction at the time of mastectomy to get the reconstruction going for the patient. Psychologically, the patient feels better about that. And then it usually requires one or two surgeries beyond that. So There isn't immediate gratification physically, but psychologically the patient knows that the process has started. The entire process of reconstruction can take up to six months to be whole, be completed, and to be done with the process.

Melanie Cole (Host): So when a woman is considering this, Dr. Elliott, what should she ask her breast cancer surgeon to help her make the decision and prepare for reconstruction after mastectomy?

Eugene Elliott, MD: Well, I think the first question is, am I a candidate? Am I healthy enough? Am I able to withstand further surgery? And then regarding the reconstructive surgeon or cosmetic plastic surgeon that's doing the reconstruction, what is that surgeon's experience? Is he board certified? Show me some results. Show me some before and after pictures. What are the risks of surgery? What are the techniques that are going to be used? What are the expectations? What are reasonable expectations? So all these issues come into play. What's also important is that the patient have knowledge whether radiation therapy be necessary because this is a technique that doesn't work well with implant reconstruction. It can cause problems. So all these issues are very important to discuss with the surgeon.

Melanie Cole (Host): And what about future breast cancer screenings after mastectomy? Do you still need that? And are there some differences in the way that you would get whether you've had a double mastectomy or only one? Dr. Elliott, what's involved in future breast cancer screening?

Eugene Elliott, MD: Usually there are no differences if a patient has had reconstruction or not, but it's the oncologist or the breast surgeon that determines long-term follow-up and what tests are necessary. But most of the time, patients, in my experience, I see patients getting MRIs and PET scans on a routine basis as far as diligent follow-up.

Melanie Cole (Host): So they can get an MRI. Is there a chance that something could shift or change or rupture? People have heard about these things.

Eugene Elliott, MD: Well, with a breast implant, just in general, there are long-term risks, and the most common long-term risks are what are called encapsulation or scar tissue or implant failure, rupture, leakage. Fortunately, these issues occur uncommonly, but if they occur, they can be dealt with. It may require further surgery. So follow-up is necessary. Surveillance is necessary. By and large, patients do very well when breast implants are used for reconstruction.

Melanie Cole (Host): And Dr. Elliott, in just the last minute or so, give us your very best advice for women that are considering reconstructive surgery after mastectomy.

Eugene Elliott, MD: Just be well informed. There is no wrong question to ask. So do your research. come, ask questions, make sure you're getting adequate time with your surgeon, make sure your questions are being answered appropriately and thoroughly, and then feel comfortable with your surgeon. Make sure you have good communication with your surgeon. That will help ensure good results. And if any complications occur along the way, if you have good communication, you can get through those complications.

Melanie Cole (Host): And good communication is so important to be able to advocate for yourself and talk to your doctor and not be afraid to ask questions. Tell people where they can find out more about you, Dr. Elliott.

Eugene Elliott, MD: Well, you can always reach me in my office. I'm at Orange Coast Memorial Hospital. I have private practice there, and my phone number is 714-241-0646. If you just Google my name, Eugene Elliott, M.D., I'll come up.

Melanie Cole (Host): That's great. Thank you so much. You're listening to Weekly Dose of Wellness. For more information, you can go to memorialcare.org. That's memorialcare.org. This is Melanie Cole. Thanks so much for listening.