Considering Breast Reconstruction After Surgery

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So there's a lot of information that's been thrown at patients when they've got the new diagnosis of early breast cancer. And it's just overwhelming sometimes. The first decision that the patient is going to need to make with a surgical oncologist before they even meet us is whether the patient will need a mastectomy versus just a partial mastectomy or lumpectomy, cause that's a very different discussion.

Once they've decided, though, to have a mastectomy, there's a very real option to do nothing. People sort of underplay that option a little bit. We've got reasonable data that shows that a lady after 12 months of undergoing just a mastectomy and going flat, that they get back to a new normal and manage that appropriately. But I will say that the majority of ladies are opting for reconstruction. And there are lots of benefits - physical, psychosocial - that data supports for the benefits of breast reconstruction.

That is where the whole discussion is important with regard to the plastic surgeon. The surgical oncologist and the patient serve a triad. And so there's multiple issues. One is radiation. So if a patient's going to get radiation, the plastic surgeon generally will be talking in a more delayed reconstruction mode. And that doesn't mean the patient doesn't get an expanded place at the time of the mastectomy just as a temporizing mechanism. But the final reconstruction is generally delayed for after the radiation. So that's the first thing.

Second aspect for delayed reconstruction would be in a lady that's got lots of medical problems, significant diabetes, is a smoker, is very overweight. Those are three examples of where the surgeon, again, may just use a temporizing expander and then do the final reconstruction at a later stage.

Overall, if there's an opportunity to do immediate reconstruction, then we like to do immediate reconstruction. Not everyone is a candidate. And we have to evaluate everyone based on their background medical history. And we're all in with our patients. We want them to get reconstructed. And so it is sometimes difficult to have a conversation where we say, "Look, we're going to probably have to delay your reconstruction or look at other options."

When you're talking to plastic surgeons, make sure they chat with you about all your options. I think that's really important if I'm speaking as a patient advocate. I think it's critical to have a surgeon that wants your best interests and will discuss every single surgical option. Even if you don't offer all those options I think a fair and unbiased discussion about all the options is critical for patients to get the full story.