When I see a new consult, I strive to ensure that my patients and their families have realistic expectations and a clear understanding of the risks involve with any surgical procedure. Managing patient expectations can be the most difficult and important aspect of a successful surgical procedure. In my practice as a plastic surgeon, I commonly hear many misconceptions from patients and their families regarding breast reconstruction after mastectomy, so I have tried to clarify some of these.
1. Everybody who has a mastectomy can have breast reconstruction.
While a federal law passed in 1998 mandated that all private insurers cover breast reconstruction after a mastectomy as well as any symmetry procedures necessary on the opposite breast, not every woman who has a mastectomy is a surgical candidate for reconstruction. While many procedures are performed to save a woman’s life or to cure disease, breast reconstruction is performed to improve the quality of life and is an elective procedure. Because it is an elective procedure, every physician and patient has to be mindful of the risk vs. benefit ratio. Patients who have the advanced or metastatic disease may not be a candidate for breast reconstruction. Other women may not be candidates because of their overall medical condition – diseases such as heart disease, diabetes, or morbid obesity can significantly increase surgical risks to the point where the risks outweigh the benefits of breast reconstruction. Another situation where the risks outweigh the benefits is in individuals who are actively smoking cigarettes or using nicotine-containing products.
2. Now you can finally get the large breasts that you always wanted.
Many women may view this as an opportunity – when battling an illness, we are all encouraged to fight, and one way to fight is to stand up in defiance. One of my patients has a t-shirt that reads, “ Yes, these are fake. The real ones nearly killed me.” Unfortunately, while we can create a breast mound with a tissue expander and an implant, we can’t always predict or guarantee that a patient will achieve a particular breast size. There are many limiting factors to how big a patient can be after reconstruction; and sometimes these factors are patient-related, while other times, they may be medically related. For example, some women don’t tolerate the expansion process well because it can be painful; some women will elect to stop expansion because of the pain and discomfort. Another reason that expansion may need to be stopped is that the skin is getting too thin. Think of the spandex that is pulled so tight, it becomes transparent. The same process can happen to your skin. And finally, there are limits to the size of the implants that are available.
It is also important to remember that a breast reconstructed with an implant will not look like a breast augmentation. Women who have a breast augmentation, have a breast implant that is placed behind breast tissue to increase the size of the breast – no tissue has been removed. A woman who has breast reconstruction in Oklahoma with an implant has had her breast removed, so the reconstructed breast will look like an implant more so than a breast.
3. This is your opportunity to get that tummy tuck and the body that you always wanted.
While many types of breast reconstruction, including TRAM flaps and DIEP flaps move tissue from your lower abdomen to create a breast, none of these flaps are a “tummy tuck.” A tummy tuck involves removing the excess skin and fat in the lower abdomen and essentially throwing it in the trash. For a reconstructive procedure, this same tissue must be harvested with its blood supply. For a TRAM flap, this usually means that the rectus (your six-pack muscle) muscle is taken with the tissue. For a DIEP or muscle-sparing TRAM
flap, the blood vessels that supply the skin and fat must be dissected free from the muscle; while minimal to no muscle is taken, the dissection through the muscle may result in scar tissue. Also, because of the need to harvest the blood supply with the skin and fat, the scar may be slightly higher than that of a traditional “tummy tuck.”
These are just some of the most common misconceptions that I encounter when counseling patients regarding Breast Reconstruction in Oklahoma. It is important to understand that as reconstructive surgeons, we will try our best to meet your expectations and provide you with the best result possible; however, there are limitations to what can be achieved. As you consider your options, always write down your questions and make sure that your concerns are addressed by your physician!