An Important Decision

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Whether to undergo reconstructive surgery is an Important decision for a woman who loses a breast to cancer.

“There is the philosophy of ‘What difference does it make? Be happy that you’ve taken off the cancer and get on with life.’ Y-Me’s perspective is that it’s a traumatic thing,” said Sharon Green, executive director, Y-Me, National Organization for Breast Cancer Information and Support. “Reconstruction offers hope and an option. We’ve had 80-year-old women call and ask ‘I want breast reconstruction – am I an idiot?”

Green said her response to the elderly as well as the young is the same: “They should be able to have a choice to do what they want to do.”

“If you’re treating the whole patient, you have to treat breast reconstruction as part of the rehabilitation process,” said Gus Galante, a plastic cosmetic and reconstructive surgeon in Munster. “Some women can live a normal life (without a reconstruction). But it’s not like losing your colon to colon cancer. A breast is an exterior body part. It’s like losing an arm or a leg.”

“When someone suffers a loss of a body part, it has an affect on self-image.”

Any woman who has undergone a mastectomy, Galante said, is a candidate breast reconstruction evaluation.

The options are numerous, including the type of reconstruction available and the timing of the surgery.

Galante said immediate reconstruction is a consideration and can become part of the rehabilitation process. That often helps a woman alleviate some of the depression and mourning she experiences due to losing a breast.

The most well-known breast reconstruction technique – the silicone gel implant – is alternately praised and castigated.

Nonetheless, the procedure is now carefully monitored by the Food and Drug Administration, said Karin Plym Forshell, attending plastic and reconstructive surgeon at The Methodist Hospitals in Gary and Merrillville.

“The gel implants are only available for re constructive purposes. To be able to use the silicone implants, the doctor has to register on a research list with the FDA,” said Plym Forshell. She now uses saline implants but said she prefers the gel implants because they feel more natural than the saline ones.

“We think silicone implants should be available to women who want them,” said Y Me’s Green.

Other procedures more widely performed include the tissue expander implant, followed by a saline implant and the more lengthy procedures known as pedicle-flap and free-flap surgeries.

According to Galante, the tissue expander procedure requires more than one surgery. The first surgery involves the implanting of a temporary tissue expander pouch at the site
the mastectomy.

The pouches are equipped with a valve. After the surgery, the doctor inflates the pouch. gradually by injecting saline into the valve during a series of office-visit procedures.

“Once the breast area has been expanded to the desired shape and size, the expander is removed, and a properly sized saline implant is inserted,” Galante said. “The second surgery is performed a minimum of four to six months after the first surgery.

“A woman undergoing chemotherapy would wait until that course is complete before undergoing her second stage of implant.”

Another form of reconstruction, flap surgery, involves a longer surgical procedure and requires more hospitalization and recovery time. In addition, the surgery requires an additional wound at the site from where the flap is taken.