Reconstruction after breast cancer surgery can be a long process. A few weeks after treatment, many of my patients ask me the same question. "Will I ever feel like myself again?" As a plastic surgeon, I can't answer that personal question for them, but I can explain to them what reconstruction has become and is capable of, and the field has changed a lot over the last decade.
Rebuilding with the body's own tissue
Autologous reconstruction employs the patient's own tissue to recreate the breast. Fat and skin are harvested from the lower abdomen, thighs, or back. One of the techniques I like to use is the DIEP flap, which harvests skin and fat from the lower abdominal wall without sacrificing any abdominal muscle. Patients have less pain and quicker recovery with less impact on their core strength than traditional muscle sacrificing procedures.
The benefit of using autologous tissue is that it will behave like 'natural' breast tissue. It should feel the same, and it can change as the patient's body changes over time. This is important because the patient, who may only be 40 years old, may outlive an implant by 40 or more years.
Fat grafting: the finishing touch
Fat grafting has been an amazing discovery for the breast reconstruction patients I treat. A small amount of fat is removed by gentle liposuction techniques from one site and prepared and injected in minute amounts into the area of the implant or reconstructed breast. It is used to smooth out irregularities, soften scars, and fill small deficits in volume. It has also proved to be very effective in patients with scar tissue from radiation treatments, which often renders the skin on the chest hardened and thin.
I've seen dramatic improvement in patients with this type of tissue damage after a few fat injections. Some patients are concerned that introducing fat into the area, where breast cancer may still lie dormant, could encourage its growth. Research to date suggests otherwise; however, we do take precautions in selecting the patients for the procedure and follow them very closely.
Not one technique for everyone
A flap is not right for every woman. Very slim patients may not have enough donor tissue, and some are not fit for a long operation. For them, an implant, sometimes combined with fat grafting for a more natural shape, can work very well. In selected patients, nipple-sparing mastectomy preserves even more of the breast's original appearance.
Planning together
The optimal results are achieved through the earliest possible collaboration between the breast surgeon, oncologist, radiation team, and plastic surgeon, as radiation therapy can significantly impact both the timing and type of reconstruction. Whenever possible, I encourage patients to make choices about what they would like to do regarding their reconstruction before their mastectomy.
Breast reconstruction is not vanity. It plays a critical role in recovery for many women. Some women will decide against reconstruction, and that is a valid choice, but it is a choice that should be made with eyes wide open, having understood the options and their trade-offs.
So, can your fat do breast reconstruction? Often, it can.
The author is a plastic surgeon and founder of 'Seena Strong'.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
