Restoring The Female Form:
Advances in Breast Cancer Reconstruction

When 32-year-old Melinda Santiago learned that her 31-year-old cousin had been diagnosed with breast cancer, her first thought was, “No, this can’t happen to her.” Disbelief turned to dismay when Ms. Santiago visited a breast specialist—at her cousin’s urging—and Stage II breast cancer was found in one of her breasts.

“My mother was diagnosed with breast cancer when she was in her late 30s, and my cousin and I got it even earlier,” says Ms. Santiago, L.P.N., at Monmouth Medical Center. “We have such a strong family history that I made up my mind to have both breasts removed.”

Her difficult decision was made easier by the shared cancer treatment that she and her cousin experienced. As one completed chemotherapy, the other was having reconstructive breast surgery.

“We were there to take care of each other,” says Ms. Santiago. “Sometimes God works in mysterious ways.”

Still a young woman, Ms. Santiago was concerned about whether or not her breasts would look and feel natural after reconstruction. She found a compassionate breast surgeon, Bennett Rothenberg, M.D., Chairman of the Department of Plastic Surgery for Saint Barnabas Medical Center, and together they chose the TRAM Flap (transverse rectus abdominis myocutaneous) as her reconstruction method.

A section of skin, soft tissue and muscle was taken from Ms. Santiago’s abdomen and used to reconstruct her breasts. Ms. Santiago reports that the result is two breasts that appear natural.

“Dr. Rothenberg really understood that I was a young, single woman who wanted the end result to look as good as possible,” she adds. “I don’t feel any less a woman because they look and feel great. It was an outstanding experience.”

Medical Advances
Dr. Rothenberg says that advances in breast reconstruction have been quite dramatic over the last 25 years. While years ago most women used to wear a prosthetic breast form after mastectomy, now more than 75 percent of women choose post surgical reconstruction, according to the National Institutes of Health. The aim of breast reconstruction is to match the natural breast as closely as possible.

“Patients need a good deal of support through the reconstruction process,” says Dr. Rothenberg. “They come into the office with a diagnosis of breast cancer and are emotionally devastated and torn about options for both treatment of breast cancer and reconstruction. We meet with them, listen to their concerns, share post-surgery photos and give them the option of speaking with other reconstruction patients.”

There are two procedures most commonly used for breast reconstruction: a TRAM Flap procedure, which uses abdominal tissue to reconstruct the breast, or the insertion of breast implants.

In a TRAM Flap procedure, the surgeon removes a section of abdominal skin, fat, and muscle from the abdomen and transfers it to the breast area. The tissue from the abdomen is shaped into a breast and sewn into place. Patients typically stay in the hospital three days, compared to the one or two-day stay with the implant operation. Though the recovery is slower, the breast usually looks and feels more natural to most women, reports Dr. Rothenberg.

“We use the tissue that would be discarded in a tummy tuck to create a more natural breast for the patient,” Dr. Rothenberg relates.

For breast implant reconstruction, patients most commonly have saline implants, although silicon breast implants are gaining in popularity. Immediate breast reconstruction is performed at the same time as the mastectomy. In delayed reconstruction, the plastic surgeon places a tissue expander where the breast tissue was removed. After post operative expansion, the expander is removed and a permanent implant is placed. In general, delayed reconstruction is the result of delayed radiation treatments, physical limitations and personal preference.

Dr. Rothenberg relates that younger, healthier patients who are neither too thin nor too heavy tend to choose the TRAM Flap procedure. Older patients with existing medical conditions more often receive breast implants.

“The woman and her surgeon discuss which type of procedure is preferred,” says Dr. Rothenberg. “It is important for the surgeon to make the patient aware of the advantages and disadvantages of both procedures.”

Other Considerations
The patient has a nipple created as part of the reconstruction process. This is usually done after the breast reconstruction has healed and settled into its final position.

The nipple may be reconstructed from grafted skin tissue, taken from other suitable areas of the body. The use of grafted skin tissue depends on the pigment color of the available skin. Another option, nipple tattooing, uses a permanent pigment.

Dr. Rothernberg adds that research has shown that breast and nipple reconstruction, whether immediate or delayed, does not deter detection of any local cancer recurrence. After reconstructive surgery, patients can continue the proper follow-up care that is required.

Overall, Dr. Rothernberg finds breast reconstruction to be a vital part of the mastectomy process for the overwhelming majority of breast cancer patients.

“It is remarkable how much the patients benefit physically and psychologically from breast reconstruction,” he adds. “They have no limitations for activity, visible cleavage, and may wear any clothing without feeling inadequate. As a surgeon, I find that their satisfaction makes it all worthwhile.”

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