Going Beyond Breast Reconstruction on BRA Day with BRCAStrong

Breast Reconstruction Awareness Day is as much about educating patients and individuals of their options as it is illuminating the factors that underlie breast reconstruction decisions. Dr. David Light joined BRCA Strong’s Medical Director, Dr. Alexea in a conversation that aimed to go beyond simple breast reconstruction options. Dr. Alexea is an infectious disease physician, cancer wellness coach, and Stage III breast cancer survivor. The pair dug into key physical and emotional considerations that patients and physicians tackle as part of the breast reconstruction process.

Listen to their discussion below or read on for answers to a few of Dr. Alexea’s questions and other salient points from the talk.

Why do women seek breast reconstruction?

“I think that reason is different for different women, but I think to sum it up… it’s basically to regain a sense of wholeness,” Dr. Light said.

While the nuances vary from patient to patient, Dr. Light said in most cases breast reconstruction is part of a physical and emotional restoration process. His assessment was in alignment with Dr. Alexea’s personal breast reconstruction experience.

“I certainly felt like this cancer is going to take so much from me. It’s going to take my hair, but that will grow back. It’s going to take my sense of wellbeing, of my health. It’s going to take my breasts away. I wanted to be restored back to a semblance of myself,” she said.

Why would a woman have to delay a reconstruction?

“Sometimes reconstructions are delayed because the outcome of treatment or the path ahead as far as treatment goes is uncertain,” Dr. Light said.

Reconstruction delays often come down to patient health. When dealing with advanced or inflammatory cancers, sometimes it is prudent to pause reconstruction while treatment is initiated and assessed. There are also patients who become delayed by issues in the reconstructive process itself, like infections, issues with implants, or complications from radiation. This group must wait until they have healed to move forward.

Unfortunately, access to reconstruction also plays a role. “There are still places in this country where there is not a plastic surgeon accessible. The breast surgeon proceeds with the mastectomy, because obviously treatment needs to occur and we need to get a patient healthy. Then, they’ll go to seek reconstruction elsewhere. They’ll travel to come and see a plastic surgeon.”

Why would a patient switch from one type of reconstruction to the other?

According to Dr. Light, the switch from implant to natural tissue reconstruction is often planned. For example, radiation and implants have a high complication rate. To mitigate issues, a plastic surgeon may place a tissue expander implant in a patient undergoing radiation and switch to natural tissue reconstruction after treatment is completed.

In some instances a switch is not planned. Infections, implant extrusion, and mechanical issues with an implant that require removal all have the potential to prompt a switch once a patient has healed.

“Unfortunately, as an infectious disease physician, I’ve had to tell a number of women that they have to have their breast implants removed as a result of an infection, and it’s a very hard process for them, and it’s a very hard thing to have to tell someone,” Dr. Alexea said.

The good news for these patients is that this is typically a temporary setback. The wide range of breast reconstruction options available can almost always offer some alternative that will work with their body.

What should patients know about aesthetic flat closure?

“Not everyone wants a breast reconstruction, but just because they don’t want a breast reconstruction doesn’t mean that they will accept anything as far as their closure,” Dr. Light said.

Chest wall contour after mastectomy is not inherently flat or even. Extra skin heals, creating ridges and deformities that can be seen through clothing. Aesthetic flat closure corrects these issues, which helps patients physically and emotionally.

“It can be not only uncomfortable, but for many patients, upsetting. Taking that extra step to say, ‘OK, I’m not going to do a reconstruction, but I still want this patient’s chest to look clean, neat, flat, no irregularities so that they can be comfortable,’ I think is important.”

Dr. Alexea capped off the discussion with an important sentiment: “Whatever we choose, whatever we come together with our plastic surgeons and breast surgeons and our team and decide, what is the best option for us as an individual patient, at the end of the day I think we’re just grateful to have teams who are rallying around us to get us through this potentially devastating diagnosis.”