The right time to start breast reconstruction—at the same time as mastectomy surgery or later—is a question that’s been debated for a long time. Years ago, when breast cancer death rates were higher and survival was the first and almost only focus, women who chose reconstruction most often waited. Recently, the pendulum has swung the other way, with women encouraged to consider starting the reconstruction process at the time of mastectomy. Two recent studies shed new light on decision making for women with breast cancer and their doctors.
An article in the September 2010 issue of the Archives of Surgery, a publication of the New England Surgical Society and the Pacific Coast Surgical Association, suggests that immediate breast reconstruction (IBR) patients who undergo post-surgery radiation treatment run a fairly high risk of complications resulting in breast implant removal. A team of ten doctors and scientists studied 302 breast cancer patients who had mastectomies. They found that of the 100 who had IBR, 44 percent developed complications which led to additional surgery and implant loss, while only 7 percent who did not have immediate reconstruction required further surgery.
As reported in that same issue of the Archives, another team of researchers studied 163 IBR patients who had chemotherapy, some before and some after their surgery. In this case, the group found, “Neither the inclusion of chemotherapy nor the timing of its administration significantly affected the complication rates after mastectomy and immediate breast reconstruction in this population.”
It would be nice if there were a definitive answer as to whether it’s best to have breast reconstruction at the same time or following mastectomy, for mastectomy patients who choose the surgery. Apparently, it’s just not that easy.
There are some big advantages to IBR, according to the American Cancer Society. When breasts are rebuilt immediately, prior to the formation of scar tissue or radiation damage, the results often look better. In addition, patients who undergo IBR have fewer surgeries than women who have reconstruction later. Then there’s the fact that women who choose IBR never have to suffer the psychological affects of seeing themselves without a breast.
But the study showing that IBR patients who have radiation run a relatively high risk of complications can’t be ignored. One doctor suggested that lymph node tests run prior to surgery might provide a preliminary idea about whether radiation will be needed later, perhaps helping a woman decide if and when to undergo reconstruction.
In any case, perhaps it’s not surprising that an answer about the best time for breast reconstruction is not applicable across the board. Tumors, breasts and patients themselves all vary widely. That’s why treatment plans are developed specifically for each individual.
It looks like each woman, along with her team of doctors, needs to take the same approach to the question of reconstruction timing.
Resources:
http://archsurg.ama-assn.org/cgi/content/short/145/9/873
http://archsurg.ama-assn.org/cgi/content/abstract/145/9/880
http://www.cancer.org/Cancer/BreastCancer/MoreInformation/BreastReconstructionAfterMastectomy/breast-reconstruction-after-mastectomy-br-recon-choices