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Feeling Whole Again After Breast Surgery: Read Barbara's Story
Breast Cancer and Reconstruction
Date: 4/1/2009

While there is nothing easy about receiving a breast cancer diagnosis, recent medical advancements offer hope to women facing the disease. As awareness of breast cancer increases, so do early detection and survival rates.

With survival, however, comes the reality of life after breast cancer — something the newly-diagnosed woman should consider from the start. For many women, the involvement of a plastic surgeon early on can mean a smoother transition into the next stage of their lives.


Meet Barbara from Columbus

Generally a healthy person, Barbara Breivik didn’t see her primary care doctor very often, but was diligent about regular visits to her gynecologist and scheduled annual mammograms since she was 40 years old. “I tend to be cystic and I was working at a pharmaceutical company that offered free mammograms, so I thought it might be a good idea to start getting them,” she says.

In November of 2007, Breivik was diagnosed with stage 3B inflammatory breast cancer at the age of 50. “It was very scary. There is no history of breast cancer in my family,” says Breivik.

Her physician referred her to The Cancer Institute of New Jersey Hamilton (CINJ Hamilton) for care. Breivik’s treatment began with five months of chemotherapy after which she decided to have a bilateral mastectomy. “I chose to have both breasts removed because of the type and stage of the cancer. I was afraid chances of reoccurrence would be greater if I’d kept the unaffected breast. The doctor felt it was a wise choice,” says Breivik.

A friend who was a survivor of breast cancer recommended Breivik contact plastic surgeon Matthew Lynch, MD, as soon as she decided to have the mastectomy. “Dr. Lynch was there from the start. He worked with the surgeon and made the marks where the surgeon would cut,” Breivik explains.

Her tissue expanders were placed during the mastectomy surgery and in December of 2008, Breivik completed her reconstruction with implant surgery. “I feel so fortunate to have found such wonderful care close to home,” says Breivik of CINJ Hamilton and Dr. Lynch.

“I contacted a second hospital in Philadelphia, but I didn’t feel as welcome there and I as given the same recommendations for treatment.”

Breivik, who enjoys golfing with her husband, Leif, considers herself to be on the upswing after her diagnosis and surgeries. “I wasn’t able to play golf last year because of the surgery, so I am looking forward to getting back into the game this spring.”

Cooperative Care
It may be difficult for a woman to bridge the gap between the immediate need for breast cancer treatment and how that treatment will affect her anatomy. That foresight, however, helps many to regain a sense of self after receiving body-altering treatments — including lumpectomy, radiation and mastectomy.

Matthew Lynch, MD, board certified plastic surgeon, has spent much of his time working with patients who are looking forward to their lives after breast cancer. “I often see a patient even before she goes in for treatment. We discuss her objectives for reconstruction surgery and I consult with the surgeon — even assisting in surgery — to ensure the best conditions to meet the patient’s goals,” says Lynch.

Reconstruction Options
Each breast cancer patient receives a unique diagnosis and has her own expectations for her care. “The objective is different for each patient and that guides us in making decisions about what kind of reconstruction to perform,” says Lynch. “Some women are focused on size, shape and symmetry, while others are more concerned about feeling comfortable and how they will look in clothing.”

Common reconstruction procedures:

Tissue flap procedures
Tissue flap techniques (including TRAM flap and latissimus flap procedures) are surgeries in which a woman’s own muscle, fat and skin are repositioned from another part of the body, like the abdomen or back, to create or cover the breast mound. These procedures are often used when mastectomy or radiation treatment does not leave an adequate amount of tissue for reconstruction.

Implant procedures
In breast implant and tissue expander surgery, the breast is reconstructed by using either a saline- or silicone-filled implant.

This approach requires less surgery than tissue flap procedures and less recovery time because the only area requiring surgery is the breast tissue. Depending upon the muscle tone of the patient, implant procedures can be done in a single stage, or in multiple stages using an expandable implant or tissue expanders. The expanders will increase the space in which the implant is placed to accommodate the appropriate-sized implant.

The Empowered Patient
Although many surgeons treating breast cancer will explain to their patient the value of bringing a plastic surgeon into the mix, it is not common practice. Women who are unaware may seek information about reconstruction after treatment, which sometimes can be too late.

Surgery, scarring and tissue damage from radiation treatments can lead to breast deformity making reconstruction difficult. “Women who are interested in reconstruction should seek the opinion of a plastic surgeon early,” says Lynch. “Whenever a mass is removed, there are areas of missing tissue. The plastic surgeon will get involved by rearranging breast tissue so that spaces are no longer there, making reconstruction more successful.”

Whatever a patient’s goals for treatment and reconstruction after a breast cancer diagnosis, education is her most important asset. “The more educated a patient is, the better decisions she will make. Get multiple opinions, talk to other survivors and do some research,” says Lynch.

“It takes time for a woman who is living with a breast cancer diagnosis to assimilate to reconstruction, but patients are generally very happy with their results. It makes them feel whole again.”

Note: The Women’s Health & Cancer Rights Act of 1998 mandates group health insurance coverage of breast reconstruction surgery following mastectomy. 

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