Breast Cancer Reconstruction Options You May Not Know

Laura Schulz, COO of Ghost Productions, was diagnosed with Invasive Lobular Carcinoma (ILC) in the fall of 2018. ILC is the second most common type of breast cancer, accounting for about 1 in 5 new breast cancer diagnoses.

Here is her story:

When I was diagnosed with breast cancer I was at stage 2, and told the rate of recovery was 93%.  The course of treatment for my tumor size required a mastectomy and breast reconstruction.  Understanding the different reconstruction options was important and gave me a sense of control and relief in knowing what my body would be like after treatment.

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During the process I did genetic counseling and had no pre-markers for breast cancer. My paternal grandmother did have a single mastectomy in her 50’s and lived another 30 years with no evidence of disease. With this knowledge I choose to also have a single mastectomy.

There are several different types of mastectomies. The right type will depend on the stage and aggressiveness of your cancer, your overall health, and your personal preferences.

Types of mastectomies:

Partial Mastectomy:

Also called a lumpectomy or segmental removal, this type of mastectomy involves removing only the part of the breast that contains cancer. The surrounding tissue, lymph nodes, and the nipples are left in place. This type of mastectomy usually has the shortest recovery time and allows you to keep most of your breast.

Nipple-Sparing Mastectomy:

This type of mastectomy removes all of the breast tissue but leaves the skin, nipple, and areola intact. Nipple-sparing mastectomies are used for both cosmetic and prophylactic purposes but may not be an option if you have large breasts or extensive cancer in your breast tissue.

Skin-Sparing Mastectomy:

This type of mastectomy removes most of the breast tissue but leaves the skin intact. The nipple and areola are removed. Skin-sparing mastectomies allow for better reconstruction options and usually have shorter recovery times than other types of mastectomies.

Total (Simple) Mastectomy:

This type of mastectomy removes the entire breast, including the nipple, areola, and some surrounding tissue. The pectoral muscle under the breast is left intact. This type of mastectomy usually has a shorter recovery time than a radical mastectomy.

Radical Mastectomy:

This type of mastectomy removes the entire breast, including the nipple, areola, and surrounding tissue. The lymph nodes under the arm and pectoral muscle are also removed. This type of mastectomy has a longer recovery time than a total or partial mastectomy but may be recommended if you have cancer that has spread to your lymph nodes and muscles.

The size and location of my tumor required a skin-sparing mastectomy. My surgeon was not able to save the nipple, and I would require nipple reconstruction, tattoos, or prosthetics in the future, if I choose to replace the nipple.

Tissue Expanders

During the mastectomy a plastic surgeon implanted a tissue expander. This involves placing temporary expanders under the skin and over or under the chest muscles. Once the expander is in place, saline solution is slowly injected into the expander to stretch the skin. This process is done over the course of several weeks. Once the skin has been stretched enough, the expander is removed and breast reconstruction surgery occurs. In my journey, I had to wait for the tissue expander to be removed until after  6 weeks of radiation.

Breast Implants and Flap Surgeries.

There are two main types of breast reconstruction: implants and flap procedures. Implants are the most common type of reconstruction, but flap procedures are gaining in popularity.

Flap procedures are becoming increasingly popular as more women learn about them. In a flap procedure, skin, fat, and sometimes muscle are taken from another area of the body—usually the back, thighs, or abdomen—and used to reconstruct the breasts. The advantage of flap procedures is that they use your own tissue instead of implants, so there is no risk of implant leakage or rejection. Another benefit is that because the flap procedures use skin that is similar in color to your natural skin tone, the reconstructed breasts will better match your existing skin color.

It was important for me to use my own tissue and not have an implant, and I was a good candidate for DIEP flap surgery. DIEP refers to the deep inferior epigastric perforator artery that is in your abdomen. The surgeon removes your belly tissue and makes a breast from this tissue, you can a modified tummy tuck and new breasts all at once! After my surgery, I had two drains in my newly reconstructed breast, and had to wear a compression strap around my abdomen for 6 weeks. I believe this was the right choice for me and the single reconstructed breast feels and looks most like my original anatomy.

Nipple Reconstruction

I may choose in the future to have nipple reconstruction. There are a few different options for post-mastectomy nipple reconstruction. The most common is nipple tattooing. A specialized tattoo artist can create a 3D looking tattoo that resembles your original nipples. Nipple reconstruction surgery is another option. A plastic surgeon will create a nipple from your breast tissue.

Nipple prosthetics are also an option. Prosthetic nipples are created from silicone and attached with special glue. The most realistic version I have seen are from Naturally Impressive. These prosthetics have organic irregularities and transparency that mimic a real nipple.

Breast cancer reconstruction options can seem overwhelming at first, but knowledge is power. Having worked at Ghost Productions on the projects above, and other general surgical animations, gave me comfort and knowledge that I would recover.

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