All About Breast Reconstruction

Question #1

I had my right breast removed for breast cancer. My surgeon diagnosed me to have Stage 3, breast cancer. I had just finished my chemotherapy. Doctor, I hope you can clarify certain things because I am interested in having a breast reconstruction but I am confused with the information I have gathered. My questions are: My oncologist say that I can have breast reconstruction but I cannot have silicon breast implants because they will increase my chances of having breast cancer again, is this true? If I can’t have breast implants what can we use? When Can I have the surgery? How is this done? How long is the recovery? Can you give me an idea how much it would cost?

Answer:

I understand the confusion because reconstruction after mastectomy for breast cancer is not very common here in the Philippines as in the United States. In fact not only the public in general are confused but most doctors as well. I respect your oncologist’s opinion against the use of breast implants but we should base our decision making on what is current knowledge about this. There are numerous studies that are against the safety of silicone implants but there are equally numerous researches that   claim otherwise. Personally I go with the stand of the USFDA where they stated that as of the moment there is no evidence that silicon implants increases the chances of the patient of having breast cancer.

Unknown to many, breast reconstruction after mastectomy does not always use silicon implants. There are techniques where the patient’s own healthy tissues are used. One of the more popular operations is called the TRAM flap where skin and fat from the lower abdomen are used to create the breast mound and skin cover. Sometimes though implants have to be used to give a more normal looking breast.

The timing of the surgery depends on the type of breast cancer and the stage of the disease when it was removed and also whether the patient is done with the adjuvant therapy. This includes chemotherapy, hormonal manipulation or radiotherapy. In simpler terms the plastic surgeon would like to be sure that the patient was cured of her breast cancer before embarking on a reconstruction. It would be very devastating to an already devastated patient if the reconstruction were done only to be taken down again because the breast cancer recurred.

The type of breast reconstruction depends on the type of cancer surgery that was done. Early stage breast cancer, requires less aggressive surgery so restoration is simple. If only the tumor mass was removed and the nipple and skin of the breast were left behind then reconstruction involves restoring the lost volume by placing an implant. If a radical mastectomy was done where all of the breast were removed then skin and fat or muscle is used to restore the breast and if these were not enough an implant maybe needed in addition to these tissues to restore breast size. Reconstruction may require a short stay in the hospital and may involve several stages of operations until satisfaction is achieved.

Question #2

I had breast implants six months ago in the US and I am generally pleased except that the right breast is a located a little higher compared to the left. I made inquiries about having the problem corrected here but I was shocked that Silicone Gel filled implants are still used here when in the US it is already banned. Why is this so? Do I have to change the implant or just have it repositioned? If I insist to use the same type of implant which is a Saline filled Silicone is it available here? Will I be charged as a new case of breast augmentation or would the doctor consider this as a redo and gave me a discount? 

Answer:

Silicone breast implants were not banned for use in the US. Silicone breast implants were introduced in the US in the late 60’s but because of persistent complaints about their safety, sometime in 1994 USFDA regulated the use of these devices. The agency set down guidelines to monitor if indeed these devices caused problems, particularly whether silicone causes breast cancer or whether the filler, silicone gel, posted some health risks. The guidelines were: 1) For patients who will have breast implants for the first time, the surgeon can use only implants made of silicone but with salt water as filler material. Patients who had breast implants before and want them changed or patients whose breasts had to be removed because of breast cancer and needs to be reconstructed can use Silicon implants with silicon gel as filler material. Now only the US and a few countries in Asia and Europe adopted this policy. In most countries world wide the patient and the doctor are given a freehand in choosing the type of implant best suited for them. Here in the Philippines our BFAD and the Department of Health leaves it to the doctors to determine what is best for the patient.

In my practice, like the great majority of plastic surgeons, I would highly recommend Silicon breast implants filled with silicon gel over silicon breast implants filled with water or saline. My basis for doing this is the fact that the USFDA itself issued statements about two years ago stating that there is no evidence that Silicone breast implants increase or decrease the chances of having breast cancer. Silicon gel, when it leaks outside the silicon shell also does not cause certain types of diseases to come out early. The other reason why I prefer Silicon gel filled implants is the fact that they have a more natural look and feel and they don’t cause the breast to collapse when the filler leaks out.

If you want me to correct your problem then we can just reposition the same implant. If in the process the implant is damaged, we can replace it with another implant of the same type and size since these implants are also available here. I would charge you as a new patient since I didn’t do the first surgery.