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Advanced reconstructive surgery offers patients multiple options

Breast cancer patients who need mastectomies have more reconstructive surgery choices than ever before, yet too few survivors are choosing these options, says a specialist in the Department of Surgery at Ohio State University Medical Center.

For patients who have had a mastectomy to surgically remove one or both breasts, the principal benefit of reconstructive surgery is an improved quality of life, says Dr. Michael J. Miller, professor of surgery and chief of the Division of Plastic Surgery at Ohio State’s Medical Center.

“About 50 percent of mastectomy patients are candidates for reconstructive surgery, yet nationwide, only about 10 percent receive it.

“Our goal is to integrate reconstructive surgery into the entire treatment plan for the patient; it should not be an afterthought,” says Miller, who specializes in cancer reconstruction.

Studies have shown that reconstructive surgery is safe and does not interfere with treatment or increase the risk of recurrence of breast cancer, he says.

A lack of knowledge about the surgical methods of reconstruction available, both on the part of patients and physicians, may be partly to blame for the low number of women who choose to undergo reconstructive surgery, Miller says.

“Reconstruction may involve artificial implants, which remain a suitable option for selected women,” he says. “Newly developed techniques use a woman’s own tissue, giving a natural look and minimizing long-term complications.”

Miller prefers to meet with patients soon after their initial diagnosis, to plan reconstruction based on individual medical needs and personal preferences. Certain types of cancer treatment, particularly radiation, may affect reconstructive surgery options.

“If we know ahead of time that the patient will require radiation, we may change our plans for reconstructive surgery, because radiation changes tissue that’s been treated, making it less able to undergo surgery reliably,” he says.

Miller often works alongside a surgical oncologist in the operating room during a mastectomy procedure. Once the breast tissue has been removed, he performs the reconstructive surgery, using the patient’s own tissue from the lower abdomen, buttocks, thighs, or back.

“This way, patients never have to be without a breast, and they have the best chance of having a breast very similar in appearance to before the surgery,” Miller says. “There are a variety of ways that breast cancer reconstruction can be done, and it’s important for patients to realize that there is no single best option for everybody.”

He suggests that breast cancer patients considering a mastectomy initiate a discussion with their oncologist and ask the following questions:

• Am I a candidate for reconstructive surgery?

• Which reconstructive surgery options are available and best for me?

• Will a plastic surgeon who specializes in reconstructive surgery be part of my oncology treatment team?

• How will chemotherapy or radiation treatment affect my planned reconstructive surgery?

• How soon after the mastectomy will the reconstructive surgery take place?

“I try to personalize the techniques and the approach to the reconstruction, based upon the patient’s preferences, personal goals, and lifestyle, because they all bear upon what might be the best operation and approach for that person,” Miller says.