“The goal of breast reconstruction is to restore one or both breasts to near normal shape, appearance, symmetry and size following mastectomy, lumpectomy or congenital deformities.”
–American Society of Plastic Surgeons
For breast cancer patients, recognizing the facts and myths in breast reconstruction surgery can be life-altering. By knowing how to identify myths and misconceptions, breast cancer patients and breast cancer gene (BRCA) positive individuals can find the right doctors and treatments. For a cancer patient, it can mean saving the nipples, preventing large, noticeable scars, and avoiding the trauma of receiving substandard results.
In an effort to debunk dangerous myths and increase awareness around breast reconstruction surgery, our breast specialists at Cassileth Plastic Surgery sat down with their peers at the Bedford Breast Center in Beverly Hills to put together a list of the top 10 myths about breast reconstruction.
MYTH #1: “You can’t keep your nipples.”
Nipple sparing mastectomy, a surgery through which the breast tissue is removed while preserving the nipple, is now extremely well studied for both short-term and long-term results. For a long time, doctors were worried that keeping the nipples would increase the chance that the cancer recurred. Studies have shown the opposite: in patients who kept their nipples, there was the same or even a lower chance that cancer would recur.
The main reason that most people don’t receive the nipple sparing mastectomy procedure is because it is harder to perform. The scar should be small and located at the crease under the breast which makes it difficult to perform the mastectomy, compared to total mastectomies which require a long incision across the middle of the breast. If the surgeon can’t perform the nipple sparing mastectomy, then they usually say it’s not safe, and it’s not safe, in their hands.
Alongside the team at Cassileth Plastic Surgery, our surgeons Leslie Memsic, MD, FACS and Heather Richardson, MD, FACS are breast cancer specialists and treatment innovators. Dr. Memsic is considered to be the pioneer of the nipple-sparing mastectomy. She understands that a patient’s aesthetic result is just as important as the cure. Nipple sparing mastectomy should be offered to every patient with a cancer free nipple. The chance of nipple necrosis (death of skin tissue) should be less than 5%, and it is less than 1% in our practice.
MYTH #2: “You have to have tissue expanders.”
Tissue expanders were invented in the 1980s to expand skin that had been removed during a mastectomy. Using tissue expanders is a great idea when you are starting from a healed total mastectomy, but if you still haven’t had the mastectomy, you may not need tissue expanders. The skin and the nipple are already the right size.
Many doctors feel more comfortable putting in an expander, even when it’s not necessary, and then coming back to fix it up later. Few doctors will readily admit that the reasoning behind the choice to put in an expander is to anticipate the risk of mastectomy flap and nipple necrosis. If there is a tissue expander, extra skin can be easily removed and the expander kept small or deflated to avoid any skin tension. With an implant in, you can’t do that. Therefore, any plastic surgeon who works with a breast surgeon that has necrosis will prefer a tissue expander, to allow for additional work when the skin dies without having to swap the implant to an expander.
MYTH #3: “You can’t have implant reconstruction after radiation.”
Bedford Breast Center and Cassileth Plastic Surgery have partnered with mastectomy and reconstruction on radiated breasts for more than a decade now with great success. We use a Provena VAC, which seals the incision and shortens healing time, to avoid any healing complications in the short term. The use of dermal matrix as an internal bra has prevented capsular contracture and other long-term complications in radiated patients.
MYTH #4: “You aren’t a candidate for reconstruction.”
Yes, you are a candidate! Almost everyone is a candidate for breast reconstruction. Between the direct to implant reconstruction and the SWIM reconstruction, we always find the right surgery for each and every patient. Shorter surgery, less surgery, minimizing pain, and reducing complications are critical to any patient with an underlying disease or recovering from chemotherapy.
MYTH #5: “You will have a scar across your breast.”
No, you won’t. Every breast reconstruction done by Bedford Breast Center in partnership with Cassileth Plastic Surgery places scars in the same places that aesthetic surgery implements, either hidden under the breast, or in a similar pattern to a breast lift surgery. A horizontal scar near the nipple or an angled scar near the nipple for a mastectomy is a bad idea—it damages the delicate blood vessels adjacent to the nipple, and increases the risk of nipple necrosis (nipple tissue loss).
MYTH #6: “You can’t change your breast size.”
Breast size can be changed—even with direct-to-implant reconstruction. Breasts can be made smaller or the same size without additional risks, and the size can also be increased somewhat if the breasts have enough skin to accommodate a larger implant. Women who desire a much larger breast who do not have enough extra skin can increase their size after their primary reconstruction, once the blood flow to the skin is normal again with fat grafting (taking fat from one part of the body, purifying it, and transferring it to another).
MYTH #7: “You can’t look good without reconstruction.”
The SWIM method is a newer type of reconstruction, which involves no implant, no expander, and no flaps. SWIM reconstruction uses the patient’s own tissue to recreate the breast.
MYTH #8: “You will look great in a bra, but not naked.”
Our primary goal is to help you feel confident that your breasts look great when you take off your clothes so that you can walk naked through the gym without reservation. We often hear that doctors say the goal is for you to look “great in your clothes.” Although this is adequate, Bedford Breast Center partners with Cassileth Plastic Surgery so that you can look and feel great naked.
MYTH #9: “You can’t radiate an implant.”
After working with many of the radiation oncologists in the Los Angeles area, we finally got most to admit that you can radiate an implant. Radiation oncologists perform therapy on whole breasts all of the time, as they do after lumpectomy therapy. Cassileth Plastic Surgery provides them a soft, normal-feeling implant reconstruction breast in which to work, so that they have a high comfort level with the procedure. We have seen this done successfully in our patients.
The radiation oncologist who performs a pre-radiation CT with vectors can optimize the angle of the radiation to include the area of worry and not unnecessarily radiate normal skin or deeper tissues.
MYTH #10: “Your breast makes you a poor candidate for reconstruction.”
Told you were too big? Too small? Too low? Too droopy? Too old? If you send us a picture of your breasts, we will give you our opinion as to whether you are a candidate for free. We are committed to the truth and to the best breasts that reconstruction can give you. From all of us at Bedford Breast Center and Cassileth Plastic Surgery, remember that breast cancer cure rates are over 95%, so you will likely be waking up to your reconstructed breasts and cancer free body down the road. Make an empowered decision about your health and demand the best!
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This article was reviewed by:
Lisa Cassileth MD, FACS Kelly Killeen MD, FACS
Board Certified Plastic Surgeon Double Board Certified Plastic Surgeon
Cassileth Plastic Surgery & Skin Care Cassileth Plastic Surgery & Skin Care
Heather Richardson MD, FACS Leslie Memsic MD, FACS
Board Certified Breast Surgeon Board Certified Breast Surgeon, Oncologist
Bedford Breast Center Bedford Breast Center