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Life After Mastectomy By Laurie Kirstein, M.D.

Life After Mastectomy: Staying Aware Outside of Breast Cancer Awareness Month
By Laurie Kirstein, M.D., FACS, Surgical Oncologist

October is Breast Cancer Awareness Month, and by now most of us are generally aware of preventative tips such as monthly self-examinations and the importance of continued regular mammograms after age 40. We’ve encountered countless PSAs, promotions, brochures, and conversations that stress what to do to help minimize our risk. But what do you do after being diagnosed, and what about after you’ve made that incredibly difficult decision to have a mastectomy?

For most women, the thought of losing one or both of their breasts in the case of a double mastectomy, can be overwhelming and troublesome. As an experienced breast surgeon, I am very aware that mastectomy brings with it many unknowns, uncertainties, and fears, and though the process can cause anxiety, it doesn’t have to. Whether you choose to undergo reconstruction or not, you have an array of options for living a happy and healthy life after mastectomy.

For those that choose to undergo reconstructive surgery, it may come as a surprise that you have a variety of options. The one that most people immediately think of are implant procedures; the most common type of which is a silicone gel filled implant, or less often, saline implants. Silicone implants were reconfigured because of patient safety concerns, and are very safe these days. They are also more natural looking and feeling, and are even shaped like a breast. You may also choose whether you have the implant procedure conducted immediately, referred to as one-stage reconstruction, or at another time. In one-stage reconstruction, the surgeon will place the implant at the time of the mastectomy. More commonly, the two-stage reconstructive process is when a plastic surgeon inserts tissue expanders after a mastectomy. Tissue expanders are like deflated balloons that are slowly inflated over the course of weeks to gently stretch the pectoralis muscle. Once the skin and muscle have had ample time to expand, the patient is eligible for a second surgery to remove the expanders and insert the implant.

Some women may decide that silicone implants are not right for them or they are not eligible for them for a variety of reasons. Tissue flap procedures can be a welcome alternative in which excess tissue from the thighs, tummy, or buttocks can be removed and repurposed to reconstruct the breast. Patients do have to consider that these procedures can come with their own concerns, including additional scars and risk of muscle damage.

My team, as well as other surgeons throughout the country, is constantly striving to stay on the cutting edge of reconstructive advances. As scientific developments continue to be made, I believe that we are on our way to making this process safer and easier, but we still have a long way to go. There are many women who choose to forgo reconstruction altogether for any number of reasons listed above or others not mentioned. These women too have options. Some may choose to wear a breast form, some may not. Others may choose to wear a breast form only some of the time while others may simply practice strategic wardrobe decisions that draw attention away from the breast region and/or call attention to other areas of the body. Whatever your decision though, the most important thing is that the decision is in fact yours, and you are the one who needs to be comfortable with it.

As we wind down Breast Cancer Awareness Month, it may be easy for us to lose focus or to let breast cancer slowly slip from the forefront of our minds. We may begin skipping our routine mammograms or neglect to conduct regular self-examinations. I want to remind everyone, both women and men, that this conversation cannot end on October 31. Though the designated month may be coming to a close, over 200,000 new cases of invasive breast cancer will still be diagnosed in women in the United States next year, and 1 out of approximately every 8 women reading this post will be diagnosed with some form of breast cancer at one point in their lifetime. Early detection is paramount in increasing a patient’s likelihood of survival, and so I urge you to continue to educate yourselves on the risk factors of breast cancer and continue to have your regular screenings to minimize this risk.

Laurie Kirstein, M.D., FACS, is a Surgical Oncologist at the Rutgers Cancer Institute of New Jersey. She specializes in breast surgery and reconstruction, utilizing the latest and most advanced technologies.