7 Things I Learned About Breast Reconstruction At The Natrelle Breast Aesthetics Experience

Most women try to live their lives without fear, but there’s one thing that gives everyone pause: breast cancer. Those two words carry a heavy weight as women assess the initial diagnosis, treatment options, and the psychological effects. The Breast Cancer Research Foundation shares that Black women face a 37% higher mortality rate compared to their white counterparts, which can feel like a tougher pill to swallow. That said, many women have been able to come out on the other side, weighing the options of breast reconstruction.

Breast reconstruction is something that each individual should carefully consider with their physician. After all, surviving breast cancer and choosing to move forward with the reconstruction phase can be a lot to handle emotionally. Options include everything from breast implants to aesthetic flat closures (smoothing and contouring the chest wall for a flat appearance).

Unfortunately, misinformation continues to spread surrounding breast reconstruction. As a result, it has played a role in many women deciding against having surgery. In honor of Breast Cancer Awareness Month, I attended Natrelle’s Interactive Breast Aesthetics Experience. Thanks to board-certified plastic surgeon Dr. Elise Min and board-certified breast surgeon Dr. Vivian J. Bea, I got a closer look at breast surgery planning, from anatomy to how individual goals shape outcomes. Keep reading for everything I learned about breast reconstruction.

1. Breast cancer can originate in multiple areas of the breast.

It’s common to believe that breast cancer originates in only one specific area of the breast. However, Dr. Bea shares that it can develop in multiple places, including the ducts, lobules, or rarely in other tissues, blood vessels, or the skin of the nipple. “There is no one-size-fits-all as it relates to breast cancer,” she says.

2. Mastectomy is not the only type of breast surgery.

Although a mastectomy is a common treatment for breast cancer, it’s not the only option. It’s all contingent on the patient’s needs. “We have a lumpectomy surgery where I’m able to remove the cancer and tissue around it, and conserve the breast,” Dr. Bea says. “And then we have the mastectomy, where I remove the breast tissue underneath the skin.”

3. Reconstruction doesn’t have to occur at the same time as the mastectomy.

The timing of reconstruction surgery comes down to a decision made by the patient and the physician. Dr. Bea says that reconstruction can be done at the same time as the mastectomy or at a later time. “Sometimes it’s because of the clinical presentation where someone’s not a great candidate for reconstruction at the time that I remove breast tissue,” she shares. “Not to mention, the woman may desire not to have reconstruction at that time for various reasons, but it can happen throughout her treatment journey, whether it’s during or six months later, or years later.”

4. Reconstruction doesn’t always mean that you’ll lose your nipple.

The type of surgery you have will determine if you lose your nipple. Dr.Bea says that there are multiple types of mastectomies which can deliver different outcomes. The first is a total mastectomy (complete removal of the breast), which can be advised when “the cancer is advanced and has taken up a lot of the skin and the tissue underneath.”

With a skin-sparing mastectomy, she says that she takes “the breast tissue while saving as much skin as I possibly can, but I remove the nipple.” Unfortunately, the call for a nipple removal could be due to “the cancer is close to the nipple, and I can’t save the nipple from a clinical standpoint, or if the patient’s breast size does not support, at that time, reconstruction of the breast pocket.” However, Dr. Bea says that some situations that involve removing tissue and lifting things up with a loose nipple can result in a plastic surgeon saving it.

Nipple-sparing, which happens to be a favorite of Dr. Bea, consists of only “removing tissue under the skin envelope. She’s able to save the skin and save the nipple, which is a desired outcome for her patients. “People who are candidates for this type of surgery are those with smaller tumors that don’t involve skin, they don’t involve the nipple, and a smaller breast size,” she explains. “That’s because with women with larger breasts, it’s harder to have the blood supply.”

5. Breast reconstruction alone does not increase the risk of breast cancer recurrence.

Dr. Bea shares that the myth of reconstruction increasing the risk of breast cancer recurrence may stem from the belief that implants can interfere with imaging. However, patients with breast implants should continue to follow their physician’s advice on mammogram screening. For patients who have had a mastectomy followed by reconstruction, routine mammograms typically aren’t performed on the reconstructed breast. Instead, follow-up may involve physical examinations and imaging when medically warranted. Ultimately, breast reconstruction itself does not increase the risk of breast cancer recurrence.

6. Breast implants are generally placed above the muscle.

According to Dr. Min, surgeons who placed implants under the muscle have found that the skin will showcase a “rippling appearance” (think folds and wavy lines on the skin) post-op as the implants settle. And unfortunately, mastectomy patients with thin tissue in the area can see signs of rippling. “We’re now kind of seeing that it actually causes more adverse effects over time when we put it under the muscle, and putting it above the muscle is faster recovery,” she says. “And if you get rippling, we can fat graft that area, and patients heal so much faster.”

7. The Keller Funnel method is used to minimize the risk of capsular contracture.

Dr. Min shares that capsular contracture occurs when the body forms scar tissue around a foreign substance, such as a breast implant. Over time, this tissue can tighten, causing the implant to feel hard. She notes that studies have linked biofilm (a community of microorganisms that can form on a surface) to the condition. So, when performing reconstruction and augmentation, surgeons use the Keller Funnel to insert implants while minimizing direct contact and helping limit potential contamination.