Unfortunately, Sunny Reicks has become an expert on different types of breast reconstruction.
After a breast cancer diagnosis and a double mastectomy at age 24, she got saline implants. Years later, after scar tissue had built up and her breasts had become hard and misshapen, the implants and scar tissue were removed and she got silicone implants.
Silicone implants: 62,972
Other implant: 155
Flap with tissue and muscle: 6,948
Flap with tissue but no muscle: 6,845
Latissimus dorsi flap: 6,058
Total procedures: 96,277
Source: American Society of Plastic Surgeons
Six months after that procedure, at age 29, she discovered a lump on her left breast, and she was diagnosed with stage III breast cancer. Her doctor removed the left breast implant and she underwent about six months of chemotherapy and six weeks of radiation.
The treatment and a lack of tissue in her chest made her a poor candidate for another implant.
But she had other options.
This summer, in what ended up being a 22-hour-long procedure called a free TRAM flap, a plastic surgeon removed fat, skin and a 1½-inch-by-2-inch piece of muscle from her abdomen and transplanted it all to both sides of her chest, reconnecting the tiny blood vessels so the tissue would have a blood supply. (Her doctor first removed the implant on the right side.)
An infection extended her hospital stay — Reicks was in for two weeks — but she's happy with the results.
“I like it a whole lot better than implants,” said Reicks, now 31. “Implants, they don't feel right. They're harder. They don't move around. Finding bras for them is very difficult. With this surgery, everything is soft again and movable.”
And, since her doctor used fat from her abdomen, “I'm much smaller than I was, which I love. I got the reconstruction with a free tummy tuck.”
The decision to undergo any sort of breast reconstruction can be a difficult one for women, but it's an option they should discuss with their physician, said Dr. Frederick Durden Jr., who performed Reick's surgery at the Nebraska Medical Center.
Some women, he said, want only to get their cancerous breasts removed and don't want to consider reconstruction. Later, he said, some of them regret not having the procedure or return to their physician seeking implants. Flap surgeries are useful in those delayed cases, he said.
Despite cosmetic and psychological advantages offered by breast reconstruction, a Columbia University researcher said in a 2011 study, fewer than a quarter of all U.S. women who had a mastectomy from 2000 through 2010 underwent reconstruction. The rates increased over the decade and were much higher among women under age 50 who had commercial insurance.
Reconstruction was significantly less likely, researcher Dr. Dawn Hershman found, with increasing age, if the woman was black or was treated in a rural hospital, a nonteaching hospital or had more than two other illnesses.
Part of the reason could be cost, Hershman said in an interview. Her study found that insurance reimbursement rates vary from state to state, and researchers were able to determine only the total cost of hospitalization. “We weren't able to separate out what was the cost of the reconstruction.”
In general, though, she said, the longer a procedure takes and the longer the person is in the hospital, the higher the cost.
Breast reconstruction after cancer should be covered, according to the American Society of Plastic Surgeons. A woman's coverage may, however, pay only a small part of the fee, the society said.
Another reason for the low rate of reconstruction may be a lack of information. Seven out of 10 women eligible for breast reconstruction after cancer surgery are not told about their options, the society said.
“This is a critical conversation that needs to happen between surgeons and breast cancer patients before surgery,” said Dr. Randall Feingold, a New York plastic surgeon who serves as a spokesman for the society.
When patients are offered reconstruction as an option, Hershman said, more than 60 percent accept.
Feingold said women can have good results with implants or flap surgeries. If a patient prefers to use her own tissue, Feingold said, a type of flap surgery that transfers only skin and fat — no muscle — from the abdomen is a “more elegant solution. ” But, as in Reicks' case, that's not always possible.
“If I could,” he said, “I would do all of them so as not to have to take any muscle.”
The more muscle taken, Durden said, the greater the risk of developing a hernia later on.
Surgeons also can use muscle, fat and skin from the back or transport tissue from the buttocks.
A flap surgery is “not a surgery that is for everyone,” Durden said.
Reicks said she could have opted for a prosthetic left breast, but after using one for a short period, she found the prosthesis to be heavy and uncomfortable. “They're a good option if you can't or don't want to do the risk of surgery,” she said, “but there is a lot of care involved.”
She said that if women have a very physical job and can't take much time off, the flap procedure may not be a good option.
“I'm certainly glad I did it,” she said.
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