Q&A on mastectomies and breast reconstruction with UF’s top plastic surgeon
Angelina Jolie’s recent announcement of her preventative double mastectomy and subsequent breast reconstruction has spurred much public discussion about genetic testing for the so-called “breast cancer genes,” options for women who have one of these genes or breast cancer itself, and possibilities for breast reconstruction for women who choose surgery.
Bruce Mast, M.D., UF’s chief of plastic and reconstructive surgery and an associate professor, recently answered questions about reconstruction options and his opinion on a recent rise in the number of mastectomies performed:
Q: What should a woman know about reconstruction when she’s considering mastectomy?
A: We work carefully with the UF Breast Center, with Dr. Spiguel and Dr. Shaw, and we really encourage everyone who is definitely going to have a mastectomy or thinking about having one to speak to us first. Even if they’re not interested in reconstruction or they’re not a candidate for reconstruction at the time of the mastectomy, we’re still very happy to speak with them so they get all their information. We don’t really want any patient anywhere to have a mastectomy without knowing their reconstructive options. We really think that’s the way it should be done, as part of the entire breast cancer treatment.
Editor’s note: Lisa Spiguel, M.D., and Christiana Shaw, M.D., M.S., are assistant professors of surgery and UF’s breast surgeons in Gainesville.
Q: There has been an increase in preventative mastectomies. Do you think this is a good thing?
A: I think it’s a good thing. I think the increase in preventative mastectomies is due to an awareness of the risks of breast cancer, the greater screening for genetic mutations like BRCA, and also the fact that the quality of the reconstructions have really increased significantly. Patients are much less fearful of being disfigured and know they could have a normal appearance and normal functioning life afterwards.
There’s less fear associated with the whole thing, and so the fear of body disfigurement doesn’t get in the way of people making, potentially, the correct decision for either prevention or treatment.
Q: Are you involved in the actual mastectomy operations?
A: Sometimes I personally do the preventative mastectomies for patients that don’t have breast cancer.
For skin-conserving mastectomies when cancer is involved, we actually mark out the skin patterns for the incisions to be used. Dr. Spiguel or Dr. Shaw would end up using those incision lines so we could shape the breast properly afterwards.
Q: Who is eligible for breast reconstruction?
A: In our mind, almost everyone is a candidate for some type of reconstruction.
Q: What options for reconstruction after mastectomy do UF plastic surgeons offer?
A: If a mastectomy is what is needed or desired for the treatment or prevention of breast cancer, then there are a variety of methods for breast reconstruction that could restore a normal l appearance.
We offer just about every single type of reconstruction available. The methods span the spectrum, from just using implants, or just using your own tissue. Many people think one or the other is the only thing they can do, but it all depends upon the individual. At UF we really customize the reconstructive procedure to the individual patient. What’s the expression? “If the only tool in your toolbox is a hammer, everything’s a nail.” We have all the tools available to us, so we really individualize the treatment to each patient.
If preventative mastectomy is done, particularly double mastectomies, we now offer select patients a single-stage reconstruction. In other words, they would come in to have their mastectomies, they’d have their reconstruction and wouldn’t need any additional surgery, and they would look normal. It preserves their nipples. It preserves all the skin of the breast, and then we usually do the reconstruction with dermal matrix grafts and implants. The only incisions used are those used for the mastectomy.
Q: How do you handle breast reconstruction for a woman who needs radiation therapy after a mastectomy?
A: If we definitely know someone’s going to have radiation treatment after a mastectomy, we don’t want to do the full reconstruction right away. The radiation may affect what we do in a negative way — cause a lot of scarring or tightening of the tissue, or something like that.
But for those folks, we still do a skin-preserving mastectomy and usually put a temporary tissue expander in to preserve the skin as much as possible, so that when the final reconstruction’s done, the cosmetic results of the breast reconstruction are much better because the actual shape of the breast is preserved as much as possible.
Q: Is reconstruction an option for women who have only a lump removed from the breast, instead of having an entire breast removed?
A: Yes. We also do what’s called oncoplastic surgery for some people that would get a lumpectomy. We do surgery on the breast at the same time as the lumpectomy is done to try to restore the breast volume and shape, so that there’s not a big lumpectomy defect and deformity of the breast. That’s still breast conserving. It’s particularly important for people who have very large, droopy breasts.
Q: How do you think actress Angelina Jolie’s recent announcement of her preventative double mastectomy and breast reconstruction will affect public opinion of mastectomy and reconstruction?
A: I think that what’s brave about what she did was going public about it. She’s someone who’s in the spotlight and her job a lot has to do with her appearance, and to go out and publicly talk about this, I think is the bravest thing.
I think, if anything, it’s going to have a positive effect. It’s going to take some of the stigma of having mastectomies away from people that would otherwise shy away from it.
They’ll see she looks normal, she is still attractive, she still can do everything she wanted to do and she’s still happy and normal. For some people, that’ll help them make the right decision for themselves.
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