Reconstruction Do-Overs

Breast reconstructions may need to be redone years later.

Breast reconstruction has given women the option to replace a breast that has been removed because of cancer. But reconstruction techniques, like most medical procedures, have improved through the years for those who, for a variety of reasons, must have their old reconstruction redone.

In 1986, I chose to have my right breast reconstructed after undergoing a modified radical mastectomy with axillary node dissection at age 37. Since I faced four months of chemotherapy for stage 2 breast cancer, my surgeon suggested I not have immediate reconstruction at the time of surgery but wait a year to allow myself to finish treatment and be ready emotionally and physically to have the reconstruction.

The delayed reconstruction gave me time to research my options, and in the summer of 1987 I tried in vain to talk my carefully chosen, board-certified plastic surgeon into doing a transverse rectus abdominis myocutaneous (TRAM) flap that would move my abdominal muscle, fat, and skin, still attached to the blood supply, from my abdomen to my chest.  

I wanted a TRAM flap for a couple of reasons. Using one’s own tissue results in a breast that gains and loses weight along with the rest of the body, and, while we didn’t know it then, studies show less risk of infection compared with using an implant. And the method would provide me a tummy tuck in the deal. But the surgeon took one look at the caesarean section scar from the birth of my daughter and said he would not cut across the scar because it would destroy the integrity of my stomach. Darn.

So, we went with the LD flap where the latissimus dorsi muscle is tunneled under the skin from the upper back to the chest wall. A small silicone implant was inserted under the muscle to increase the size of the breast, and, to make a long story short, after having the first implant replaced with a second model a year after surgery because of a hardening of the scar tissue (known as capsular contracture), having the left breast surgically lifted to match the right breast, and having the areola and nipple tattooed, I had a nice replica of the real thing.

Fast forward to fall 2007 when my annual mammogram and subsequent biopsy indicated I had ductal carcinoma in situ (DCIS) in my other breast. The location of the DCIS meant lumpectomy wasn’t an option, so I scheduled a second mastectomy and met with a plastic surgeon to discuss immediate reconstruction—and some tweaking to my then 20-year-old reconstruction on the other side to remove an indentation above the breast that had always bothered me.

Because I wanted to update my old reconstruction, the discussion with my plastic surgeon was more complicated than just matching an existing breast. It also meant I was part of a small group of women who have a reconstruction redo.

A reconstruction redo can happen immediately or years down the road—and for any number of reasons. The woman may dislike the outcome, or the breasts no longer match because of age, the power of gravity, an implant rupture, or infection.

Every woman undergoing a reconstruction redo is unique, says John Canady, MD, president of the American Society of Plastic Surgeons and a professor of plastic surgery at the University of Iowa. “Obviously no two women come to primary reconstruction with the same issues,” he says, “and no two women come in for a redo with the same issues.”

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