Learning about Breast Reconstruction
- Chelsea McCreight, 28, was diagnosed with stage three breast cancer in February 2022. And ever since her first breast implant surgery, she’s had am arduous recovery that’s led to many health issues.
- There are two options for women opting for reconstructive breast surgery; they can either use their own tissue or have implants.
- Most women who get implants do well with them, but there are some things to keep in mind if you consider getting them like the fact that they can cause problems and monitoring is required following the procedure.
The young mother of two was diagnosed with stage three breast cancer in February 2022. Her treatment included chemotherapy and a double mastectomy, but McCreight also underwent reconstruction surgery that left her with a slew of problems. She even said her wounds were slow to heal and the breast implants were “coming out of her body” after reconstruction.
Read More"I am now left with one breast and have had a balloon installed under my muscle that will slowly be inflated over the next few months until my body is in a position to have further implants installed, which will mean that I will be in pain for many more months," she said. "All of this has had a huge impact on our family life at home. My boys basically spend all day either at school or at childcare before coming home for a few hours before bed because I don't have the energy to be able to look after them.”
Understandably so, the whole ordeal has had “a huge impact” on McCreight’s mental health.
"I am living in constant pain and I know that I will have to go through this for many more months,” she said. "If it wasn't for the support from my partner and family I just don't know where I would be at the moment because there are times that I just don't want to be here anymore after everything that I have been through.”
Learning about Breast Reconstruction
Breast reconstruction after a mastectomy can look different from person to person, and it’s important to know that you have options and some women even choose to go “flat” entirely. One of your options is to use your own tissue for the reconstruction and have the procedure done at the same time as your mastectomy.
In a conversation with SurvivorNet, Dr. Andrea Pusic, the chief of Plastic and Reconstructive Surgery at Brigham Health, explained that new connections for blood flow are devised and the end result is quite natural.
"The lower abdomen will have a scar from hip to hip, it's much like a tummy tuck only the fat removed has now been formed into a mound to create the new breast,” Dr. Pusic said. “This is a long (eight hour) surgery, and the hospital stay is three to five days.
“You will leave the hospital with drains and will need at-home care until the drains are removed. If you are having radiation, this surgery is probably not available as the skin has to be in good condition. It would be done after you have healed."
Another option for breast cancer survivors is having the implant. This reconstruction procedure can also be done at the same time as the mastectomy or later on.
If you've elected to go with this path, there are two options for the procedure: using a breast tissue expander which is a two-step process or direct-to-implant reconstruction which is completed at the same time as the mastectomy.
Breast Reconstruction: Implants vs. Your Own Tissue
With the tissue expander implant reconstruction, Dr. Pusic explains that an expander is put in between the skin and chest muscle at the same time as the mastectomy surgery or afterwards if you've chosen delayed reconstruction. The expander has a small valve that will be filled gradually over time with saline every one to two weeks, stretching the skin until the area is ready for the permanent implant.
"It's a minority of women who are great candidates for direct implant placement,” Dr. Pusic said. “But when we can do it, we can do it, and we can do it safely. It is a great technique because women come in for their mastectomy surgery, and they do go home with the breast reconstructed.”
The reason that many women aren’t great candidates for direct-to-implant reconstruction is because it works best for women with small breasts and/or women who are having no skin removed and preserving the nipple and areola.
Are Breast Implants Safe?
Despite, the harrowing journey that Chelsea McCreight has been on with her implants, it important to note that most women who get implants do well with them. But the American Cancer Society suggests that women should consider the following factors if they’re thinking about getting breast implants:
- The longer you have breast implants, the greater the chance you might need more surgery to remove and/or replace your implant later.
- You might have problems with breast implants. They can break (rupture) or cause infection or pain. Scar tissue may form around the implant (called capsular contracture), which can make the breast hard or change shape, so that it no longer looks or feels like it did just after surgery. Most of these problems can be fixed with surgery, but others might not.
- Breast MRIs may be recommended every few years to make sure silicone gel implants have not broken. Your health insurance might not cover this. Talk to your plastic surgeon if you have any questions regarding the indication for breast MRIs.
In a joint statement for SurvivorNet, Mount Sinai's Dr. Sarah Cate, the lead physician for the Special Surveillance Breast Program at Mount Sinai Beth Israel, and Dr. Jordan Jacobs, a plastic and reconstructive surgeon, took the time to talk about breast implant concerns for breast cancer survivors after a recently released FDA safety communication stated that the FDA had received 10 medical device reports (MDRs) about squamous cell carcinoma and 12 reports about various lymphomas related to breast implants.
In regards to this specific FDA release, the two experts said they "personally don't think there is cause for alarm," and insisted that the preliminary data shared by the FDA does not definitively link breast cancer to implants. Still, the "the fact that the cancers were found in the implant capsules is certainly concerning and requires further investigation."
They also mentioned that the FDA required the placement of black box warnings on breast implant packaging and implemented an implant checklist for patients to review and sign prior to surgery in October 2021. Moreover, the two doctors noted that anaplastic large cell lymphoma, a rare form of non-Hodgkin lymphoma, has been "associated with textured implants for several years."
"We do not use these at Mount Sinai," the doctors wrote. "This is a separate issue though, and almost all the implicated implants have been taken off the market."
Additionally, the two doctors wanted to remind readers that implants do require monitoring and adverse events should be reported to the FDA.
"Patients who have implants placed for either cosmetic or reconstructive purposes should have yearly follow-up with their surgeons," Dr. Cate and Dr. Jacobs told SurvivorNet. "And there are recommendations from the FDA for routine (every 2-3 years) MRIs to evaluate the integrity of the implant and the surrounding capsule."
Contributing: Teaganne Finn
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