Breast reconstruction, which rebuilds the shape and appearance of the breasts, is an important step in the healing process for many women recovering from breast cancer. A growing number of patients who are diagnosed with breast cancer — including many in the earliest stages of disease—choose to have their breast tissue removed to avoid any chance that the cancer may come back. This procedure is known as a mastectomy.
“The reality of having your breasts removed due to cancer is a significant loss,” explains Erin Groover, MSW, LCSW, a behavioral health clinician who specializes in oncology at Summit Health. “Every woman is different, but there is a grieving process that occurs as well as a multitude of feelings from sadness and anxiety to anger and fear. They worry about what their body will look like or what their partner is going to think and wonder why this happened to them.”
Nearly 40 percent of women who have a mastectomy decide to have breast reconstruction. Some patients can have both surgeries in the same day while others must wait months, or even years, because they need additional treatments such as chemotherapy or radiation.
“Breast reconstruction helps restore balance both emotionally and physically,” adds Ms. Groover. “A lot of the women I see who have breast reconstruction talk about this idea of feeling whole again. Breasts are part of their identity, and reconstruction helps them reclaim who they are. For some patients, it helps minimize these very significant changes that have happened to their body.”
Research shows that having immediate reconstruction can lead to better mental health outcomes. Patients report lower levels of anxiety and depression, poor body image, and diminished sexual well-being after mastectomy when they do not have to wait for breast reconstruction. Jain Joseph, MD, a plastic surgeon at Summit Health, says immediate reconstruction is almost always preferred when medically feasible. “The patient does not have to endure months to possibly years of dealing with a mastectomy and feeling uncomfortable in her own body,” he says. “Mentally, patients often feel like a part of them is still there.”
Many women also seek reconstruction following lumpectomy, a procedure in which only part of the breast tissue is removed, particularly in cases of large breasts. “We are able to help cure their cancer while alleviating some of the chronic neck and back problems they suffer from due to the extra weight of larger breasts,” explains Dr. Joseph.
A team of dedicated physicians, nurses, and support staff guide women through the entire process. “At Summit Health, our breast surgeons, plastic surgeons, oncologists, therapists, and navigators work tirelessly to make sure women not only get their cancer treated, but also are physically and mentally secure in the way they look and feel throughout the process,” he adds. Sarah Fuzesi, MD, a breast surgeon at Summit Health, says it is important that patients have an open dialogue with their physician. “As a surgeon, you are meeting a woman for the first time and asking them very intimate questions almost immediately. It is our job to make them feel comfortable and give them the proper education and context for their decisions.”
The experience varies for every patient, and surgeons need to be sensitive to a range of needs and emotions. The impact a mastectomy has really depends on a woman’s relationship with her breasts. For some patients, breasts are an important part of their perceived beauty and intimate relationship with their partner. Stage of life is also an important factor—women in their 20s, 40s, and 80s tend to feel very differently about their breasts.
“A lot of times when a woman makes a decision about breast reconstruction, their expectations are almost more important than the outcome,” explains Dr. Fuzesi. “Whenever I talk to a patient about reconstruction, I try to tease out what is important to them and what they are worried about so we can find the best option. It may be curing the cancer, the way they look, or their family or friend’s opinion. Ultimately, the decision is about what is going to make them feel whole again.”
In certain cases, women find reconstruction increases their self-esteem. “Patients can use reconstruction to help them achieve their ideal body image, whether it involves a change in the size or shape of the breasts,” says Dr. Joseph.
After reconstruction there is often a period of adjustment. Sometimes the expectation of what their breasts will look or feel like does not always match up with reality. “Following mastectomies, the most common thing women notice is the numbness of the overlying skin and the nipple, if preserved. While there are microsurgical techniques to help create sensation to the breast skin in cases of flap reconstruction, these do not necessarily restore all skin sensation, and there is a portion of time the skin will be numb before the nerve fibers reach the skin,” explains Dr. Joseph.
This can have an impact on intimacy. Ms. Groover says it can take time for women to become comfortable again with their body and partner. “The two people in the relationship really need to work together with sensitivity and patience,” she says. Summit Health offers a variety of behavioral health services that can help, from individual therapy and coaching to group work and couples counseling.
Breast reconstruction is an important way for women to gain back control of their body, life, and physical relationship with their partner. It signifies the final step in a long journey. “When someone is diagnosed with cancer, there is often a line drawn in the sand. There is a feeling of me before my cancer and me after my cancer,” she explains. “Breast reconstruction brings completion and closure. The patients I see who have reconstruction finally feel like they can move forward and not be held back anymore.”
Many women who have a double mastectomy also elect not to have reconstruction. There is no medical downside, explains Dr. Fuzesi. “Some women do not want to complicate their surgery. They may feel that having breasts is less important to their overall well-being, or they may be comfortable with what a mastectomy without reconstruction will look and feel like. Whichever surgery they decide to have, as long as it is an informed decision, is really up to the patient.”