According to The American Cancer Society, breast cancer is the most common cancer in women, regardless of race or ethnicity, and it is the second most common cause of death from cancer among white, black, Asian/Pacific Islander and American Indian/Alaska Native women.
You may have had or are about to have a mastectomy, either because you've been diagnosed with breast cancer or are at very high risk of developing it in the future. If so, your doctor may have told you about options to rebuild your breast or breasts — a surgery called breast reconstruction.
Listen in as Dr. Bradley Mudge, board certified plastic surgeon and a member of the Medical Staff at Corona Regional Medical Center discusses your options for Breast reconstruction following breast cancer surgery.
Selected Podcast
Breast Reconstruction After Mastectomy
Featured Speaker:
Bradley P. Mudge, MD
Dr. Bradley Mudge a board certified plastic surgeon performs an array of cosmetic and reconstructive procedures at his state of the art of facility in Newport Beach California. Novare Plastic Surgery & Skin Care Center and Orange Coast Surgical Center is located just inside Fashion Island Newport Center allowing patients the comfort and ease of being treated in an exclusive private setting. The facilities beauty, convenience along with the JACHO Accredited Ambulatory Surgical Center truly sets it apart from the rest. Whether you're a new or a returning patient we ask that you take a look at all of the procedures we offer and call any of our friendly staff to learn more. Cosmetic and follow appointments are also available at any of our three convenient dermatology offices. Transcription:
Breast Reconstruction After Mastectomy
Melanie Cole (Host): You may have had or are about to have a mastectomy. Either you’ve been diagnosed with breast cancer or are at a very high risk of developing it in the future. If so, your doctor may have told you about options to rebuild your breast or breasts, a surgery called “breast reconstruction”. My guest today is Dr. Bradley Mudge. He’s a board certified plastic surgeon and a member of the medical staff at Corona Regional Medical Center. Welcome to the show, Dr. Mudge. I’d just like to start by asking you, what do you tell women every day about breast reconstruction if they’re also going through cancer treatment?
Dr. Bradley Mudge (Guest): Well, the conversation about breast reconstruction is fairly lengthy and based upon their previous education and what research they’ve done themselves, but I like to stress that the choice for reconstruction is a personal choice and entirely up to them. There are many options that we can help people with so that the process has to be tailored to their expectations, their desired outcomes, their available down time and so forth. But, I do like to stress that it’s an opportunity to make themselves a little more whole again after a fairly emotionally and physically disfiguring surgery and a chance to get back something that they would’ve lost otherwise.
Melanie: Let’s discuss some of those breast reconstruction options that you mentioned. What options does a woman have if she knows she’s either having prophylactic mastectomy because she’s been found to have the genetic link, or because she’s just gone through cancer treatment?
Dr. Mudge: Reconstruction can roughly be divided into two broad categories: that being using your own tissue or using an implant, and there is a hybrid of those two categories as well which works well for some people. The final choice on what a woman will decide upon depends a lot on her body habitus, her smoking history, the extent of her cancer, her available down time, her willingness to have various scars on her body and so forth. Each of those options is available and just requires a fair bit of research with each patient to determine it. Something fairly exciting and another option women have over the past probably 4-5 years, is nipple preservation. Many women electing for elective mastectomy, whether that is for a positive gene testing or painful lumps in their breasts or whatever the cause may be, many of these women will actually elect to preserve their nipple areolar complexes. In addition to that, there’s been a recent trend towards preserving the nipple areolar complex in someone who actually has cancer, and that’s kind of an exciting option for those who meet the necessary criteria.
Melanie: How do they decide between immediate or delayed breast reconstruction?
Dr. Mudge: That will depend a lot on how aggressive their tumor is, sometimes the urgency of it and the timing with the general surgeon. If there is a plastic surgeon and a general surgeon willing to do both at the same time, most of the time that’s going to be a better option. It obviously saves the woman from having one more surgery. In addition to that, it alleviates that time when they are totally flat and actually a little bit indented. It kind of takes away some of that emotional stress and fatigue that can come from looking at a fairly disfigured chest. So, we prefer to do it immediately if possible. Something that might change that a little bit on really aggressive tumors where chemo needs to be started as soon as possible in the post op period, we’ll sometimes hold off on that because we don’t want the breast reconstruction to interfere with the urgency of the chemotherapy. There used to be a trend where if you knew you were going to receive radiation therapy, that you would wait to get your breast reconstruction. That’s changed quite a bit over the past decade and now, the thinking is it’s best to go ahead and initiate the reconstructive process with some sort of implant in there and try to stretch the skin out a little bit to help you get that extra skin you’re going to need before the radiation injury is applied to the breast.
Melanie: What types of implants are used for breast reconstruction now?
Dr. Mudge: The most common would be a silicone implant. Probably 95% of women get a silicone implant. In that category, then, we do have an exciting new implant, what we call “highly cohesive implant”, meaning a little bit thicker. So, that’s very useful in the reconstruction for women because after a mastectomy, there’s very little, what we call “subcutaneous tissue” or tissue beneath the skin left, and if you place a normal standard silicone implant in, it can look quite rippled and abnormal. The highly cohesive implants maintain their shape a little better and give an overall better appearance to the breast, although you do sacrifice a little softness to it. Saline implants are another option and, at times we still use those, particularly when a woman wants to be quite large. The silicone implants only come up to 800cc in size, so we’re limited how large we can make those. In those cases, saline is a good option.
Melanie: And, what about breast reconstruction using your own tissue, the flap procedure? Tell us about that.
Dr. Mudge: There’s two basic ways to do that and then there are other variations which are a little more usual. You can use your abdominal tissue. That’s called a “TRAM flap” and sacrifice one of your rectus abdominis muscles or your six-pack muscles and move the abdominal tissue up to the breast and reconstruct it that way. That process has significantly more down time, more scarring and certainly more risks than an implant reconstruction would have. The other thing that’s changing over the past few years in that regard is a lot of women are doing bilateral mastectomy and reconstruction. That number has really increased significantly during the past decade. It would be fairly hard to use both abdominal muscles for that because it leaves you with a fairly weak abdominal wall. That’s the TRAM flap. The other option is the latissimus dorsi flap which is bringing some muscle around from your back with a skin paddle with it and reconstructing the breast mound that way. Typically, unless the woman is looking for a fairly small breast, the latissimus flap method will also require implants to be placed.
Melanie: What changes for screening after this reconstruction? Are they able to have mammograms or is it ultrasound after that? Tell us about that.
Dr. Mudge: That would vary and sort of be left up to the oncologist depending on how aggressive their tumor was and how close the tumor was to the margin. You can still have a mammogram and some women will still get those per their oncologist’s request. The gold standard and probably the best way to look at it would be with an MRI which can not only detect soft tissue changes such as early recurrences or suspicious lesions in the breast but it can also evaluate the integrity of the implant itself and give you an idea if the implant could be ruptured.
Melanie: Does the implant have to be replaced at some point?
Dr. Mudge: The common thinking is that implants should be replaced every 10 years. In the world of cosmetic surgery, that’s not an absolute requirement because you will notice when it’s ruptured. Your mammogram will show it and there’s no urgency to get them replaced. In the world of reconstruction, it’s a little more complicating and, in general, I would recommend a reconstructive patient have re-implants, change that every 10 years just to prevent that rupture which can be a lot more destructive in a reconstructed patient as compared to a cosmetic patient. That’s not to say that the leaking silicone is causing problems with the rest of your body such as chronic fatigue, lupus and things we used to worry about. That’s all been disproven, but the reason for not wanting a rupture in a reconstructed patient is because there’s so very little soft tissue left, by the time you clean out that ruptured silicone, you’re going to have very, very thin flaps and tissue left which will hamper the aesthetic result.
Melanie: Will they have feeling in the reconstructed breast?
Dr. Mudge: If the nipple areolar complex is preserved, it will have essentially no feeling. You might have a small bit of feeling at best but the main nerve that runs through the breast to give sensation to the nipple would have been removed during a mastectomy. If they have sacrificed their nipple areolar complex and are left just a transverse or a crossways running scar, the feeling is very limited in the area. Much after any surgery, such as a facelift or tummy tuck, there’s very little feeling around the scar. Some of the feeling comes back as the years go by which is a good thing because areas in your body that are numb are not great because they can be subject to burn or pressure or freezing, things like that, but essentially they won’t have a lot of feeling over the breast, especially the central portion of the breast.
Melanie: And, how will aging affect that breast?
Dr. Mudge: Well, the good news is that, in general, with an implant reconstruction and the artificial skin sling that we placed in the inside, there’s very little drooping of the breast as the years go by. They stay up and in high and appropriate position and shouldn’t move much at all. Anyone will undergo the typical skin changes such as thinning and perhaps age spots and wrinkles on the breast tissue but the implants themselves and, thus, the breast mound should not descend down the chest wall much at all.
Melanie: And, in just the last few minutes, Dr. Mudge, what should people that may have to have a mastectomy think about when seeking care? What should they look for?
Dr. Mudge: With regard to the mastectomy itself, that would be something a general surgeon would discuss with them. I would encourage everyone who is thinking about or needing a mastectomy to at least request to speak with a plastic surgeon so they can get input and see what their options are. Breast reconstruction isn’t going to be for everyone but a woman should know that it’s available if she wants it and be allowed to discuss her options with a knowledgeable professional.
Melanie: And, why should they come to Corona Regional Medical Center for their care?
Dr. Mudge: I think Corona Regional Medical Center has a uniquely efficient operating room. The anesthesiology staff is excellent. Their operating room is spacious and it’s just a very pleasant place to work. I’m speaking as a surgeon now. The hospital is going through a lot of changes and improvements which are making the rooms upstairs where you’ll spend one to two nights much more pleasant and friendly for your family and just a variety of other structural and logistical changes in the hospital make the service there quite excellent.
Melanie: Thank you so much for being with us today, Dr. Mudge. You’re listening to Corona Regional Radio with Corona Regional Medical Center. For more information, you can go to CoronaRegional.com. That’s CoronaRegional.com. Physicians are independent practitioners who are not employees or agents of Corona Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole, thanks so much for listening.
Breast Reconstruction After Mastectomy
Melanie Cole (Host): You may have had or are about to have a mastectomy. Either you’ve been diagnosed with breast cancer or are at a very high risk of developing it in the future. If so, your doctor may have told you about options to rebuild your breast or breasts, a surgery called “breast reconstruction”. My guest today is Dr. Bradley Mudge. He’s a board certified plastic surgeon and a member of the medical staff at Corona Regional Medical Center. Welcome to the show, Dr. Mudge. I’d just like to start by asking you, what do you tell women every day about breast reconstruction if they’re also going through cancer treatment?
Dr. Bradley Mudge (Guest): Well, the conversation about breast reconstruction is fairly lengthy and based upon their previous education and what research they’ve done themselves, but I like to stress that the choice for reconstruction is a personal choice and entirely up to them. There are many options that we can help people with so that the process has to be tailored to their expectations, their desired outcomes, their available down time and so forth. But, I do like to stress that it’s an opportunity to make themselves a little more whole again after a fairly emotionally and physically disfiguring surgery and a chance to get back something that they would’ve lost otherwise.
Melanie: Let’s discuss some of those breast reconstruction options that you mentioned. What options does a woman have if she knows she’s either having prophylactic mastectomy because she’s been found to have the genetic link, or because she’s just gone through cancer treatment?
Dr. Mudge: Reconstruction can roughly be divided into two broad categories: that being using your own tissue or using an implant, and there is a hybrid of those two categories as well which works well for some people. The final choice on what a woman will decide upon depends a lot on her body habitus, her smoking history, the extent of her cancer, her available down time, her willingness to have various scars on her body and so forth. Each of those options is available and just requires a fair bit of research with each patient to determine it. Something fairly exciting and another option women have over the past probably 4-5 years, is nipple preservation. Many women electing for elective mastectomy, whether that is for a positive gene testing or painful lumps in their breasts or whatever the cause may be, many of these women will actually elect to preserve their nipple areolar complexes. In addition to that, there’s been a recent trend towards preserving the nipple areolar complex in someone who actually has cancer, and that’s kind of an exciting option for those who meet the necessary criteria.
Melanie: How do they decide between immediate or delayed breast reconstruction?
Dr. Mudge: That will depend a lot on how aggressive their tumor is, sometimes the urgency of it and the timing with the general surgeon. If there is a plastic surgeon and a general surgeon willing to do both at the same time, most of the time that’s going to be a better option. It obviously saves the woman from having one more surgery. In addition to that, it alleviates that time when they are totally flat and actually a little bit indented. It kind of takes away some of that emotional stress and fatigue that can come from looking at a fairly disfigured chest. So, we prefer to do it immediately if possible. Something that might change that a little bit on really aggressive tumors where chemo needs to be started as soon as possible in the post op period, we’ll sometimes hold off on that because we don’t want the breast reconstruction to interfere with the urgency of the chemotherapy. There used to be a trend where if you knew you were going to receive radiation therapy, that you would wait to get your breast reconstruction. That’s changed quite a bit over the past decade and now, the thinking is it’s best to go ahead and initiate the reconstructive process with some sort of implant in there and try to stretch the skin out a little bit to help you get that extra skin you’re going to need before the radiation injury is applied to the breast.
Melanie: What types of implants are used for breast reconstruction now?
Dr. Mudge: The most common would be a silicone implant. Probably 95% of women get a silicone implant. In that category, then, we do have an exciting new implant, what we call “highly cohesive implant”, meaning a little bit thicker. So, that’s very useful in the reconstruction for women because after a mastectomy, there’s very little, what we call “subcutaneous tissue” or tissue beneath the skin left, and if you place a normal standard silicone implant in, it can look quite rippled and abnormal. The highly cohesive implants maintain their shape a little better and give an overall better appearance to the breast, although you do sacrifice a little softness to it. Saline implants are another option and, at times we still use those, particularly when a woman wants to be quite large. The silicone implants only come up to 800cc in size, so we’re limited how large we can make those. In those cases, saline is a good option.
Melanie: And, what about breast reconstruction using your own tissue, the flap procedure? Tell us about that.
Dr. Mudge: There’s two basic ways to do that and then there are other variations which are a little more usual. You can use your abdominal tissue. That’s called a “TRAM flap” and sacrifice one of your rectus abdominis muscles or your six-pack muscles and move the abdominal tissue up to the breast and reconstruct it that way. That process has significantly more down time, more scarring and certainly more risks than an implant reconstruction would have. The other thing that’s changing over the past few years in that regard is a lot of women are doing bilateral mastectomy and reconstruction. That number has really increased significantly during the past decade. It would be fairly hard to use both abdominal muscles for that because it leaves you with a fairly weak abdominal wall. That’s the TRAM flap. The other option is the latissimus dorsi flap which is bringing some muscle around from your back with a skin paddle with it and reconstructing the breast mound that way. Typically, unless the woman is looking for a fairly small breast, the latissimus flap method will also require implants to be placed.
Melanie: What changes for screening after this reconstruction? Are they able to have mammograms or is it ultrasound after that? Tell us about that.
Dr. Mudge: That would vary and sort of be left up to the oncologist depending on how aggressive their tumor was and how close the tumor was to the margin. You can still have a mammogram and some women will still get those per their oncologist’s request. The gold standard and probably the best way to look at it would be with an MRI which can not only detect soft tissue changes such as early recurrences or suspicious lesions in the breast but it can also evaluate the integrity of the implant itself and give you an idea if the implant could be ruptured.
Melanie: Does the implant have to be replaced at some point?
Dr. Mudge: The common thinking is that implants should be replaced every 10 years. In the world of cosmetic surgery, that’s not an absolute requirement because you will notice when it’s ruptured. Your mammogram will show it and there’s no urgency to get them replaced. In the world of reconstruction, it’s a little more complicating and, in general, I would recommend a reconstructive patient have re-implants, change that every 10 years just to prevent that rupture which can be a lot more destructive in a reconstructed patient as compared to a cosmetic patient. That’s not to say that the leaking silicone is causing problems with the rest of your body such as chronic fatigue, lupus and things we used to worry about. That’s all been disproven, but the reason for not wanting a rupture in a reconstructed patient is because there’s so very little soft tissue left, by the time you clean out that ruptured silicone, you’re going to have very, very thin flaps and tissue left which will hamper the aesthetic result.
Melanie: Will they have feeling in the reconstructed breast?
Dr. Mudge: If the nipple areolar complex is preserved, it will have essentially no feeling. You might have a small bit of feeling at best but the main nerve that runs through the breast to give sensation to the nipple would have been removed during a mastectomy. If they have sacrificed their nipple areolar complex and are left just a transverse or a crossways running scar, the feeling is very limited in the area. Much after any surgery, such as a facelift or tummy tuck, there’s very little feeling around the scar. Some of the feeling comes back as the years go by which is a good thing because areas in your body that are numb are not great because they can be subject to burn or pressure or freezing, things like that, but essentially they won’t have a lot of feeling over the breast, especially the central portion of the breast.
Melanie: And, how will aging affect that breast?
Dr. Mudge: Well, the good news is that, in general, with an implant reconstruction and the artificial skin sling that we placed in the inside, there’s very little drooping of the breast as the years go by. They stay up and in high and appropriate position and shouldn’t move much at all. Anyone will undergo the typical skin changes such as thinning and perhaps age spots and wrinkles on the breast tissue but the implants themselves and, thus, the breast mound should not descend down the chest wall much at all.
Melanie: And, in just the last few minutes, Dr. Mudge, what should people that may have to have a mastectomy think about when seeking care? What should they look for?
Dr. Mudge: With regard to the mastectomy itself, that would be something a general surgeon would discuss with them. I would encourage everyone who is thinking about or needing a mastectomy to at least request to speak with a plastic surgeon so they can get input and see what their options are. Breast reconstruction isn’t going to be for everyone but a woman should know that it’s available if she wants it and be allowed to discuss her options with a knowledgeable professional.
Melanie: And, why should they come to Corona Regional Medical Center for their care?
Dr. Mudge: I think Corona Regional Medical Center has a uniquely efficient operating room. The anesthesiology staff is excellent. Their operating room is spacious and it’s just a very pleasant place to work. I’m speaking as a surgeon now. The hospital is going through a lot of changes and improvements which are making the rooms upstairs where you’ll spend one to two nights much more pleasant and friendly for your family and just a variety of other structural and logistical changes in the hospital make the service there quite excellent.
Melanie: Thank you so much for being with us today, Dr. Mudge. You’re listening to Corona Regional Radio with Corona Regional Medical Center. For more information, you can go to CoronaRegional.com. That’s CoronaRegional.com. Physicians are independent practitioners who are not employees or agents of Corona Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole, thanks so much for listening.