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Breast reconstruction can aid psychological healing

Army Lt. Col. Owen Johnson III, a plastic surgeon at William Beaumont Army Medical Center at Fort Bliss, Texas, discusses options available for reconstructive surgery with a patient. (U.S. Army photo by Marcy Sanchez) Army Lt. Col. Owen Johnson III, a plastic surgeon at William Beaumont Army Medical Center at Fort Bliss, Texas, discusses options available for reconstructive surgery with a patient. (U.S. Army photo by Marcy Sanchez)

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More breast cancer patients are becoming breast cancer survivors. But that survival sometimes comes at the cost of losing part or all of a breast – sometimes both breasts. That’s where reconstructive surgery comes in.

“After a mastectomy, breast reconstruction restores form,” said Air Force Maj. Justin Fox, a plastic surgeon at Wright-Patterson Air Force Base, Ohio. “There are several studies that say this helps in psychosocial and sexual well-being, all of which are part of any cancer treatment. It’s not just about the appearance and form, but also the psychological well-being of the patient.”

Fox said breast reconstruction as a part of cancer care is one of the few procedures backed by national health care policy, which requires TRICARE and insurance companies to provide reconstructive services.

“It’s not to enhance someone’s appearance or cup size,” he said. “It’s to restore them to as close as possible to where they were before a mastectomy.”

Fox said the options for having reconstructive surgery are explained when doctors talk with patients about their overall cancer treatments.

“I talk with them after their oncologist or cancer surgeon discusses what might need to be done, sometimes even before the patients have decided which surgery they will have,” he said. A lumpectomy is removing the diseased portion of the breast; a mastectomy is removing the entire breast.

“I start by telling patients that even if they have just a portion of the breast tissue removed, the plastic surgeon can play a role,” Fox said.

Lt. Col. Michelle Nash, branch chief at the Air Force Research Laboratory at Wright-Patterson, had a double mastectomy after being diagnosed with breast cancer earlier this year.

“At one point after my diagnosis, I remember thinking, why do I need reconstructive surgery? But after considering it, I decided not having it would be a difficult thing to deal with,” she said. “For me, getting reconstructive surgery was the right thing to do.”

Fox said there are options for breast reconstruction besides the use of implants. “[Patients] can use their own tissue from their abdomen, back, or inner thigh to re-create the breast,” he said.

Nash said she’s on the thinner side, so implants were a better option for her. The procedure began during her mastectomy. After the general surgeon removed her breast tissue, Fox placed expanders between her skin and chest muscles. The expanders have ports.

A few weeks after her surgery, Nash began going to Fox’s office weekly for saline injections. Fox adds more each time so that eventually, Nash’s skin will have stretched enough to accommodate the implants. The total amount of saline she’ll receive is based on the amount of breast tissue that was removed.

“I’m OK with the small cup size I had before my mastectomy,” Nash said. “I wasn’t looking for an upgrade.”

About a month after her “final fill,” Nash will have surgery to replace the saline with the implants.

“It’s a slow, gradual process,” Nash said. “And it’s been uncomfortable at times. But I have a very supportive work environment, and I’ve been able to do half-days at home, or take time off, when I haven’t felt well enough to go into work.”

Fox said patients don’t have to decide right away what they want to do about reconstructive surgery. “I believe you have better results if you do reconstruction immediately,” Fox said. “But there’s usually no time limit. A woman can come in a year or even five years later, and ask about her options.”

“The options may be different, depending on her cancer treatment,” Fox said. “But in my mind, there’s never a point where I would tell them they’ve waited too long.”

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