" Looking back at the last year, I will remember it as the year I beat cancer,” says Susan B., 45, a breast cancer survivor. "The high point of my entire year was my breast reconstruction. It made me feel complete, and symbolized ridding myself of the cancer and returning to health."

In the blur of days after she was diagnosed with breast cancer, Susan’s days were filled with doctor visits, family phone calls, tears and discussion of treatment options for her cancer. Susan's general surgeon scheduled her for a modified radical mastectomy and referred Susan to a plastic surgeon to discuss options for breast reconstruction.

After reviewing the risks, benefits, alternative treatments and receiving medical clearance, Susan selected to have immediate breast reconstruction using her own abdominal muscle, fat and skin (TRAM flap), the same day as her mastectomy. She chose the surgery to avoid getting an implant and to lose her tummy fat. After the surgery, Susan was hospitalized for three days and she returned to work six weeks after the surgery.

"Having the breast reconstruction helped me deal with the loss of my breast and the fear of cancer, and got me back to a state of feeling good about myself as a woman, a mother and a wife," says Susan. She was also glad to be able to resume activities like swimming, bike riding and running and feels her appearance in clothes, swimsuits and naked is better now than before she got cancer.

Susan is not alone. More and more women who have had mastectomies are opting to restore their missing breasts through breast reconstruction. Clearly, the physical and psychological transformation that occurs through breast reconstruction helps women deal with the sense of personal loss that is experienced after a mastectomy. According to the American Society of Plastic Surgeons, between 1991 and 2001, breast reconstruction increased by 174%, from 29,607 to 81,089. Since 1998, breast reconstruction and the alteration of the opposite breast for symmetry for women who have undergone a mastectomy, is an insurance covered procedure, in part thanks to the Women's Health and Cancer Rights Act.

Breast reconstruction can be immediate, the same day as the mastectomy, or delayed, in the months or years after the initial breast cancer surgery. The advantages of immediate reconstruction, in addition to the lower cost and significant psychological and aesthetic advantage, include the fact that its only one surgery, one anesthesia, and one recovery period. Studies by Schain et al., Noone et al., and Dowden show that immediate reconstruction has positive psychological benefits for women: lower distress, less anxiety, and less recall of the pain of the mastectomy. Immediate breast reconstruction patients have similar survival rates to patients without reconstruction, and local recurrence rate is no higher.

How Its Done

Reconstruction can be done using a woman's own body tissue (autologous flap reconstruction) or using a prosthesis or implant. The three most common flaps used to reconstruct the breast include the back (latissimus dorsi muscle), abdomen (TRAM, transverse rectus abdominis muscle flap), or buttocks. With this type of surgery, the surgeon takes great care to hide the scars as much as possible. When tissue is taken from the back or abdomen, the blood supply comes from the underlying muscle, transferring as much skin, fat, and muscle as needed to restore the breast volume and shape. Using the abdominal muscle, fat and skin (TRAM flap) is a very popular choice, because patients like Susan can get the added benefit of a tummy tuck, improving the contour and appearance of the abdomen. Also using a patients own tissue, the newly reconstructed breast has a soft, natural feel and appearance. But keep in mind, TRAM flap breast reconstruction is major surgery, which means three to six hours in the operating room, three to five days in the hospital, and a four to six week recovery period.

When buttock tissue is used, microsurgery is needed to repair the blood vessels. The muscle is moved up to the chest and the surgeon attaches the buttock blood vessels to blood vessels in the chest, to restore blood supply.

Implant Ideology

Pam W., 38, married with two young children, lost her right breast to cancer two years ago. This year she was diagnosed with breast cancer in her left breast, and scheduled a left mastectomy. Her oncologic surgeon referred her to a plastic surgeon, before her surgery, where she discussed the options available, her goals and her medical history. Ultimately, Pam selected bilateral reconstruction with implants because she wanted a quick recovery, minimal down time and less surgery.

Pam's left breast was removed with a skin sparing mastectomy, preserving the breast skin for a better shape and appearance. This allowed the surgeon to immediately insert a saline breast implant in the left breast. During Pam's left mastectomy, the surgeon inserted a tissue expander (an outer bag of silicone, with saline inside) in the right chest, where Pam had no breast, and no skin.

The tissue expander is slowly inflated with sterile saline on a weekly basis in the doctor's office, starting approximately four weeks after surgery, when the incision is healed. The tissue expander slowly stretches the chest wall skin, similar to what happens during pregnancy, to recruit skin that was removed with the mastectomy. A tissue expansion breast reconstruction requires two surgeries, which are usually on an outpatient basis, and take less than three hours. The second surgery is scheduled after three to four months, when enough skin and subcutaneous tissue has been stretched at the previous mastectomy site. At that time, the tissue expander is removed, and a permanent implant (either saline or siclicone) is inserted. The risks of the implants include the possibility of rupture, displacement, or hardening of the scar tissue around the implant. If there is a problem, the implant can be removed entirely or replaced, in a relatively minor outpatient operation. In a bilateral breast reconstruction, placing the same size implant in each breast pocket assures the best symmetry.

Pam was thrilled with the results. "After my breast reconstruction, I felt more like myself, able to wear clothes and participate in activities without fear of a prosthesis being dislodged or moving. My children are happy I can go swimming with them again," she says.

For more information on breast cancer reconstruction, check out The American Society of Plastic Surgeons at www.plasticsurgery.org or The American Society for Aesthetic Plastic Surgery at www.surgery.org.

Getting breast reconstruction can be an important part of the healing process of breast cancer for most women, and its availability is a major reason that woman are seeking out earlier treatment. If you are facing breast cancer and recovery, make sure you include reconstruction among your many options. Its one way to start rebuilding your body - and your life.