Many women who undergo a mastectomy following a breast cancer diagnosis also opt for breast reconstruction. And reconstruction options have changed dramatically over the last 10 years, according to Dr. Lifei Guo, chair of plastic and reconstructive surgery at Lahey Clinic.
First, the timing of the reconstruction process has changed. Before, the mastectomy and first reconstructive surgery would be completely separate.
“Now it has become more and more immediate,” Guo said.
Along those same lines, the time in between placing implants after a mastectomy has reduced. Previously, a breast surgeon would perform a mastectomy, and then tissue expanders would be put into place. The expanders hold space for implant or reconstructive surgery at a later date. Today, both surgeries — the mastectomy and implant surgery — can be done at once.
Finally is the advent of a new perforator flap called the DIEP flap. In this process, a surgeon takes tissue from the abdominal area to use to reconstruct the breast. But the DIEP flap process does not affect the abdominal muscles.
Guo completed his training in the Harvard system. He came to Lahey from Brigham and Women’s Hospital, where he worked primarily with breast reconstruction patients. In fact, many of his patients followed him to Lahey, he said.
At Lahey, Guo said one of the best parts of the process is the multidisciplinary approach the hospital takes with its cancer patients. Guo is part of a team, including the breast surgeon, medical and radiology oncologists, social worker and breast health navigator who sit down with a patient to discuss treatment options.
Depending on the type of breast cancer at which stage the patient is diagnosed, Guo said breast conservation options, such as a lumpectomy, aren’t viable.
“If I’m involved early on, I am able to guide their decision a little bit,” Guo said.
During the team meeting, Guo fields questions pertaining to cosmetics, as well as concerns about how radiation would affect the reconstruction process, since radiation can distort the tissue.
“The patient is always concerned with how long the surgery takes,” he said.
Although reconstruction starts immediately after a mastectomy, Guo said the full process is a series of about two to three surgeries. If a patient chooses reconstruction, he’ll meet with her three to six weeks before the initial surgery, then on a weekly basis for about a month, followed by check-ups every couple of months and follow-up surgery as needed to complete the process.
If there’s no radiation or chemotherapy, Guo said the reconstruction could be complete in less than a year.
Guo said, with many patients diagnosed at a young age, faced with the reality of having to lose a breast, he knows his work can make a big difference in their lives.
“It’s a very rewarding surgery field to be in,” Guo said.
