“Is it normal to have already undergone seven breast reconstruction surgeries after mastectomy (performed in 2016)? I finally freed myself from the cage of induced menopause and my period has returned, but I have not finished my reconstruction and cosmetic surgery: I am on my third prosthesis, and this is not good either. It is true that I moved and changed surgeon, hospital and region, but is it possible to replace 4 implants, do 2 mastopexy in the contralateral breast and, after 5 years, have not yet completed the reconstruction? Jokingly, I now call myself a patchwork woman! Even from a psychological and oncological point of view, I was not followed as I would have expected. How long can you resist in the midst of a storm if you never see a calm sea or land in the distance? ” (Valentina)
Answered by Marzia Salgarello, Associate Professor of Plastic Surgery and Head of the Plastic Surgery Department of the Agostino Gemelli University Hospital Foundation.
Breast Health, the newsletter is born
Cara Valentine,
unfortunately what she told in her outburst is the situation of many women. The one with the prosthesis is a type of immediate reconstruction and that seems an easy solution, but it is not certain that it is the best way in all cases, and some patients, like her, run into problems. The reason is that it is not as simple an operation as it may appear: after a mastectomy not only the volume must be reconstructed, but also the shape and symmetry with the other breast. To this complexity are added the variables of post-reconstruction.
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From what he writes, we understand that in his case the reconstruction was not ‘happy’ from the beginning, although we cannot know why, and what happened. In any case, it is important to remember that the prosthesis is not the only possibility. Often in patients who have a complicated prosthetic history we make a radical change of strategy and propose a reconstruction with their own tissues, called autologous. Tissues are usually taken from the abdomen, transferred, revascularized and shaped. It is a complex operation, which requires a hospitalization of about 5 days, while the recovery usually takes 20-30 days (more or less double what is necessary after the prosthesis). From an aesthetic point of view, the result can be very natural, also because the breasts change like the rest of the body: it gets fat, slims and ages like any other part.
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The state encourages breast reconstruction after breast cancer, but not autologous. It is in fact a demanding intervention which, however, has a low reimbursement by the health system. These reconstructions are so uneconomical for hospitals that they are often not encouraged, and therefore are not always offered to women who could benefit from them. I do not deny that it is a bad situation, because we find ourselves being forced to use prostheses even when we know that they are not the most suitable solution.
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I propose autologous reconstruction to all radio-treated patients because I know that the prosthesis will be a lifelong problem for them. Radiation therapy, in fact, has a very heavy impact on the tissues and the prosthesis, which can sometimes harden and cause pain. This treatment changes the destiny of the reconstruction, both from an aesthetic and functional point of view, for this reason with the DonnaxDonna project we are working on a new booklet dedicated to this topic, which will be released next September (you can find those created so far here).
Not knowing her clinical case, I can’t say if autologous reconstruction could be a way for her too. Everything is feasible in principle, but the local situation, general and psychological health must be evaluated, and the oncologist must give her opinion. However, whenever possible, in situations of symptomatology and deformity, therefore of medical and not purely aesthetic necessity, the State reimburses a new reconstruction.