This subject has been coming up a lot since the announcement of Christina Applegate’s breast cancer diagnosis. Although it shouldn’t take a celebrity to bring about awareness, it should be something on our minds once a month during our self breast examinations. According to the U.S. Cancer Statistics Working Group, in 2004, 186,772 women and 1,815 men were diagnosed with breast cancer. Worse, 40,954 women and 362 men died from breast cancer in 2004. Breast Cancer Awareness Month is coming up soon so please get into your physician and have a screening performed to be sure. Even if breast cancer doesn’t run in your family, one day out of your year to go and have a mammogram won’t kill you, but not doing so may.
I have a very good friend, we’ll call her Loretta, who has a history of breast cancer and fibrocystic disease in her family. Loretta lost one breast to breast cancer in 2004. Just one, not both; she is now in her 60′s and hasn’t had a problem arise in her remaining breast as of yet but she feels it is only a matter of time. She chose not to have breast reconstruction because she says, “I know who I am. I don’t need breasts. I am at an age where it didn’t matter to me, My [late] husband didn’t mind either.” Although she confided that the external prostheses are heavy and awkward and she now wishes she had had a bilateral mastectomy. She is proof that there is life after mastectomy regardless whether or not you choose to have breast reconstruction. Loretta is active, confident, wise–all the attributes I look up to as a woman.
Loretta, whose mother died from breast cancer, has been a volunteer at We Care Cancer Support Center in the Tri-state area (based in Arizona). She has helpedso many people get through the bad times after their diagnosis and has supported them during their treatments. She is a cancer survivor who, she feels, more than likely has another battle ahead of her. She is a huge proponent of breast cancer screening and feels that the best form of prevention is early detection.
But, what if you wish to have breast reconstruction? Maybe, unlike Loretta, you feel that having breast reconstruction can help you feel “normal” or in some way may distancs you from the fact that you had a mastectomy. There are treatments available so that you don’t have to be reminded of your breast cancer.
Your Options In Breast Reconstruction
Now that you have beat cancer’s butt, if you choose to have breast reconstruction there are a few options you may not have thought of. Everyone automatically thinks silicone implants, but there are a few other options, as well as combo-options.
- Latissimus Dorsi Muscle Pedicle Flap: The Latissimus Dorsi muscle is the large muscle on your back. Reconstruction using the LD is considered a pedicle flap procedure. A pedicle is what a flap of skin is referred to when it is still left attached to the body’s blood supply so that the viability of the flap can be maintained. The opposite is a free flap (see below) when the tissue is removed entirely from the body and then reattached via sutures. With a pedicle flap, the tissue is still connected via a blood supply and re-situated and reattached in its new position via sutures. The nipple (if not affected by cancer) is also usually left on a pedicle when possible so that it can be left on the body. If not, a cosmetic tattoo can match the color and size of the other nipple if applicable. A hole is often time made in the LD and the muscle is then pulled forward (under the skin) and reattached over where the breast mound once was. This offers augmentation and creates a small to medium sided breast. Usually, however, further augmentation with an implant is necessary. In this case, a tissue expander is utilized to make a pocket and a breast implant is then inserted. The LD is often used to hide the implant when the pectoral muscles are removed due to cancer. The scars for this procedure are often on the breast, as well as on the back either horizontally, or vertically under the arm.
- Pedicle TRAM Flap: A Pedicle Tram Flap is a flap using the Transverse Rectus Abdominis Myocutaneous (hence, TRAM). The TRAM is left on a pedicle, as explained above, to increase the chances of graft viability. The TRAM flap seems to be the most often used method due to the use of the body’s own fat creating a natural breast feel. The TRAM flap is obtained by creating an almost football shaped incision on your lower abdomen and removing the rectus abdominus muscle, fat and skin, and then removing the skin and inserting the flap under the skin of the breast (where the nipple is normally removed). The skin is then sutured into place and eventually a “nipple” is colored in using cosmetic tattooing. The bonus is that essentially, you get a tummy tuck procedure as a bonus. The scars from this procedure are on the breast, as well as a horizontal scar on the lower abdomen as is typical with a tummy tuck.
- Free TRAM Flap Breast Reconstruction: This procedure is similar to the above procedure however the flap is severed from any blood supply and reconnected using microsurgery to a blood supply located in the breast area.
- Gluteal Free Flap Techniques: When a patient does not wish to have a scar on the lower abdomen, or when tissue may not be sufficient in very thin patients,. Superior Gluteal Artery Perforator (SGAP) flaps and Inferior Gluteal Artery Perforator (IGAP) flaps are the two options in gluteal free flap procedures. In the SGAP procedure, the flap is removed from the middle of the buttock area and is then resituated on the breast mound. Microsurgery reconnects a blood supply that will increase the chances of graft liability, In the IGAP procedure, the flap is removed from the lower buttocks, placing a scar in the crease of the buttocks. Either way the procedure creates a scar on both the breast and the buttocks, which is less obvious than the lower abdomen.
- Breast Augmentation Using Breast Implants: Just as with standard breast augmentation, augmentation can be restored to the breasts using an internal prosthesis. These prostheses are made from silicone elastomer and filled with either silicone or saline. Often an expander is utilized to create a pocket and the breast implant is inserted at a later date. Please see www.breastimplants4you.com for more information.
- Check with your surgeon for more options which may be available to you
Whatever your choice, whether you choose to reconstruct or not, the important thing is your health. Being cancer free is what matters most! Breasts or no breasts you are a woman and a survivor. No one will ever forget that. Breast reconstruction is a personal decision that does not define who you are on the inside. But it an option that is available to you if you so choose.
Thai Breast Slap, a method purported to be a century old, is said to increase the size of the bust by 1 to 4 inches. The method is said to incorporate aggressive slapping, massaging and pinching of breast tissue, fat and the underlying muscle of the breasts and other areas of the body to increase the breast size (as well as thin areas of the abdomen and surrounding ribcage. 
