New study from Daily News (Los Angeles 10/20)

A very recent report released this week stated that 43% of women diagnosed with breast cancer are not told about breast-reconstruction options from a survey by the nonprofit Cancer Support Community.

Also, nearly 88% of women who had discussed options with a surgeon were pleased with their subsequent decisions. These are the very numbers, that since the 1998 congressional act that allowed for breast reconstructive procedures to be covered under insurance that we are working towards improving....

Immediate vs. Delayed Reconstruction

There are many factors that go into the decision regarding the timing of breast reconstruction. Sometimes women prefer to proceed with a mastectomy and other needed cancer treatment, leaving the question of possible reconstruction for later. Sometimes there are clear medical reasons why a delay is preferable, and sometimes women strongly prefer a single major surgery and awakening with a "new" breast.

As breast reconstruction has become increasingly common, there have been more studies to determine the best and safest practice in a range of situations. Two recent studies have provided information about instances in which delayed reconstruction is safer and have been reassuring about chemotherapy, either pre or post surgery, not causing additional complications.

One study from Dr. Rodney Pommier and colleagues at the Oregon Health and Sciences University found that complications after radiation occurred in 44% of women who had immediate reconstruction and only 7% of women who did not (and who, presumably, had reconstruction later or not at all). Dr. Pommier suggests that sentinel node biopsies prior to mastectomy surgery will often identify those women who will likely need post-operative radiation therapy, and further discussion can then include the higher risk of complications from this course. At BIDMC, women who anticipate radiation therapy are often counseled to delay reconstruction until later.

The other study from UCSF found that women who had chemotherapy, either pre or post surgery, were no more likely to have surgical complications than women who did not receive chemotherapy. Thirty-one percent of women studied had a complication that required a second surgery, but the incidence was the same among women who had chemotherapy and those who did not.

If you would like to read more:

http://www.sciencedaily.com/releases/2010/09/100920172632.htm

All of this supports the need to have thoughtful discussions with your doctors as you consider your surgical options. No single course is best for all women, but we are increasingly able to individualize recommendations and understand the best choices for women making these difficult decisions.

2010 Making Strides Walk for Breast Cancer

This past sunday our nurse Maria walked and raised funds for Breast cancer research along with several breast reconstruction patients from our practice. Hopefully it wasn't too windy out during the day, but I hear that the walk was truly inspirational with many others whose lives have been affected by breast cancer also out for the afternoon - Congratulations to all!

Breast reconsruction at the American Society of Plastic Surgeons annual meeting

The annual meeting of the American Society of Plastic Surgeons is currently being held in Toronto, Canada, and a much discussed topic at the meeting the increasing role of using one's own fat as a "filling" agent from one part of the body to the chest/breast area in reconstruction; typically, this involves liposuction from one area to fill various areas of the breast reconstruction through a process of purifying the fat cells in the operating room. There is alot of basic science research going into understanding how these fat cells survive on their own in another part of the body

New study in Archives of Surgery about delayed reconstruction after mastectomy

There were 2 articles that came out about "delayed" reconstruction following mastectomy. While this adds another article to the discussion, it highlights the point about talking to your plastic and reconstructive surgeon about reconstruction and the nature of the disease.... for instance, for people who definitely need radiation after a mastectomy, delayed is an option to consider; tissue expanders, however, may still be placed at the time of mastectomy for two reasons - preserving the breast envelope skin, and providing at least one form of breast reconstruction during the process of radiation and treatment after mastectomy

there are considerations regarding how the final incisions/scars will appear with delayed reconstruction, and however in the long run, for instance, having a soft, durable abdominally based flap might be better.....regardless, ask your plastic surgeon about these options - understanding the process sometimes becomes involved!

Followup to New York law

As we have been reading about ramifications to the newly passed law in New York regarding providing options of breast reconstruction to individuals requiring mastectomy, I think about the continued majority of patients in this country who have not had reconstruction, either by not having the opportunity or otherwise....

New York law to educate women about breast reconstruction options

I just read that there New York Gov. David Paterson signed legislation requiring all hospitals to tell female patients about options for reconstruction after mastectomy; it is amazing that it has required a mandate for patients to find out about their options in one state..... however, I tell my patients that even in this country no more than 1/3 of patients undergoing a mastectomy have breast reconstruction, which means 66-67 percent don't have any reconstruction!

Removal of the Chemo Port!

I had a patient today who asked that we remove her chemo therapy port... as part of the steps of breast reconstruction,
we were also performing some balancing/touch-up's to the breast reconstruction and the chemotherapy port (which is placed for intravenous placement of chemotherapy medication) is often visible on the upper part of the chest under the collarbone....

regardless, there are a number of patients certainly eager to have it removed, and it is certainly a milestone in the whole process of breast cancer treatment and reconstruction!

Resources for Decision Making

Making a decision about breast reconstruction is very difficult. There are a number of choices, and it can be overwhelming in the best of times--let alone immediately after a cancer diagnosis when you are definitely not thinking your most clearly. A colleague developed this useful list of online resources for information. I would add the importance of speaking with other women who have had the kinds of surgery that you are considering. As we all know, you always hear something different from patients than you do from doctors. Ask your breast surgeon or plastic surgeon for contacts. If that does not work, please feel free to email me (hhill@bidmc.harvard.edu), and I can make the connections for you.

With thanks to Margery Gallece:

There are some good online resources.It's important to keep in mind that not all types of reconstruction are available to individuals based on factors such as treatment options, body type, etc., so it's advisable to get a couple of consults with local plastic surgeons. It's also important for women to read the small print about implants. Implants have a "shelf life" of about 10 years and should be replaced after that. This is a conversation that is often glossed over in the process of decision making. It's vitally important for women to know about that.Reconstructing Aphrodite is probably the most complete photo book (not cheap) showing reconstruction. On July 28. Living Beyond Breast Cancer had an educational teleconference scheduled on this topic: Breast Reconstruction: Understanding Your Options, Our July teleconference will help you learn about your choices for breast reconstructive surgery. This teleconference can now be heard as a podcast on their website.http://www.lbbc.org/content/event/breast-reconstruction-understanding-your-options.asp?c=educational&t=participate&sn=teleconferencesThere was a web site titled "Show Me" and a book. Some of the techniques in that book are now outdated but it was very good. You can access some of the photos and stories at this link on Dr. Susan Love's web site:http://www.dslrf.org/searchresults.asphttp://www.breastcancer.org/pictures/reconstruction/http://www.networkofstrength.org/information/treatment/reconstruction.phpThere are newer reconstruction techniques although not everyone is a candidate for these and it is not available everywhere:http://www.diepflap.com/?gclid=CPa53NS5-KICFRAN2godBWK5hg

Am I a candidate for a DIEP flap?

Patients always call asking me if they are a candidate for a DIEP flap. There are not many things that are absolute exclusions. To determine if you are a candidate, you need to come in for a consult. Even if you are overweight or have had previous abdominal surgeries, you may still be a candidate. Not all abdominal surgeries disrupt the Deep epigastric inferior perforators which make up the DIEP flap. Never assume that you cannot have one, make a consult appointment first. Your doctor will determine if you have enough belly tissue available to make an adequate breast reconstruction, and will be able to go over the probable size with you at the time of your visit.

National Survey for Women who have had Reconstruction

If you have had breast reconstruction, please take a few minutes to complete this survey from the Cancer Support Community. Your responses, all confidential, will help design more resources and information for women considering this surgery.

http://www.thewellnesscommunity.org/fm/Media/Wellnet/Summer-2010/Breast-Reconstruction-Surgery.aspx

Planned radiation following mastectomy for treatment

There remains the question of immediate reconstruction (at the same time of the mastectomy, and at the same surgery) versus delayed reconstruction (breast reconstruction performed after the mastectomy, which can be weeks to months following the initial mastecotmy)... This is an important discussion, as there are different viewpoints regarding the approaches... and a personal decision that is important to understand fully - initial tissue expander placement followed by subsequent staged "final" reconstruction versus no reconstruction and so on... be sure to ask what the differences may be, what the incisions may look like after reconstruction, and what their opinion is regarding implant reconstruction in the setting of radiation....

Nipple Sparing Mastectomy

Nipple Sparing Mastectomy
7/24/2010 (10:11:04am)Tags: mastectomy reconstruction nippleComments: (0)
It seems obvious that one of the more difficult parts of breast reconstruction is creating a new and natural-looking nipple and arerola. Women sometimes wonder about the possibility of a mastectomy that spares the nipple. Here is a brief interview, from MedScape, with Dr. Lisa Newman from the University of Michigan Medical Center about this surgery:

Nipple-Sparing Mastectomy With Breast Reconstruction
Lisa A. Newman, MD, MPH
Posted: 06/25/2010
Question
My patient is a 35-year-old woman with a clinical stage I left breast cancer. She has a strong family history of breast cancer and is considering bilateral prophylactic mastectomy with immediate reconstruction. She has asked about nipple-sparing mastectomy. Is this a safe approach, either for the therapeutic or the prophylactic mastectomy?

Response from Lisa A. Newman, MD, MPH
Professor of Surgery; Director, Breast Care Center, University of Michigan, Ann Arbor
Reports of nipple-sparing mastectomy are appearing more frequently in the published medical literature, with most groups suggesting that the procedure is not only technically feasible, but also oncologically safe. However, it must be strongly emphasized that the conventional mastectomy, which entails sacrifice of the nipple-areolar skin, is still widely considered to be the gold standard procedure for patients requiring mastectomy for either cancer treatment or risk reduction. Studies of nipple-sparing mastectomy have been retrospective in nature with variable selection criteria,
including mixed samples of patients undergoing the procedure for prophylaxis or treatment; the patient follow-up intervals have been relatively brief.
Nonetheless, the preliminary data in regard to outcomes following nipple-sparing mastectomy are promising, suggesting that it is a technique worthy of further study and should be rigorously evaluated in the context of a prospective clinical trial. Historically, the largest series of bilateral prophylactic mastectomy, such as the Mayo Clinic database,[1] featured cases performed by plastic surgeons as subcutaneous (nipple-sparing) mastectomy. In the now-landmark study of approximately 1000 selected high-risk women undergoing prophylactic mastectomy in this setting, Hartmann and colleagues[1] found that prophylactic mastectomy reduces breast cancer risk by 90%, and of the 7 prophylactic failures, only 2 were cases of breast cancer occurring in the retained nipple-areolar skin. These results have prompted others to explore nipple-sparing mastectomy for breast cancer as an extension of the skin-sparing mastectomy concept. The skin-sparing mastectomy includes a periareolar incision but sacrifices the nipple-areolar skin, and is now routinely
coupled with immediate breast reconstruction, with well-documented acceptably low local recurrence rates that are comparable to those reported after conventional mastectomy.[2,3] Pathologic analyses of the nipple-areolar skin from mastectomy specimens reveal occult cancer in this tissue in 6%-58% of cases,[4,5] with risk for occult nipple-areolar
involvement highest with central tumors. This has prompted some investigators to offer nipple-sparing mastectomy to patients with peripherally located disease. Simmons and coworkers[6] found that most cases of occult nipple-areolar
involvement were related to disease within the nipple, and this group has reported excellent local control with areolar- sparing mastectomy in 17 cases, but with follow-up limited to only 2 years.[7
Several single-institution groups have reported their outcomes with nipple-sparing mastectomy, with wide variation in local recurrence rates ranging from 0% to 28%, and with median follow-up intervals often shorter than 2 years.[8-10] In contrast, rare reports of larger sample sizes with longer follow-up have also demonstrated low local recurrence
rates.[11,12]
Of note, at least 1 group from Italy has reported on routine use of intraoperative radiation to the retained nipple-areolar skin.[13] The consistent observation that failures only rarely involve the preserved nipple-areolar complex has nonetheless prompted concerns that the limited exposure from a nipple-sparing mastectomy might actually compromise the adequacy of the mastectomy, leaving more at-risk breast tissue in the remote portions of the breast/chest wall.
Nipple-sparing mastectomy would be the preferred procedure for cases of small unicentric breast tumors located more than 2 cm peripheral to the areolar edge, as well as for cases in which the intraoperative frozen section analysis revealed no evidence of occult nipple-areolar involvement.
Patients considering this procedure should be informed that the nipple-areolar skin will need to be sacrificed if any disease proximal to the area is identified pathologically, and that if preserved, the nipple-areolar skin may be insensate or develop necrotic wound complications. Of importance, patients must also be informed about and understand the lack of high-quality prospective data in regard to the oncologic safety of this procedure.
Supported by an independent educational grant from Susan G. Komen for the Cure.

Free Teleconference re Breast Reconstruction

It can be very hard to identify the best web resources about breast cancer. One very fine organization and website is Living Beyond Breast Cancer: www.lbbc.org
They have the best printed materials of any organization that I know. Additionally, they sponsor many educational programs, both "live/in person" and teleconferences. Here is information about a July 28th teleconference about reconstruction options:

7/28/2010
Breast Reconstruction: Understanding Your Options
Our July teleconference will help you learn about your choices for breast reconstructive surgery
Speaker: Karen M. Horton, MD, MSc, FRCSC
Register now for this free teleconference about breast reconstruction.
Join Living Beyond Breast Cancer for our next free teleconference, Breast Reconstruction: Understanding Your Options, from 12:00 p.m. to 1:15 p.m. Eastern Daylight Time (EDT) on Wednesday, July 28.
Karen M. Horton, MD, MSc, FRCSC, a board certified plastic surgeon with Women’s Plastic Surgery, will help you learn about:
Different types of reconstructive surgeries
The latest research in rebuilding the breast
How to determine the option that is best for you
Microsurgery, nipple reconstruction and immediate versus delayed surgery
The stages of the reconstruction process
What to expect during your recovery
This teleconference will also discuss questions to help you explore whether you want to consider reconstructive surgery.
About Our Speaker
In addition to her board certification, Dr. Horton is a reconstructive microsurgeon. She practices in the Pacific Heights area of San Francisco.
Dr. Horton educates, empowers and informs women about options for breast reconstruction after cancer. Her goal is to use techniques that do not sacrifice major body muscles, enabling women to have reconstruction with the least number of stages. She specializes in microsurgical breast reconstruction, including DIEP flap, SIEA flap and TUG (inner thigh) flap.
Dr. Horton has published review book chapters on breast reconstruction. She presents clinical papers at national and international scientific meetings and has won research awards.
About the Program
Our speaker will give a brief presentation, followed by a question-and-answer period. To participate, you need only a telephone or computer with Adobe Flash Player or Windows Media Player. Social workers may be eligible to receive continuing education credits; see our registration form for more details.

breast reconstruction and implants

I saw a patient of mine who had had 9 implant replacement procedures at another hospital who continued to have discomfort from the implant. I usually tell patients that Implant based reconstruction, while it certainly offers potentially a quicker upfront recovery potentially, may involve several implant exchanges or revision procedures in the future related to the implant (deflation, shift in position, visible surface asymmetries on the skin that are seen). On the other hand, breast implants for reconstruction can be the best option for other patients, depending on their history and physical examination.

Chemotherapy and timing of breast reconstructive surgery

As with a number of patients, chemotherapy can be a necessary part of the treatment process, as well as hormonal therapy. Usually, at the conclusion of chemotherapy, if one is in the process of breast reconstruction, we usually will wait at least one month for any staged procedure as part of breast reconstruction... The one month timing is for the body and immune system to recover... a patient's blood count may also be checked during that timeframe to make sure that things are getting back to normal

The Final Stage: Nipples and Tattoos

I was very pleased to be invited by Dr. Lin to occasionally contribute to this blog. I have been an oncology social worker at BIDMC for more than thirty years and work primarily with women who have breast cancer. In addition to my professional interest, I have a strong personal one as I have been diagnosed and treated for two primary (unrelated) breast cancers, once in 1993 and once in 2005. I write a daily blog for BIDMC called Living with Breast Cancer; there is a link to it on the right side of this blog. To tempt you to read more of my musings, I am sharing here a recent entry about Nipples and Tattoos (that title ususally is an attention-grabber):

Breast reconstruction is always a hot topic, and women sometimes wonder about the value of the final phase: nipple reconstruction and tattooing.
A woman in one of my hospital-based groups recently asked others on our Listserv about their experiences. It occurs to me that others may find these comments helpful. I am, therefore, attaching some of the letters that she received in response to her questions.
If you have anything to add about your own reconstruction and decisions, I would love to hear from you. Just click on "comments" and share your thoughts.
My experience with tattoo/nipple recon was mixed. the nipple reconstruction does indeed protrude slightly, but this is not a problem since the saline pouch is a little smaller than the original and thus a small falsie covers the deficiency. As for the tattoo, Erickson did a fair job after I advised him on how to mix the colours. It is, by the way, not entirely painless even with novocaine. The ink fades slowly so the tattoo has to be darker than you might expect at first. In short, my view now is that had I had a double mastectomy and recons, the whole nipple and tattoo process would have been worthwhile; if I had it to do again, I wouldn't bother.
I had nipple reconstruction and a tattoo. The nipple was initially a little "pronounced" but it flattened. I requested a pale tattoo which faded to the point where it is almost not visible now. Dr.X trained with the doctor who did my reconstruction so I think you need not worry about the nipple if he does it even though he did not do any of my surgery. Dr. X did my tattoo. I would follow his advice about color. I did not and as I said, it has faded a lot.
My name is XXXX I had the nipple reconstruction. I was hoping for the most realistic version possible. So I wanted them to stick out like my previous ones did. My reconstructed nipples stick out but not very much nothing like the real ones. They look fine it's just for me when I look at them I think OK reconstructed. Also my tattoos faded very quickly. I had been told they would but I thought it would take a long time. Not so very much lightened to the point of needing to be redone even before the first year was up. I just had my 1 year follow up with the plastic surgeon and she thought they needed to be redone as well. I hope this helps,
I'm not really qualified to answer, as have only had lumpectomy. But I did some reading when I accompanied a friend to her nipple tattooing, though I'm hardly an expert.
If using a non-medical tattoo artist, please make sure that he/she follows the Mass. Dept. of Public Health model regulations for "body art" (attached), and uses sterile inks/needles. There is always a risk of infection/lymphedema in the affected breast. If the breast has been radiated, tattooing would be an increased risk due to the nature of radiated skin. My friend's tattoo was done by her surgeon's nurse. The only problem was that the choice of colors for the nipple tattoo was somewhat limited (sort of like choosing grout colors for tile) — there are only a few shades for each skin tone. Although the nurse did make "dots" with the tattoo needle, instead of a solid line, which would have been more unnatural, we couldn't get a close enough color match to her other nipple. We were told that tattoo inks do fade over time, though.
She did have her nipple reconstructed, and it does stick out a little bit, but it looks quite natural- perhaps your surgeon has photos of his work? One more thing -- I did have a "Nipple Party" for my friend, to commemorate the completion of her reconstruction. We thought it was a nice idea.
I can't be a LOT of help, but I did have nipple reconstruction. The nipples stuck out for a few months + or -, but soon became basically flat and almost completely unnoticeable. There is perhaps the slightest outline of a nipple in the very thinnest nighty. For the most part I wear stretch camisoles (with an inside elastic 'bra') now that I don't really need a bra - and the nipples can't be seen through these at all. I believe, however, there are several ways to reconstruct the nipple, so suggest you find out which version your surgeon suggests/does.
I have to say that getting nipples (which originally I wasn't going to do as I was out of energy & wanting the nighmare to be over) turned out to be a huge emotional boost to me. Having the 'details' gave my new 'breasts' personality. A glance in the bathroom mirror reflected an image that looked very natural. With a bilateral mastectomy, 'matching' a 'real' breast wasn't an issue.
My tattoos (almost 3 years now) have faded (the pink/brown colors don't have the lasting power of red/blue & my doc doesn't like to make them too dark), so I am considering having a touch up. Be really, really clear with your surgeon how big you want the aeroli to be...its not possible to make them smaller once tattooed.
I have had a nipple reconstruction and then a couple years later I had it tattooed by the PA that assists the surgeon that did my TRAM flap. My reconstructed nipple does stick out some but it is softer and is not nearly as noticeable in clothes as my natural one is. So, I have often gotten more padded bras to conceal my natural nipple whereas it is not an issue for my reconstructed one..
I also eventually did get my tattoo, just last September, a little more than two years after my surgery, and think that for me, because I had the nipple reconstructed, it looks more natural than it would than if I hadn't done it because the tattoo is more uniform in color than my natural one. For my natural one the nipple is darker than the areola. I've been tempted to go back for a little "touch up" to get a more natural effect. If the color scheme were closer to my natural nipple it might make having a reconstructed nipple less important as I think this is what makes it look more natural, out of clothes anyway. I guess I mean I think that having the coloring right might be more natural looking than having the reconstruction but don't know if going to a tattoo artist will increase the likelihood of a better tattoo outcome or not.
From what I understand there are several nipple reconstructions that may be offered; grafting from either behind the ear or the labia, the star origami -style which is done w/very little discomfort but needs the tattoo to define the color & shape, or just a tattoo, w/o depth or dimension. I had my reconstruction in '98 using a wedge of my back muscle & skin, i had the first of the origami type but didn't go back for the finish so the skin feels smooth rather than protruding and had the tattoo done last year by a tattoo artist not a plastic surgeon, she used several colors and her shading gives the illusion of depth. I like it – it is very subtle (I think). The result probably depends on the surgeon, yes?
My experience with tattoo/nipple recon was mixed. the nipple reconstruction does indeed protrude slightly, but this is not a problem since the saline pouch is a little smaller than the original and thus a small falsie covers the deficiency. As for the tattoo, Dr X did a fair job after I advised him on how to mix the colours. It is, by the way, not entirely painless even with novocaine. The ink fades slowly so the tattoo has to be darker than you might expect at first. In short, my view now is that had I had a double mastectomy and recons, the whole nipple and tattoo process would have been worthwhile; if I had it to do again, I wouldn't bother.

Is this cosmetic??

I went to see a patient on the floor today after her DIEP surgery, and she asked me, " Is this cosmetic, what I just did?" She went on to explain that her oncologist, out of town, really gave her the impression that this was not necessary.

We truly feel that this is not cosmetic surgery. Working through a breast cancer diagnosis, treatment, and mastectomy is a life changing process. The time spent on rebuilding yourself is not cosmetic, but is really meant to give you back what was taken from you. Every diagnosis and treatment regimen is individual, and although most may not know exactly what you are going through, I hope you surround yourself with those who attempt to understand it. Understanding that the process of reconstruction is worth it, is offered to make you feel whole again, with hopes that you can go through your day without being preoccupied with your diagnosis.

You are a woman with breast cancer, often a mom, wife, sister, full time working woman, who wants to lead a normal life, despite a diagnosis. Reconstruction can help you get back to feeling like you again. DO NOT let anyone tell you otherwise. Often, talking to a medical team such as our Boston DIEP group, who feels strongly about this, can give you support throughout this process. Talk to other women that have gone through this. Many of our patients feel this is most helpful.

Ultimately, surrounding yourself with people who support you, and a medical team that is behind you, will make for a more positive experience....

Choosing the type of reconstruction

I saw a patient of mine a few weeks ago who remarked, "Up until I received my diagnosis of breast cancer, I felt in control in life, able to make decisions about life, family, and work.... Now, I have been through treatment, surgery, and treatment now following surgery.... my reconstruction is the only thing I feel I have control over...."

While, indeed, issues of health often have seemingly unknown paths and future, our job as plastic and reconstructive surgeons is to first and foremost educate, in this case regarding breast reconstruction.... The consultation for breast reconstruction should be educational, and may be a process in order to provide as much information as possible about all the options... At the end of the day, the choice for reconstruction is one that everyone is one same page about.....

Tough times are meant to be shared

If you have been diagnosed with breast cancer, you do not need to tackle it alone. Many of our patients come in and say they do not want to burden family or friends , afraid they will "bring them down." "I have to be strong for my family..." However, it is in these tough times where you need to reach out. Approximately 1 in 8 woman get diagnosed with breast cancer. Chances are, someone you know has been touched by breast cancer. The only way for you to know is to reach out. Family support is priceless during tough times. This is going to be a journey for you, and you should take charge of it. Reach out to family, friends, talk to other woman through support groups, and even social work can help guide you. Your breast care or reconstructive nurse can help guide you. Don't be afraid to ask for help.

Breast reconstruction after weight loss procedure

I had one of my patients who had undergone a lap-band procedure come in after having a bilateral (two-sided) mastectomy ask me if she would be a candidate for deep inferior epigastric perforator flap reconstruction. Certainly, following significant weight loss patients can be a candidate, in order to use the excess tummy tissue for reconstruction.

In addition, it is important to know that individuals who otherwise has not had a weight loss procedure may still be candidates for breast reconstruction. Weight alone usually is not a singular factor to cause someone to be or not to be a candidate for breast reconstruction.

From mastectomy to being whole again

My nurse Maria related a story to me about a patient recently she spoke to. She told me that the patient, after having a mastectomy, passed by her mirror daily during her morning routine, and immediately following her mastectomy and the months afterwards undergoing radiation therapy and chemotherapy for breast cancer, was constantly reminded of her mastectomy by the appearance of her chest, the clothes she couldn't wear, with each time she passed by the mirror as a constant reminder.

She had her breast reconstruction, and through each stage of the reconstruction, over several months, her reminder of the mastectomy grew less and less. She finished her breast reconstruction and recovered. One day during her morning routine, she noticed that she had passed by her mirror without even noticing or stopping to think about her mastectomy and breast cancer.... and at that point she felt whole, and a complete person.

Welcome to the Beginning of a New Breast Reconstruction Blog!

Hello, and welcome to the first installment of a Breast reconstruction blog with updates, thoughts, and other views related to why breast reconstruction matters, if you have had a mastectomy or need a mastectomy.