Breast Sensation Following Mastectomy and Reconstruction
In the past decade, many women at risk for breast cancer have increasingly elected to undergo a preventative treatment known as Prophylactic Mastectomy. This simply means removing a normal breast in an effort to prevent the possibility of future disease. Prophylactic mastectomy is most commonly offered in cases where the BRCA gene is identified and sometimes offered to women who have developed cancer in the opposite breast. Interestingly, studies from MD Anderson Cancer Center do not support a survival advantage in prophylactic mastectomies in the non-BRCA population.
The idea of prophylactic mastectomy became more acceptable as reconstructive techniques of the breast improved and it became possible to create a more natural appearing and feeling breast.
A recent article in the New York Times sheds light on an important deficiency in breast reconstruction – that is the profound loss of sensation in the reconstructed breast. More importantly, many women featured in the article reported that they did not feel properly informed as to the disadvantages of breast reconstruction. For example, when advised the breast would “feel” normal, many patients understood this to mean the breast would feel normal to them. Instead, what was meant was that the breast would feel normal to the examiner – an important distinction.
No one would argue the benefits of reconstructing an attractive and natural feeling breast in the case of breast cancer. In fact, the benefits to the patient are undeniable and supported by multiple journal reviews. However, it is important to have a full understanding of the breast reconstruction process and long-term outcomes.
The important take home message in the New York Times article is that we as physicians should be better educating our patients about breast reconstruction.
Education on breast reconstruction must include a discussion of alternative techniques in breast reconstruction; complication rates associated with implant based reconstruction; the effects of adjunct treatments (chemotherapy and radiation) on the reconstructed breast; quality of life considerations including sensation of the reconstructed breast; and finally – the maintenance of a reconstructed breast over a lifetime.
With regards to sensation of the breast mound, it appears that using one’s own tissue, or autologous breast reconstruction provides the best chance for regaining sensation in the breast. The return of erogenous sensation seems unlikely regardless of reconstructive techniques.
An exciting and emerging possibility is to re-establish sensation of the newly reconstructed breast using nerve grafts and microsurgical reconstructive techniques. Advances in nerve grafting have made this a viable option although long-term results remain to be seen.
When considering breast reconstruction after mastectomy, be prepared to ask your surgeon a list of questions in an effort to understand the process and outcomes. I find it is a better experience for both the surgeon and patient to enter into a partnership based on a complete understanding of available choices and the process toward healing. The first step is to identify a Board Certified Plastic and Reconstructive Surgeon facile in several techniques of breast reconstruction. In this manner, you can be assured that the best solution matching your unique situation and goals can be formulated after an informed discussion with an expert.
Dr. Reddy is a Board Certified Plastic & Reconstructive Surgeon with additional training in Microsurgery and Breast Reconstruction. His practice is located in Atlanta, GA.