Understanding the Maze of Breast Reconstruction


By Jeanni Brosius

It can be overwhelming to hear the word “cancer” coming from your doctor. When Misty Brown of Cabot was diagnosed with breast cancer in 2014 at the age of 29, she knew there were many things to consider.


“When I was diagnosed with Stage III Infiltrating Ductal Carcinoma in July 2014, my doctor and I decided to do neoadjuvant chemotherapy before surgery in February 2015,” Brown said. “This gave me the confidence that the chemotherapy was effective, because the tumors were shrinking as the treatments progressed. Since the breast cancer was in two quadrants, and I carry the BRCA1 gene, I wasn’t eligible for a lumpectomy and decided on a double skin-sparing mastectomy to decrease my chances of a recurrence.”

The BRCA1 and BRCA2 genes are named using the “BR” in breast and the “CA” in cancer, because the mutation of these genes are most commonly associated with breast cancer.

“These genes put women at a higher risk factor for breast cancer,” said Dr. Michael Spann, reconstructive surgeon at Little Rock Plastic Surgery. “I always tell sisters and daughters of women who have been diagnosed with breast cancer to get checked…. It’s better to know than to ignore.”

Because there are many available options, and the information could be overwhelming and take time to process, Spann recommends that patients bring someone with them to each visit to assist them through the journey.


“I’m the guy you want to see when the cancer is gone; our role is reconstruction, and we never want to interfere with the recovery,” Spann said. “If you need radiation, we prefer you wait for reconstruction, but chemo doesn’t affect [the reconstruction surgery].”

The first priority is treating the cancer, but there are some decisions about reconstruction that should be made soon after diagnosis. Some women decide against reconstructive surgery, and others have options on the type of reconstruction.

“Many times women aren’t given many choices when it comes to treatments, but they have choices when it comes to reconstruction, and that puts them in a position of power and gives them choices,” Spann said.

Spann said the most common reconstruction surgical procedure combines skin expansion with implants. After the mastectomy, the plastic surgeon steps in and inserts a balloon expander beneath the skin and chest muscle to stretch the skin.

Another procedure is more complicated and uses a skin flap, utilizing tissue from another part of the body – usually the back, abdomen or buttocks.

Both surgeries are followed by a final procedure that reconstructs the nipple and areola.

Brown said when she met with her plastic surgeon, he showed her several photos of women who were in various stages of reconstruction. She said this gave her a better understanding of the process and enabled her to make informed decisions.

“I think seeing photos of a surgeon’s work is important, so you understand the changes your body will go through as reconstruction progresses,” Brown said.


“Another thing I had to consider was whether or not I’d have enough sick leave to cover an extended recovery period,” Brown said. “I also had to make sure I had someone available to help me with daily activities while I recovered. I had to modify my home a few ways to make life easier, including buying a couch with a recliner in it and replacing the shower head with one that had a detachable head with a hose.”

According to the American Cancer Society’s website, you should be up and around in about six to eight weeks. If implants are used without flaps, your recovery time may be shorter. Some things to keep in mind:

• Reconstruction does not restore normal feeling to your breast, but some feeling may return over a period of years.

• It may take up to about eight weeks for bruising and swelling to go away. Try to be patient as you wait to see the final result.

• It may take as long as one to two years for tissues to heal and scars to fade, but the scars never go away completely.

Psychological Consequences

Women who go through breast cancer treatment, mastectomies and reconstruction often go through an emotional period. Other women who have gone through the reconstruction process are always helpful, and talking with a mental health professional may also be beneficial during the adjustment.

“At the end of the day, their breasts will never be the same, but it doesn’t change who they are,” Spann said. “It affects some women, because they’re afraid of what their husbands will think. I encourage the husbands to know that this does not take away from who she is as a woman.”

Carey Markum of Cave City survived breast cancer twice, and the second time opted for a mastectomy and reconstruction. She said post-reconstruction is difficult at first, because the shape and size are different.

“Some women are very concerned about not having nipples,” she said. “I’ve been married for 20 years, and since my surgery, my husband has not seen me without a bra on but a handful of times, and that was by accident.”

Markum suggests not focusing on that part of the process; however, she said a husband or boyfriend plays a huge role in how a woman feels.

“I didn’t realize how much it has affected me … that’s probably why I haven’t noticed it, because [my husband] is so supportive.”

Brown said it was difficult to look at her scars in the mirror or to be confident during intimate moments.

“I thought my breasts were a part of what defined me as a woman and losing them was emotionally challenging for me,” she said. “But I learned to change my attitude and saw my scars as battle wounds and proof that I became a warrior in my fight against breast cancer.

“I still fear changing in the locker room at my gym and the stares I might get from other women who may not understand, but I am always open to educating others about breast cancer.”


Markum and Brown both suggest that women do research and ask many questions.

“Make sure you do your research on the doctor who is doing your procedure,” Markum said. “This can make a huge difference in the end results.”

When visiting a plastic surgeon, Brown suggests asking about the pros and cons of each method as it relates to your body type and your treatment plan.

“Don’t rush the reconstruction process, especially if you have complications,” Brown said. “You can always get a prescription for prosthetics that will give you the projection you need to fill out your clothes like you once did if you delay reconstruction or decide against it entirely.

“The most important thing is beating the cancer, so always make that a priority,” she continued. “If you feel like you need a second opinion, get one. Some women have the ‘go big or go home’ attitude when it comes to reconstruction and later find that they don’t like the outcome. Be realistic about the size of your reconstructed breasts, especially as they compare to your pre-cancer size.”

Span and both women also stress that having a good support system at home and making adjustments to your surroundings will speed up the recovery process.

To learn more about breast reconstruction, visit platicsurgery.org.



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