The American Cancer Society estimates about 287,850 new cases of breast cancer will be diagnosed in women in 2022. That means women in the United States currently have a one in eight chance of being diagnosed with breast cancer.
In the face of a breast cancer diagnosis, most patients’ thoughts are a flurry of concerns about survival rates, treatments, appearance, and the overall impact on their life and loved ones.
It’s a conversation that Dr. John Hijjawi, Intermountain Healthcare plastic and reconstructive surgeon, has on a regular basis with patients.
“Whenever I see a cancer patient, I start with emphasizing the fact that the most important thing is dealing with the cancer,” Dr. Hijjawi said. “After that, I tell them, we can talk about the reconstruction side.”
Although there are many breast cancer patients who have no interest in reconstructive surgery, Dr. Hijjawi said there are studies that show that for a significant percentage of women, having some sort of breast reconstruction is very beneficial to them emotionally.
“Some women’s identity is closely linked to their body,” Dr. Hijjawi said. “Some studies even suggest that if a patient can have the reconstruction done at the same time as the mastectomy, it really helps them.”
For Dr. Hijjawi, the most important thing is to educate patients about their options so they can make the decision that is best for them.
“Not all women know that reconstructive surgery is an option, and, if they do know about it, they may not know what their options are,” Dr. Hijjawi said. “I think it is also important for them to know that all health insurance companies are required to cover reconstruction associated with breast cancer.”
The conversation usually starts with the general surgeon who performs the cancer surgery, but Dr. Hijjawi said it is important to know the options even before the cancer removal surgery because there are often cases where the reconstruction can take place at the same time.
“Not every woman is a candidate for every option, but if you discuss it early you can make sure you don’t remove certain options before considering them,” Dr. Hijjawi said.
Options for breast reconstruction
In general, there are three possibilities for breast cancer reconstruction.
- Implant only
- Autologous reconstruction, which uses the patient’s own tissue rather than an implant. Typically taken from the abdomen or back.
- Implant, combined with using your own body tissue
“There are pros and cons to all and the options available are based on a variety of factors,” Dr. Hijjawi said. “I think there can be as much variety in the decisions patients make as there are individuals making them.”
What is Microvascular Breast Reconstruction?
Microvascular breast reconstruction uses the DIEP (deep inferior epigastric perforator) method to restore the breast using a patient’s skin and fatty tissue. DIEP only takes the skin, fat, blood vessels, and sensory nerves.
“This living tissue reconstruction done at Intermountain facilities , leaves the muscle,” said Dr. Hijjawi. “With these DIEP or DIEP Flaps, abdominal wall complication rates drops down from 0 to 3 percent. So, it’s a huge winner with our patients.”
Microvascular breast reconstruction is offered by plastic surgeons at Intermountain Medical Center, Intermountain McKay Dee, Intermountain LDS and coming soon to Intermountain St. George Regional Hospital.
Teamwork
Oncoplastic surgery combines cancer removal and breast reduction techniques. When performing the microvascular surgeries, the general surgeon and plastic surgeon physicians work together to anticipate problems and treat them before they happen.
During surgery two surgeons will work under individual microscopes, reconstructing both sides at the same time, completing the intricate surgery connecting blood vessels and sensory nerves.
Regardless of the kind of surgery someone chooses, or even their reasons for surgery, Dr. Hijjawi said his approach is simply to take the best care of each patient individually and help them make the best decision for themselves as possible.
“Our goal is to try to find the treatment that fits the patient and not make the patient fit the treatment,” said Dr. Hijjawi. “Patients deserve options”
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