Each year, 4000 to 5000 new breast cancer patients are diagnosed in Israel, and many need a full or partial mastectomy. This process can cause physical and emotional distress, and to ease the process, women are offered breast reconstruction after surgery.
Dr. Madah Ihab, a senior physician in the plastic surgery department at Tel Aviv Sourasky Medical Center was a guest on the "Expert Clinic" podcast to explain exactly what breast reconstruction is, how it's performed and for whom it's recommended.
Ihab stated that breast reconstruction is a stark term. In reality, it's about several processes that enable doctors to rebuild a breast. He said that after a partial mastectomy, it's the doctors' responsibility to think about building a breast similar to the other side, and in the case of a double mastectomy, developing new breasts to make a woman feel as good as possible.
He further emphasized that "mastectomy is a dirty word," and it's not terminology used today. Instead, it's called an excision that preserves the skin of the breast. Ihab explained that the surgeon empties the breast tissue from the inside and the reconstruction is done with the remaining skin envelope.The question of how much should be removed from the breast in the case of a cancerous tumor is complex, and according to Ihab the medical teams do everything in their power to remove as little as possible.
Ihab said that in modern medicine there are many tools that help the entire team know exactly how much of the breast needs to be removed, and they try to cut out as little as possible. Ihab added that if they succeed in performing only a partial resection of the breast tissue, it can be filled in several ways.
If the incision is small and the skin is preserved, it's possible to do an operation similar to a breast lift, which will give an aesthetic result similar to a breast lift, and then a lift can be done on the healthy breast.
Ihab added that it is difficult to achieve the feeling of a natural breast. He said that if the breast is emptied from the inside, the sensation in the nipple won't return, but in the case of an oncoplasty – a breast lift – there's a good chance that the sensation will return.
When to perform reconstructive surgery?
Another question that worries women is whether to perform the reconstruction in the same operation as the excision, or if it's better to recover completely first. Ihab said that each case is individual. There are cases with an option for immediate reconstruction during surgery to remove diseased tissue, yet in some cases the decision is more complex.
The woman has to decide if she's interested, and age also plays a role. From a medical point of view, there's also a question of whether radiation is necessary or not, and whether skin is to be cut or not. So in some cases, even if the woman wants, postponing restoration is necessary.
Ihab stated that as a doctor, he must explain all the options so women can choose the most comfortable direction. Ihab is in favor of saving patients more and more surgery and they always prefer doing fewer procedures. Yet he always says to new patients, "Welcome to the breast reconstruction clinic, we'll meet a lot," because in many cases after the immediate restoration, another small correction or injection of fat is needed to achieve the perfect aesthetic result.
But it does help a woman come out of the surgery feeling that she hasn't lost her breasts, and this feeling is very important.
Ihab is personally connected with breast reconstruction procedures because he knows when a patient enters the operating room with cancer, when she leaves she often asks if everything went well.
This shows how important the feeling of having a breast is for women. Ihab added that self-confidence is very important. When the patient is happy and excited that she still has breasts, it's more crucial than if they're similar to what they were before, because it gives a satisfying sense of body image.
He added that in terms of the resemblance to the original breast(s), with modern medicine it's possible to get beautiful results and over time the patient will feel that it's hers.