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Breast Cancer Myth Busters with Dr. Joanna Ng-Glazier

Dr. Joanna Ng-Glazier explains different breast reconstruction options after undergoing breast cancer surgery and treatment.
Breast Cancer Myth Busters with Dr. Joanna Ng-Glazier
Featuring:
Joanna Ng-Glazier, MD
Joanna Ng-Glazier, MD interests include Breast reconstruction and augmentation, skin cancer reconstruction, body contouring after weight loss and pregnancy, fat grafting, facial and cosmetic surgery, non-surgical rejuvenation, lower extremity reconstruction, migraine surgery. 


Transcription:

Alyne Ellis (Host):  When you have a mastectomy, the physical changes can feel overwhelming. The good news though, general reconstructive and aesthetic surgery. Here to tell us more about this procedure, is Dr. Joanna Ng-Glazier, a Plastic and Reconstructive Surgeon specializing in breast reconstruction and augmentation at Emerson Hospital. This is The Healthworks Here podcast from Emerson Hospital. I’m Alyne Ellis. Thanks so much Dr. Ng-Glazier for joining me today.

Joanna Ng-Glazier, MD (Guest):  Thank you. It’s a real pleasure to be here.

Host:  So, let’s start with what is breast construction?

Dr. Ng-Glazier:  Breast reconstruction is sort an umbrella term that is used to describe the creation of a breast mound or shape in a patient who has had a part, or all of their breast tissue removed as a result of breast cancer surgery. Whether or not that is a lumpectomy or a mastectomy. The goals of breast reconstruction really are to restore one or both breasts to as normal of a shape, appearance or symmetry as possible. And this usually involves having a plastic surgeon work in conjunction with both the breast surgeon and the patient to best meet their reconstructive and aesthetic goals. Reconstruction is usually performed in different stages and can either be done at the same time as the mastectomy or at a later date. And can take up to a year after your cancer surgery to complete.

Alarmingly, the majority of women who undergo breast cancer surgery, may not choose to undergo reconstruction because they are simply not aware or told that they have the option to do so. And others may not have access to a plastic surgeon. And so, the goal really for every woman who has a breast cancer diagnosis is to be aware of these options.

Host:  So, let’s deal with just breast reconstruction and I’m defining that as the larger procedure of really filling in the breast and is that necessary for all breast cancer surgery?

Dr. Ng-Glazier:  No, it is not necessary for everyone. And not everyone who has breast cancer needs a reconstruction surgery. It is certainly a highly individualized and personal choice as well as something a woman should choose to learn more about or pursue if it aligns with her personal goals, rather than to fulfill someone else’s desires or to fit a certain societal self-image. So, if a woman is relatively healthy, has a positive outlook and realistic goals for restoring her breast for body image, then it will be a good option. And it’s important to know that a reconstructed breast will never quite feel or look the same as a breast that was removed. And that it may take some time to accept this new result. Additionally, there will be scars on your breast and potentially other areas of your body, although we do try our best to hide them.

The good news is that breast reconstruction following a mastectomy whether or not that is performed on one side for cancer or on both sides prophylactically as in the case of someone who has the BRCA gene for example, is covered by most health insurance policies. And the Women’s Health and Cancer Rights Act of 1998 requires that most health plans cover post-mastectomy reconstruction. And this includes revisions and any future symmetry procedures including breast lifts, augmentations, or reductions on the nonaffected breast. And today, there are so many different options for breast reconstruction that a woman can really voice her opinion as to what she desires and she can choose what is best for her to complete what I call this journey to healing after someone has undergone the entire breast cancer diagnosis and treatment.

Host:  So, can a person get an implant at the same time as the mastectomy is done?

Dr. Ng-Glazier:  Yes, they can. So, with newer techniques, it’s been proven from a cancer perspective to be very safe and most plastic surgeons are performing direct to implant procedures which is where a permanent implant is placed at the same time as your mastectomy. And this can be either placed above or below the chest wall muscles. And sometimes, a piece of extra support matrix which is called an acellular dermal matrix or ADM will be used to provide a better outcome for you reconstructed breast.

It's important to ask your plastic surgeon whether or not you would be a good candidate for this. Typically, women who do not smoke, have smaller cup breasts, for example a size A or B without much excess overhanging skin and good skin quality after mastectomy are good candidates. It certainly decreases the amount of surgery or numbers of surgeries that you would have to undergo which is also a positive thing.

Host:  And what about for people who are afraid of implants? Are there other options that you can do instead?

Dr. Ng-Glazier:  Absolutely. So, one of the most common types of breast reconstruction in the United States is what we call implant-based reconstruction which involves placement of a balloon type tissue expander to both create a pocket or a space where the breast tissue used to be. And this allows the muscle and the skin to conform to the newly reconstructed shape as the breast heals from your cancer surgery. This expander is ultimately removed down the line in the second surgery and replaced with a permanent implant to complete the reconstruction.

It's important to know that most saline and silicon based implants in the United States have a very decent safety profile. Most of the cohesive gels that are used today in both the shell and the implant itself are form stable compared to earlier formulations from the 1990s for example. We use mostly smooth shelled implants these days which decreases your risk of BIAALCL which is a rare type of lymphoma that is associated with textured implants. That being said, some women are not comfortable having an implant in their body as there can be risks of rupture or device malposition.

And fortunately, you can choose not to have implant based reconstruction. Which can involve the use of your own tissue to recreate the breast mound. And this can range from rearrangement of the tissues after a lumpectomy which is what we call oncoplastic surgery to taking skin, muscle and tissue from another part of your body what we call flap reconstruction to using your own fat cells from another part of the body to recreate this breast and that’s what we call fat grafting. So, a lot of options other than implant based reconstruction do this and it’s important to ask your plastic surgeon what types of reconstruction are offered and what to expect including your length of stay, specific risks involved with each type of surgery and your recovery expectations.

Host:  Now let’s go into the other procedure that sometimes happens and that’s the nipple sparing mastectomy.

Dr. Ng-Glazier:  Absolutely. So, in addition to different types of reconstructive options, there are different types of mastectomies that your breast surgeon can perform. And these are all dependent on a patient’s body type, the cancer treatments they may receive including radiation and chemotherapy and factors like whether or not someone smokes as well as the mastectomy type itself. So, many breast surgeons now perform either a skin sparing mastectomy or a nipple sparing mastectomy in order to remover your breast cancer. In the first type, all the breast tissue including the nipple, what we call the nipple areolar complex is removed. In certain women, you can remove the breast tissue but safely leave the nipple intact from a cancer perspective. And this ultimately results in a better aesthetic outcome and increased levels of patient satisfaction with their reconstruction.

Nipple sparing mastectomy because it includes the entire skin envelope, and the nipple has allowed the plastic surgeon to perform certain reconstructive techniques like the direct to implant procedure that we had mentioned earlier. And this allows the patient to receive as we’d mentioned their implants at the same time as their mastectomy and minimize the number of surgeries the patient may need.

For women who undergo the other type of mastectomy, the skin sparing mastectomy, they will likely require a nipple reconstruction in the future, or many can choose to get a 3-D tattoo which are actually quite impressive and phenomenal I’ve heard.

Host:  Now what about breast reduction at the time of cancer surgery?

Dr. Ng-Glazier:  Yes. In women who are larger breasted to begin with and who experience rashes under the breast, back and shoulder pain or bra strap grooving as a result of their larger breasts, they can choose to have a reduction surgery at the same time as their cancer surgery. We can perform this either with oncoplastic techniques where the tissue is rearranged after a lumpectomy to make the breast smaller or in cases of mastectomy, we can reduce the entire skin envelope and create a smaller perkier breast so to speak. We can also perform a reduction on the unaffected side that does not have the breast cancer in order to match the reconstructed breast.

Host:  Is there anything else you’d like to tell us about all these procedures?

Dr. Ng-Glazier:  Yes, I think the underlying message is that reconstruction can be viewed as the final step of your breast cancer journey, what we call closing the loop and that there is such a large range and variety of reconstructive options that a woman can choose these days. Which is fantastic. And as a result of that, every woman who has breast cancer should have the chance to meet with a board certified plastic surgeon to learn about their options. I think for the month of October, that breast cancer reconstruction awareness is as important as breast cancer awareness itself. And ultimately, myself included, most plastic surgeons really enjoy being able to provide this type of surgery for their patients and most women who do choose reconstruction are really quite satisfied with the results down the line.

Host:  Well thank you so much Dr. Ng-Glazier, for joining us today.

Dr. Ng-Glazier:  Thank you. It’s been a great pleasure.

Host:  Dr. Joanna Ng-Glazier is a Plastic and Reconstructive Surgeon specializing in breast reconstruction and augmentation at Emerson Hospital. For more information on breast cancer visit www.emersonhospital.org/breasthealth. Thanks for listening to Emerson’s Healthworks Here podcast. This episode is part of a five part series on breast cancer. Make sure to catch the next episode by subscribing to the Healthworks Here podcast on Apple podcasts, Google podcasts, Spotify or wherever podcasts can be heard. I’m Alyne Ellis. Thanks for listening.