• Breast Reconstruction and Plastic Surgery Program

    Offering the highest standard of care before, during and after cancer treatment

    Not so long ago, surviving breast cancer usually meant major surgery and severe disfigurement. Surgery is still the most common treatment, but today’s methods are much more refined than in years past. And advances in plastic surgery are providing more options for reconstruction of one or both breasts.

    At Anne Arundel Medical Center, you have access to the highest standard of care, the full range of solutions available for your situation, and a team that’s committed to your needs and preferences. Your surgeons will be breast cancer specialists with advanced training and experience in surgical oncology or breast surgery. Their personal and professional commitment is to ensure you have the best possible outcome, support and care experience. Our breast surgeons and plastic surgeons work together seamlessly, and also work closely with medical oncologists, radiation oncologists and radiologists. This multidisciplinary team offers a level of collaboration that is uncommon in highly specialized care.

    Facing cancer is never easy, but we make every effort to make it easier. You can turn to us at any point in your care, from diagnosis through treatment, recovery and follow-up. We will create a plan of care designed just for you, and make sure you have the resources and support you need at every step.

    Understand your options

    Federal laws ensure your access to breast cancer care, but no current laws require your access to a plastic surgery consult. Many women are never informed of the benefits and options a specially trained plastic surgeon can offer. Those laws are likely coming, thanks to the committed efforts of the American Society of Plastic Surgeons.

    The truth is, the Women’s Health and Cancer Rights Act, passed in 1998, requires all group health plans that cover mastectomy (removal of a breast) to also cover reconstructive surgery, as well as lymphedema management, a breast prosthesis and other benefits. This coverage includes matching surgery for the other breast if needed. The WHCRA, also known as Janet’s law, is named after Janet Franquet, who was denied reconstructive surgery after a mastectomy in 1997.

    If you aren’t having a mastectomy, your surgeon will still need to make an incision (cut) on or near the breast to remove the tumor. The placement of that incision will greatly affect how your breast looks and how you feel about your breast. We’ll discuss this with you before your surgery, so we’ll know your preferences and you’ll know what to expect.

    Your first option: no reconstruction

    While we’re passionate about offering the best and safest options for breast reconstruction, we also recognize that some women may decide against it. A woman undergoing a small lumpectomy (removal of a tumor leaving the rest of the breast intact) may not benefit from reconstruction. But even a woman who chooses or needs a total mastectomy (removal of the entire breast) may not want reconstructive surgery. Rarely, a woman may be advised to avoid reconstruction for medical reasons.

    If you choose total mastectomy without reconstruction, simply living without the breast is one option. Another option is use of a breast prosthesis, which can be worn daily or as often as you choose. It’s true that this option is less costly, complicated and time-consuming than having additional surgery. Should you choose no reconstruction, our doctors can provide you with a prescription and information on where to buy a breast prosthesis, which is usually covered by insurance. Many types and materials are available, from simple inserts to realistic breast forms that can be attached with magnets and adhesive.

    Methods of reconstruction

    If you choose reconstruction, our breast and plastic surgeons will work with you to determine the best technique and timing for your situation. Our surgeons are skilled in the latest, most advanced methods, and our staff will treat you with compassion and dignity. We’ll answer any questions you have and make sure you have the resources and support you need at every stage.

    Depending on your needs and preferences, your reconstruction may involve:

    Timing of reconstruction

    The timing of your breast reconstruction will depend on your situation and preferences. One important factor is whether or not you will need radiation therapy. Radiation can damage the blood supply to normal cells as well as cancer cells. This can slow healing and increase the risk of infection and other complications after surgery.

    Immediate reconstruction

    If you’re unlikely to need radiation therapy to fight your cancer, we may offer to do reconstruction (placing an implant or tissue flap) when we do your mastectomy.

    Delayed immediate reconstruction

    If it’s unclear whether you will need radiation therapy, we may offer to place a breast tissue expander during mastectomy. If you need radiation or other treatment, the expander can remain in place until your treatment is complete, and then we will begin to expand your skin to make room for an implant or tissue flap. If you don’t need radiation treatment, we can begin expanding your skin right away.

    Delayed reconstruction

    In some cases, immediate or delayed-immediate reconstruction may not be recommended because of upcoming radiation therapy or other medical reasons. However, reconstruction may be an option in the future. This is called a “delayed reconstruction.”

    Risk factors

    Part of planning reconstructive breast surgery is considering risk factors and taking steps to reduce the risk of related complications. We’ll talk to you and gather as much information as we can about your health history. We’ll also consider whether you will need radiation therapy or other treatment. Then we can work together to ensure that you’ll have the best chance for good results and a smooth, successful recovery.

    Some common risk factors that we might need to address before your surgery include:

    • Diabetes – We’ll work with you to help you get diabetes under control. Well-controlled diabetes results in fewer and less severe surgical infections and complications.
    • Previous or future radiation to the operative area – Radiation can damage the blood supply to normal cells as well as cancer cells. This can slow healing and increase the risk of infection and other complications.
    • High blood pressure – Getting high blood pressure under control can make surgery safer and improve your health for years to come. Your anesthesiologist will monitor your blood pressure and other vital signs during surgery.
    • Connective tissue disorders such as lupus or scleroderma – It’s important to consider how these conditions can affect various organs. Your primary care provider and other doctors can inform your surgeon about the nature and severity of your condition and any steps that he or she needs to take.
    • Clotting or bleeding disorders, such as a history of deep vein thrombosis or pulmonary embolism – Your surgeon and other doctors can take steps to prevent blood clots or excessive bleeding during and after surgery.
    • Obesity and related conditions, such as obstructive sleep apnea and reflux – Your doctors will need to closely monitor your breathing and airflow during surgery and take other steps to ensure your safety.
    • Stress and anxiety – Your surgeon will introduce you to resources to help ease any stress or anxiety related to your illness and treatment.

    Complications

    Your surgical team will make sure you’re aware of any risks associated with your upcoming surgery. You’ll be instructed not to eat or drink anything after midnight the night before your surgery. This important precaution is to prevent you from vomiting while you are unconscious, which could cause you to choke or cause breathing problems.

    Besides the risks of general anesthesia, the basic risks of surgery include (but are not limited to):

    • Bleeding
    • Infection
    • Healing problems and wounds
    • Pain
    • Scars (both normal and enlarged)
    • Asymmetry
    • The need for revisions
    • Total or partial failure of flaps and grafts
    • Unsatisfactory cosmetic results

    Your doctors will talk to you about any risks or possible complications specific to your case. No surgeon or other doctor can predict or prevent all complications. But we make every effort to avoid them, identify them and treat them promptly and effectively.

    Keep in mind...

    • In almost all cases, there are reasonable, safe and elegant ways to rebuild or repair your breasts after breast cancer treatment.
    • Whatever your needs, we’ll talk to you about all your options for reconstruction.
    • Medicare and insurance covers mastectomies, matching procedures, revisions and complications.
    • We will work seamlessly with you to change your reconstructive plan if your situation changes.