Eva Nedelka was already grappling with so much when she was faced with important decisions that would affect her future. Her battle with breast cancer was difficult enough, and in addition to facing that reality, she also had to contend with fears and doubts about her future. Having to undergo a double mastectomy, she also worried about losing part of her identity. “Some people might think that it’s vanity, but for me, I didn’t want to lose what makes me feel feminine. I know what makes a woman is her personality, that is who you are, but it’s my body.” After weighing her reconstruction options with her doctor, Eugene, OR plastic surgeon Kiya Movassaghi, MD, DMD, Eva decided to undergo a breast reconstruction with implants following her mastectomy to restore the form and shape of her breasts.

Eva’s story is not a unique one. According to the National Breast Cancer Foundation, 1 in 8 women will be diagnosed with breast cancer in her lifetime. A double mastectomy to remove both breasts is often performed to get rid of cancer or also to reduce breast cancer risk. Here, Brentwood, TN plastic surgeon and Communications Commissioner for The Aesthetic Society, Kye Higdon, MD discusses the latest options in breast reconstruction and how the procedure can change the lives of patients like Eva.

When should a patient start considering aesthetic plastic surgery if they are undergoing a mastectomy?

“Patients should seek consultation immediately when they are considering mastectomy for any reason. Many plastic surgeons are passionate about breast reconstruction, and a large group of them advocated to Congress in support of breast reconstruction awareness. In 2015, we helped the successful passage of the Breast Cancer Patient Education Act, which resulted in women receiving educational resources when anticipating breast cancer treatment to know their options for reconstruction by a plastic surgeon.”

What are the most common reconstruction options?

“There are many options for breast reconstruction for patients, and these can differ depending upon the type of mastectomy. For example, some patients opt to preserve breast tissue with a partial mastectomy, followed by radiation to the breast. This approach is called ‘Breast Conservation Therapy’ and can be an effective option for those appropriate from an oncologic standpoint. In another example, some women choose to have a complete or total mastectomy, which could include allowing the patient to keep their nipple, called a nipple-sparing mastectomy. In cases where the nipple cannot be kept, the patient will often need a skin-sparing mastectomy. Options for reconstruction can be with implants, with their own tissues, and in some cases a hybrid approach where an implant is used with their own tissues. Sometimes women choose not to have reconstruction at all due to personal reasons.”

What is the difference between an implant-based and a tissue-based reconstruction?

“Implant-based and tissue-based reconstruction are the two main types of breast reconstruction surgery. Implant-based reconstruction can be in one or two stages, depending on various factors such as medical conditions, implant size, tissue thickness and vascularity.

One-stage implant reconstruction is performed when the implant is placed after a mastectomy without first placing a tissue expander. Some call this approach ‘direct-to-implant reconstruction.’

Two-stage reconstruction is performed when a temporary tissue expander is placed, usually during the mastectomy, and then is expanded over time to offer the patient more control over their size and shape of reconstruction. A second surgery is typically an outpatient procedure where the ultimate implant is placed into this pocket created by the expander. Implant options include both silicone and saline implants.

Implant-based reconstruction is by far the most common method in the U.S.; however, tissue-based reconstructions have become increasingly popular, especially for patients with a history of radiation, previous scarring, problems with past implants, or those who do not want implants. Tissue-based reconstructions use the patient’s own tissues from another part of the body, such as the abdomen or thighs, to reconstruct the breasts. Both implant- and tissue-based reconstruction provide excellent options for breast cancer patients and have high satisfaction rates.”

What are the emotional and mental benefits patients have noted after a reconstruction?

“Numerous evidence-based outcome studies have shown that there is a significant emotional and mental benefit to breast cancer patients seeking breast reconstruction. Although women are certainly not defined by having or not having breasts, the breast is part of the feminine form for many people.”

What is one thing everyone considering a breast reconstruction should do?

“Seek out experienced breast oncology surgeons for your mastectomy and a board-certified plastic surgeon experienced in breast reconstruction for your reconstruction.”

Learn More

Watch Eva’s story and learn more about her experience in The Aesthetic Society’s docuseries, “Beyond the Before & After,” supported by Allergan Aesthetics, an AbbVie company.

To learn more about aesthetic procedure options and to find a surgeon near you, go to TheAestheticSociety.org