Rebuilding After Breast Cancer
Date: February 3, 2014
When healing takes shape
When Nikki Jones, a 38-year-old lawyer in Washington, D.C., first heard her diagnosis—breast cancer—she only had one thought: get it out. But then she started to worry about the breasts she would be left with. What would they look like? How would they feel?
These are common concerns for women trying to wrap their heads around an already difficult diagnosis, says Troy Pittman, M.D., a surgeon in the Department of Plastic and Reconstructive Surgery at Johns Hopkins Bayview Medical Center. “Many women are afraid that they will feel less than whole, or that they will only be comfortable being intimate with their partners in the dark,” he says.
Luckily, these women have options. Plastic surgery is so much more than cosmetic surgery, says Dr. Pittman. In fact, the majority of plastic surgery procedures at Johns Hopkins Bayview are reconstructive, including breast reconstruction after cancer surgery, body-contouring procedures after bariatric surgery or other major weight loss, reconstruction after skin cancer, or post-traumatic reconstruction. “We are able to close the loop on disease and give patients back what was taken away,” says Dr. Pittman.
What many women don’t realize is that federal and state laws require insurance companies that offer coverage for mastectomy services to also cover the cost of breast reconstruction after removal of a patient’s breast tissue. This includes any surgery required on the opposite breast for symmetry, whether it be breast augmentation or reduction.
A Unique Approach
After her cancer diagnosis, Jones did plenty of research. She decided to come to the Johns Hopkins Breast Center based on what she found. “It’s the best treatment center for breast cancer in the region,” she says. Still, for years Jones had been using another major health system for all of her health care needs, and she was nervous about making the switch.
Her appointment in August helped alleviate all of those fears. First, Jones met with Mehran Habibi, M.D., director of the Johns Hopkins Breast Center, who walked her through her treatment options. They determined that a lumpectomy (a procedure to remove the tumor), followed by chemotherapy and radiation treatment, would be the best approach for her. Then Dr. Habibi picked up the phone and called Dr. Pittman, who was able to meet with Jones just a couple of hours later to discuss her breast reconstruction options.
That’s one of the things that makes the Johns Hopkins Breast Center unique: a multispecialty team of providers—surgeons, radiologists, medical and radiation oncologists, plastic surgeons and patient navigators—works collaboratively under one roof to analyze patient cases and create treatment plans. “We are literally in the operating room together,” says Dr. Pittman. “It’s a very unique approach.”
The team behind Jones’s care brought her peace of mind. “It was comforting to know that Dr. Habibi and Dr. Pittman were in constant contact,” she says.
Jones talked to Dr. Pittman about her biggest concerns surrounding her lumpectomy: scarring and loss of sensation to her nipples. The tumor was large, and removing it would leave a noticeable indentation in her breast. “He explained all of my options, but left the decision up to me,” says Jones.
After careful consideration, Jones opted to have her lumpectomy and her reconstruction about a week apart in September. Although they can be handled as a single procedure, Jones wanted to wait for the biopsy of her lumpectomy to come back clear—indicating that Dr. Habibi had been able to remove all cancerous cells from her breast—before undergoing her reconstruction. Dr. Pittman remained an important part of her initial lumpectomy, though. The day before surgery, he mapped out incision lines so that Dr. Habibi could remove the tumor in the most minimally invasive way possible, with the ultimate reconstructive plan in mind. Dr. Pittman also was in the operating room during the lumpectomy to offer guidance.
Because Jones had large breasts, she and Dr. Pittman decided to perform a breast reduction on the opposite breast along with the reconstruction, and were able to use her own tissue to fill the indentation left by the lumpectomy, in a procedure known as oncoplastic surgery.
Understanding Your Choices
“Reconstruction of a breast that has been removed due to cancer or other disease is one of the most rewarding surgical procedures I perform,” says Dr. Pittman. “New surgical techniques and devices have made it possible for plastic surgeons to create a breast close in form and appearance to a natural breast.”
Women who undergo a mastectomy (complete removal of the breast) or a lumpectomy (removal of the tumor) have a number of reconstructive options. They may choose to use a silicone or saline implant to restore their feminine form. These devices, which have been deemed completely safe by numerous studies, are able to offer a much more natural look and feel than they did in years past. Women also may choose autologous reconstruction, meaning that the patient’s own tissue, not an implant, is used to rebuild the breast. Both options have advantages and disadvantages, which plastic surgeons like Dr. Pittman carefully review with each patient. In an autologous reconstruction, tissue can be used from the back, abdomen, thighs or buttocks. Many women opt to use tissue from the abdomen because they like the added “tummy tuck” benefit it provides. Others choose to couple a breast reduction with the reconstruction, as Jones did.
Living with Confidence
Since her reconstruction, Jones has been able to return to all the things she loves, and more. The cancer diagnosis has inspired her to live a healthier lifestyle; she met with a nutritionist and is exercising more. “Exercising is so much easier now than it was before my reconstruction,” she says. “It’s been wonderful.”
And Jones doesn’t even have visible scars to serve as a daily reminder of her cancer battle. “Dr. Pittman was able to keep all of the incision marks under my breasts. Even now, they are almost gone,” she says.
Jones isn’t finished her journey—she is now undergoing chemotherapy—but it hasn’t stopped her from enjoying life each and every day. She returned to practicing law in October. On weekends, she and her spouse enjoy going to local music shows, watching college football, spending time with friends, or going for a motorcycle ride. “My breast cancer diagnosis was just a blip on the radar for me,” says Jones. “I’m going to keep living my life.”
Body Contouring After Weight-Loss Surgery
Patients who have successfully lost a substantial amount of weight, especially after bariatric surgery, are often frustrated to find that their new, smaller clothes don’t fit the way they’d like due to excess skin. Body contouring surgery can be the final step in helping them to achieve their goal.
“An ideal candidate for body contouring is someone who is motivated, has good nutrition, doesn’t smoke, and has reached a plateau in their weight loss,” says Dr. Pittman. Body contouring improves the shape and tone of tissue that supports fat and skin, and removes excess sagging from areas of fat loss.
Body contouring has a very high patient satisfaction rate, says Dr. Pittman. Patients find that after surgery they are able to exercise more freely and buy flattering clothes right off the rack. “It’s often the final push they need to become even healthier,” he says. In fact, Dr. Pittman is interested in researching the long-term effects that body contouring has on control of weight and management of chronic illness.
To schedule an appointment with the Department of Plastic and Reconstructive Surgery, call 443-997-9466.
To schedule an appointment with the Johns Hopkins Breast Center, call 410-550-8282.