"What really has me excited about performing breast reconstruction for Houston women is that we have a variety of techniques at our disposal," says Dr. Camille Cash. "We now have several different surgical approaches we can use, and the ultimate result is a much more natural looking breast."
"We also understand the importance of breast reconstruction in restoring a woman's femininity, sensuality and, in fact, her very identity," Dr. Cash continues. "As more women triumph over breast cancer, the focus shifts from merely surviving to moving forward. It's not just about 'removing,' it's also about 'restoring.'"
Breast Reconstruction from Dr. Cash
One way things have changed recently, according to Dr. Cash, is that many more breast reconstructions are done at the same time as the mastectomy. Dr. Cash works closely with a number of skilled breast surgeons, and she is especially proud to be part of an all-woman breast surgery team. The only African American female board-certified Houston plastic surgeon, she stands alongside her colleague, Elizabeth Bonefas, M.D., the mastectomy surgeon, ready to go when it's time. "She takes it away (the cancer), I give it back (a breast)," says Dr. Cash. The patient benefits by having an understanding team to safeguard both their health and body image all in one surgery.
Patients who are candidates for this approach are grateful they can avoid the deformity that mastectomy produces, Dr. Cash notes. But she also works with many patients who have gone years without a breast. "When these women wake up from surgery, their femininity has been restored and they feel whole again."
Candidates for Breast Reconstruction
Most women who need a mastectomy are candidates for breast reconstruction. The best candidates are those whose prognosis suggests that a mastectomy should successfully eliminate their cancer completely.
If you're a mastectomy patient considering reconstruction, it's important to have realistic expectations for your new breast. It won't look exactly like your natural breast, but it will help you feel balanced and whole again.
Dr. Cash suggests you begin discussing reconstruction right away with your breast surgeon and your oncologist. Not only is it possible to have reconstruction at the same time as your cancer surgery, but you may begin treatment with a more positive outlook if you know that reconstruction is available. You will recover from the diagnosis and treatment of breast cancer surgery looking and feeling less traumatized.
She also encourages breast cancer patients to request a consultation with her as they prepare for their mastectomy. She can help you understand your options and plan.
The Breast Reconstruction Procedure and Recovery
Dr. Cash works with each breast reconstruction patient in a highly-individualized way. The procedure is much more complex than other breast surgeries, and no two patients are alike.
There are many factors to consider when planning breast reconstruction. One is whether it is safe for you to have a reconstruction at the same time as your mastectomy or not. Dr. Cash and your mastectomy surgeon will guide you in this decision. Also it is important to determine what type of breast reconstruction is right for you. Often breast reconstruction requires more that one procedure and you want to make sure that you are very comfortable with your plastic surgeon.
Women who are candidates for having breast reconstruction at the same time as their mastectomy awaken from the combination procedure with a new breast. Sometimes this one-step approach involves replacing the removed breast tissue with a silicone or saline implant. This approach is very uncommon because often the skin of the chest is too fragile immediately after a mastectomy to safely place an adequate size implant.
More often a tissue expander or temporary breast implant is placed at the time of surgery and is partially inflated at the time of the mastectomy. The expander is gradually inflated with saline solution by Dr. Cash during routine post-operative visits. This allows the skin to be gently stretched after it has recovered from the mastectomy. In a second procedure, the expander is removed and replaced with either a saline or silicone gel implant.
Breast reconstruction can also be performed using a patient's own tissue.
In a latissimus dorsi flap reconstruction, Dr. Cash uses the skin and muscle from your back and rotates this tissue to your chest to recreate your breast. An implant is commonly placed beneath this flap to provide additional volume.
The TRAM (transverse rectus abdominis myocutaneous) flap reconstruction uses the skin, fat and muscle from your lower abdomen to reconstruct the breast. Ideal candidates will not require an implant to achieve their desired result.
Breast reconstruction surgery is performed under general anesthesia. Procedure and recovery time vary depending on many factors, most notably the type of approach used to rebuild the breast. Some patients also elect to have a breast lift, breast reduction or even a breast augmentation on the non-affected breast to bring both sides into proportion with each other.
Dr. Cash knows you will have many questions about your breast reconstruction options. You'll appreciate the time she'll spend with you during your consultation and her assistance in deciding what's right for you.
How much pain can I expect during recovery?
Breast reconstruction is generally more involved than other forms of breast surgery, so you can expect some discomfort for a few days or even a few weeks after your procedure. Most patients are able to manage their post operative pain with medication.
At the time of surgery, Dr. Cash will also place an implanted pain pump that will bathe the surgical site with a local anesthetic. These pain pumps greatly reduce the amount of post-operative pain and reduce your need for oral pain medication.
What is recovery time like?
Recovery time varies. If you have a combined mastectomy-reconstruction, it may take a few weeks or even months for you to feel back to normal. Recovery time for each stage of a two-step reconstruction is often somewhat shorter.
What about reconstructing my nipple?
Reconstructing a nipple and areola usually involves another surgical procedure after breast reconstruction. The nipple reconstruction will be performed with the skin and tissue of the newly reconstructed breast. This surgery is less invasive than the reconstruction itself. A new areola can be created with the use of medical grade tattoo.
Do I have to have my nipple and areola reconstructed?
Nipple/areola reconstruction is not a must, but Dr. Cash finds that patients have a much higher level of satisfaction with their breast reconstruction once a nipple and areola are created.
What are the advantages and disadvantages of the flap approach?
Women who decide to have a flap procedure often feel that their new breast tissue feels much like their other, natural breast. And for some, there's the added comfort of not having an implant inside their body. On the other hand, the flap approach leaves more scars on the body and generally involves a more difficult recovery than surgery with an implant.
Dr. Cash finds her relationships with women seeking breast reconstruction an extremely rewarding aspect of her practice. In fact, she is committed to carrying the messages of hope and renewal to the underserved minority community as part of her role on the board of directors of Sisters Network, Inc.
Dr. Cash invites you to request a consultation for a personal, private plastic surgery appointment. Or, you can call (713) 571-0600 to schedule a visit with us.