We learned that surgical techniques and implants have improved so much—even in just the past 3–5 years—that some women who had breast reconstruction just few years earlier are opting for revision reconstruction, and they’re genuinely happier with their results.
Here’s why Dr. Squires is more optimistic than ever about the care women facing cancer and reconstruction are getting, and what the future holds.
What do women facing breast cancer need to know about reconstruction, that they may not know yet?
Dr. Squires: One of the things women tend to be surprised by is that breast reconstruction is a covered insurance benefit, by law. It’s covered for both women who’ve just had breast surgery, and for women who, for whatever reason, had breast surgery in the past and didn’t have reconstruction at the time. They don’t always know it’s an option even 15 or 20 years down the road, and their options are better now.
The spectrum of breast reconstruction is bigger than most women realize. One of the things I try to talk a lot about is lumpectomy reconstruction. The majority of women with breast cancer in this country are having lumpectomies for their breast cancer surgery, but they don’t know there are good reconstruction options for lumpectomies too—everything from filling in a divet, so they aren’t reminded that they had cancer, to making your breasts look better than before. Even a breast reduction or lift falls into that reconstruction category, in this context. Sometimes women think they want to have mastectomies, but when they hear that they could have a lumpectomy combined with a breast lift, they realize that might be a better choice for them.
I always recommend that women try to go, if they can, to a place with a dedicated breast team, with a fellowship-trained or specialized breast surgeon, who either does their own breast reconstruction or has a plastic surgeon there who does it. So women can make sure they’re getting access to and information about all their options.
Sometimes, surgeons don’t do certain kinds of reconstruction, don’t have them in their toolbox, so they might not even present them as an option.
How much have you seen technology and techniques change, just over the past five years?
Dr. Squires: The last five years have been huge. We have microsurgery for autologous (flap) reconstructions, which can allow for muscle-saving reconstructions like DIEPs (a type of flap surgery that uses your lower stomach skin and fat to reconstruct your breast.) We’ve been doing DIEPs for longer than five years, but now surgeons are doing DIEPs more aesthetically. We’re making the abdominal contour better, shaping the breast better. A lot of people are combining flaps with implants. Sometimes DIEP flaps can’t always give you the best projection alone, so it’s a nice combo.
Also, our fat grafting has gotten so much better. So sometimes if I’m doing flap reconstruction, I will fat graft my flaps to help with upper pole or central breast fullness, or help make them look more natural in matching the other side. I use fat grafting in most of my implant reconstructions too, and sometimes after lumpectomy. All of that has gotten better.
I now feel more comfortable offering women revisions, because I actually know I can do better. I feel very confident.
How have you seen nipple reconstruction evolving?
Dr. Squires: The biggest change is that many women are able to keep their nipples now with nipple-sparing mastectomies. We’ve seen major changes in the breast surgery world over recent years and most of us are really expanding the indications for nipple-sparing mastectomies. At this point, nearly 100 percent of my patients have nipple-sparing mastectomies.
We all know that we don’t have great nipple reconstruction options yet. The projection doesn’t stay very well. So for women who don’t keep their nipples, I’ve been so happy with 3D nipple tattooing. They look beautiful. I sometimes cannot get over the results.