Breast reconstruction proves vital part of recovery after cancer

With breast cancer, we often think about new medical therapies to beat the disease, but many women face a more private and emotional battle to cope with what they've lost—their breasts.

Two Raleigh women, though, found that breast reconstruction surgery was a vital part of their recovery.

After the shock of a breast cancer diagnosis, Lisa Joyner and Mary Broughton both knew they had to fight it with everything they had.

For both women, long-term survival meant a mastectomy—surgical removal of the affected breast—plus the personal choice to reduce their future cancer risk by removing the healthy breast as well.

"But it was so hard," Joyner said. "It was extremely tough going into that decision. I remember feeling like it was stripping me of everything that made me feel like a woman."

Broughton felt the same way.

"You know, a woman losing her major parts that make her feminine," she said. "It's devastating."

Last December, 48-year-old Broughton learned the tumor in her left breast was caught early; it had not spread.

Her oncologist said even with chemotherapy and surgery to remove the tumor, or the entire left breast, the risk of recurrence was high.

The decision for a double mastectomy was an easy one due to her 13-year-old son Owen.

"I really wanted to have that opportunity to watch him graduate from high school and college," Broughton said. "I want to be there for him.”

Plastic surgeon Dr. Glenn Lyle met with Broughton and her cancer surgeon before her surgery to plan breast reconstruction immediately after the mastectomy.

"The first step is placement of a temporary implant called a tissue expander," Lyle said.

The expander is placed under the chest muscle, which gives the above layer of skin time to recover.

"That implant can then be stretched out, slowly, over time—over the, say, next four to six weeks," Lyle said.

By June, Broughton had finished chemotherapy and looked forward to the end of October when she would go back into surgery to have permanent implants put in.

Joyner, 49, along with her husband Oscar, faced the same decisions four years ago, but she wasn't as quick to choose reconstruction after the double mastectomy.

She waited six weeks before getting the breast expanders and later the implants and nipple procedures.

"I think most studies show that most women feel better about their reconstruction with having nipple reconstruction performed," said plastic surgeon Dr. Rhett High, who was Joyner's surgeon.

Getting permanent implants was the day Broughton had been waiting for.

"This is the finishing line for me," she said.

Lyle marked her chest where he would create incisions to remove the expanders and replace them with implants.

"It's usually not nearly as much discomfort as the first operation," Lyle said. "It's usually much, much easier than the mastectomy."

It's an outpatient procedure with a recommended week off from work.

Lyle says most insurance didn't cover the costs until 1998. Now, though, insurance companies have to provide the coverage.

"(Insurance companies) are mandated by law to cover reconstruction, including further reconstruction, creating nipples, doing a tattoo to give the resemblance of an outer areola," Lyle said.

More than a week later, Broughton still had drainage tubes and faces nipple procedures, but she was pleased with the results.

"I like the proportion, the size, what it makes me look like in clothes," she said. "So I'm on the road to completeness."

The promise of reconstructive surgery gave Broughton hope, but Joyner first doubted whether reconstruction could cover the scars—both physical and emotional—of mastectomy.

"I wish I had known then what I know now," Joyner said. "And what I know now is scars do heal."

There was a time when silicon gel implants were taken off the market due to manufacturing problems, such as leaking. Now, both Lyle and Raleigh Plastic Surgery say silicone gel implants are high quality and much safer.

Most women choose the silicone gel variety, but some women still get the saline filled implants.

Lyle says 10 to 20 percent of implants have a leak by the 10 year mark, so an occasional MRI exam is recommended. He says it's a fairly simple procedure to replace the implant.