Breast reconstruction surgery: In which cases surgeons prefer not to do it?

Sometimes as part of breast cancer treatment mastectomy is performed to remove the tissues affected by cancer. This surgery followed by a loss of a breast of breasts can lead to serious psychological problems in women, but now many of those problems can be overcome thanks to another surgery called breast reconstruction, which can help reconstruct the shape and the appearance of the breast.

According to Dr. Raffi Gurunluoglu, plastic surgeon from Cleveland Clinic, usually, breast reconstruction takes place during or soon after mastectomy.

There are different types of breast reconstruction. During reconstruction, a plastic surgeon can create a breast shape using an artificial implant, a flap of tissue from another place on your body (it’s called autologous reconstruction), or both.

Breast reconstruction is thought to be a rather safe procedure, and, according to research, it doesn’t raise the risk of recurrence of breast cancer. But there are cases when surgeons prefer not to perform this surgery:

• If the patient has advanced breast cancer with metastases. Such patients usually have other, more urgent things to deal with. Besides, most surgeons would prefer not to perform major reconstructive surgery on a patient who is already too sick. But, according to Dr. Gurunluoglu, in some forms of advanced cancer the surgery can still be performed for the psychological benefit of the patient.
• If the patient is a current smoker. The thing is – smoking increases the risk of complications after any surgery, including breast reconstruction. ‘In my practice, if a patient is a current smoker, I would prefer not to do the reconstruction because of the increased risk of complications and healing problems,’ Dr. Gurunluoglu said. Of course, if the patient is a smoker, it doesn’t mean they will have complications no matter what, but still, the risk is much higher than in non-smokers. Medical literature suggests that patients should quit smoking 6 weeks prior to surgery date.
• If the patient is morbidly obese or has uncontrolled diabetes or uncontrolled blood pressure issues. In such patients the risk of postoperative complications is quite high.
• If the patient is going to receive radiation therapy. Radiation can affect the result of breast reconstruction and make it look much worse. That’s why, if the patient is goind to need radiation therapy after mastectomy, it’s usually recommended to perform breast reconstruction after finishing the radiation.