When a woman is diagnosed with breast cancer, many thoughts and emotions run through her mind. But being diagnosed with breast cancer today is not like it used to be. The outcomes are often much better and treatment options can be very personalized to fit the patient’s needs. Post-mastectomy reconstructive breast surgery can have a positive effect on quality of life for women requiring breast reconstruction. All women who are candidates for breast reconstruction should be made aware of the options available to them. In honor of Breast Cancer Awareness Month as well as Breast Reconstruction Day, Dr. Jamie Moenster briefly discusses what’s most important to know about breast reconstruction.
Why would a patient have a bilateral mastectomy when only one breast has cancer?
This is a very personal choice for a female battling breast cancer. Many women who chose or opt for bilateral mastectomy are women who have a lot of concern or worry for the opposite breast developing breast cancer a second time. There are also women who are looking to get a very symmetric reconstructive outcome after their mastectomy. A bilateral mastectomy, which is sometimes called a double mastectomy, is a process in which a general surgeon or a breast surgeon will remove the cancer side of the breast, sample the lymph nodes on that side and do a prophylactic mastectomy on the opposite side for cancer prevention. Bilateral mastectomies can also be done for carriers of the BRCA gene. The BRCA gene is a gene that produces a protein called breast cancer type 1 susceptibility protein. This is a preventive measure with bilateral mastectomies for BRCA carriers. A lot of times this can be done sparing the nipple or where the nipple areola complex is not removed.
What does the reconstructive process consist of?
There are two main types of reconstructions. Implant based reconstructions and autologous reconstruction. Implant based reconstruction is typically a three stage procedure. It is either done immediately at the time of mastectomy or in a delayed fashion after mastectomy and adjuvant chemotherapy and radiation if it is needed. Stage one of the reconstructive process includes placement of a tissue expander which can be blown up or expanded with saline in the office over time to get the patient to the size breast that she would like. Stage two involves removal of the temporary tissue expander and placement of the permanent implant. Saline, silicone gel or highly cohesive shaped silicone gel implants can be used. Stage three is the reconstruction of the nipple areola complex with tattooing of the pigmented portion of the areola. The autologous based reconstructive options are a TRAM (trans-rectus abdominal flap) or DIEP which is where skin and tissue is taken from the abdomen in order to recreate the breast. These can be combined with or without an implant based on the breast desired by the patient. The latissimus dorsi of the back is another autologous option.
The reconstructive process is a big part of the emotional as well as the mental recovery from a breast cancer diagnosis. It is a legal right for the patients to be reconstructed and it is covered by health insurance whether the mastectomy was performed recently or long ago. The most important part of the reconstructive process is removal and treatment of the cancer. The reconstructive process may be delayed or performed later to ensure all oncologic therapies are completed.
Dr. Jamie Moenster believes that each plastic surgery patient has distinctive needs, wants, and desires. By taking the necessary time to listen to you in your consultation, she will tailor an individualized, personal treatment or surgical plan to help meet your aesthetic goals. She focuses on cosmetic and reconstructive surgery of the face, breast and body including breast reconstruction and body contouring. She also performs many nonsurgical options including fillers, Botox, lasers, chemical peels and sclerotherapy.
A native of Missouri, Dr. Moenster graduated from Kirksville College of Osteopathic Medicine in Kirksville, Missouri. She then completed five years of residency in general surgery and two years of fellowship in plastic and reconstructive surgery at South Pointe Hospital/Cleveland Clinic Health Systems in Cleveland, Ohio. She served as the chief resident in both general and plastic surgery. Dr. Moenster is dual Board Certified in Plastic, Reconstructive and General Surgery by the American Osteopathic Association and the American Board of Osteopathic Surgeons.
Dr. Moenster earned the title Fellow of the American College of Osteopathic Surgery (FACOS) in 2012. The FACOS designation is granted for demonstrating commitment to the practice of surgery, surgical teaching, authorship of professional papers/posters, and participation in local, state, and national organizations. She has been recognized for her research in breast reconstruction at the national and state level. She received the Resident Achievement Award by the ACOS in 2010. She was awarded the CORE/OUCOM Resident of the Year and Skills Lab Instructor of the Year.
She is on staff at Northwest Medical Center, Canyon Vista Hospital, Northwest Tucson Surgery Center, and St. Mary’s Carondelet.
In her free time she enjoys cooking, working out, and traveling with her husband, Dr. Chris Weyer (Dermatologist/Mohs surgeon), a native of southern Arizona.