Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Breast reconstruction is a surgical procedure used to restore a woman's breast to a shape and size after mastectomy (entire breast removed) or after lumpectomy (part of the breast is removed). This can be achieved by either using the patient's own tissue or using implants (prosthetics). If the nipple and areola (darker area around the nipple) are also removed during the mastectomy, then both can be reconstructed following completion of breast “mound” reconstruction.
Although breast reconstruction is considered to be an integral part of the healing and recovery process, it is not appropriate for everyone. Reconstructive efforts should not interfere or complicate the treatment of breast cancer. The primary goal of the initial surgery is to treat breast cancer and at the same time plan for a reconstruction if the patient is a good candidate.
Who is a candidate for breast reconstruction?
First and foremost, everyone should be aware of the of the Women's Health and Cancer Rights Act of 1998 which mandates insurance carriers to cover the cost of restorative procedures following mastectomy. Restoration after cancer treatment does not necessarily include surgery. For some women it may be as simple as just wearing an external prosthesis or a form-fitted bra. Reconstructive surgery is another option for restoring ones femininity and womanhood, but it is clearly more involved.
The decision to have breast reconstruction is one that is highly personal and one that should be made by the patient without any outside influence from others. Sometimes reconstruction becomes secondary as one is learning how to cope with the diagnosis and treatment. Reconstruction is considered if the patient does not have any medical conditions that would significantly complicate the healing process (such as diabetes, obesity, smoking, high blood pressure, and history of chest wall radiation). Although breast reconstruction can improve a woman's self-image following a mastectomy or lumpectomy, it is likely that there will be some emotional adjustments in order to accept the results of breast reconstruction. Although breast reconstruction procedures can result in a natural looking breast, a candidate should be prepared to accept that a reconstructed breast may never look or have the sensation of their natural breast.
When considering restorative options, the first decision for a woman to make is whether or not they are interested in a reconstructive procedure. If so, then one has to consider the next question of whether reconstruction should be done at the time of the mastectomy or be “delayed” until the breast cancer treatment is completed. At times, even if a patient desires to have “immediate” (at time of mastectomy) reconstruction, their surgical team may recommend that a “delayed” procedure carries less of a risk and less interference with the cancer treatment.
Many women opt to have reconstructive surgery after breast cancer surgery. Reconstructive procedures can use implants or tissues obtained from other locations in the body. These procedures can be done at the time of mastectomy, or they may be performed months or even years later.