Breast Reconstruction: New Hope and A New Standard of Care

In just a few shorts weeks during the fall of 2003, Becky Keziah went from enjoying good health to seeing a very long list of medical specialists— a process she said made her head spin. She was diagnosed with breast cancer after a routine mammogram and found herself completely overwhelmed by the array of medical consultations, surgical procedures, treatments and other considerations. Becky said she was puzzled when her oncologist added a plastic surgeon to the mix.

“I remember asking, ‘Why? Is he a forensic plastic surgeon because I do not care if I am a good-looking corpse’,” she said. “I could not fathom seeing a plastic surgeon at that point in my life.”

Charles Kays, M.D., of Wilmington Plastic Surgery, said Becky’s reaction is not uncommon. “Ten to fifteen years ago, reconstruction was not considered vital in the treatment of breast cancer,” said Dr. Kays, who estimated that 85% of his practice is breast reconstruction. “Now, offering patients the opportunity to discuss their options for reconstruction is the standard of care. Not all women want to do the surgery, but seeing a plastic surgeon to learn more is part of the treatment.”

Furthermore, Dr. Kays said that in late 1990s, federal and state laws were passed requiring all insurance companies, including Medicare, to cover the cost of breast reconstruction following cancer treatment. “So cost is not really an issue any longer, either,” he said.

Recognizing breast reconstruction as a medical, rather than cosmetic, surgery marked an important milestone in handling the disease. “Breasts help define the feminine physique,” said Dr. Kays. “For many women, there are psycho-sexual issues and a sense of loss associated with the diagnosis. Reconstruction ultimately helps women get over the trauma of cancer.”

According to Dr. Kays, not only have attitudes toward breast reconstruction improved dramatically in recent years, so has medical technology. In recent years, silicone has replaced saline as the standard material for implants. “The new silicone implants are made from cohesive, or memory, gel,” said Dr. Kays. “The way they are engineered, if you chopped them in half, they would not leak.” Saline implants have had a history of complications due to leaks.

Dr. Kays estimated that 29 out of every 30 breast reconstructions done by the physicians at Wilmington Plastic Surgery use silicone gel. Saline is still widely used in expanders, temporary implants that are used to stretch out the skin over time.

Not only is silicone considered safer, it looks and feels more natural. Additionally, the areola, or nipple, area is dyed to create a more natural look.

Lumpectomies, removal of just the cancerous lump rather than the entire breast, have also become far more common over the years. Dr. Kays reported that the survivability with lumpectomies is about the same as with mastectomies, or surgical removal of the entire breast. “Lumpectomies are followed up by radiation,” said Dr. Kays. “You almost always need to treat the remaining tissue.”

In lumpectomy cases, there is often a breast lift involved, and treatment to the other breast is needed to gain symmetry. The cost of the additional procedure is covered by insurance, as well, said Dr. Kays.

According to Dr. Kays, the success rate of breast reconstruction is 95-96%. “Patients should at least try it,” he said. “It is usually successful and in the few cases where it isn’t, there is peace associated with having tried.”

Dr. Kays said he strives to give his patients something they will be happy with. “This is a very emotional issue for women,” he said. “It can have a profound impact on their happiness. I can’t lose sight of that.” Dr. Kays said he cannot help but build a relationship with his patients and get attached to them. “I take care of my patients the way I would want somebody to take care of my own wife and two daughters,” he said.

“The beauty of Dr. Kays’ role in my breast cancer treatment is that his focus was not involved in the pathology of the cancer,” said Becky, “but in the recovery from a disease that had started to define my life.”

Becky said she thanks God daily not only for allowing her to survive the disease, but also for “putting such a compassionate and caring health care professional in my life.” She nominated Dr. Kays for the Silent Angel Award, which he received in 2006.

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