Mastectomy or Lumpectomy?

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Submitted by Twin City Plastic Surgery

There is nothing easy or simple about a cancer diagnosis. From the moment a patient hears the words “you have breast cancer,” she begins an exhausting schedule of medical appointments, treatments, and procedures. While much attention is given to treating the patient’s medical condition, she also needs support in thinking through her options impacting her health and appearance.

The vast majority of breast cancer diagnoses involve some type of surgical treatment with lumpectomies being more common in early-stage cancer situations. According to the American Cancer Society (ACS), 57 percent of women with early stage (Stage I or II) breast cancer have a lumpectomy or partial mastectomy and 36 percent have a full mastectomy, with others electing non-surgical options. Thirteen percent of women with late stage breast cancer (Stage III or IV) have a lumpectomy or partial mastectomy and 60 percent have a mastectomy.

The ACS also tells us 20 to 40 percent of women who undergo mastectomy have breast reconstruction which typically includes an implant, tissue from another part of the body, or a combination of the two.  Some types of reconstruction can begin during the mastecomy surgery itself, so having a reconstruction plan from the beginning of treatment is critical. Of course, some women are not candidates for lumpectomies due to the size or location of the tumor. But for a woman who has options, how does she make the decision to remove part or all of her breast?

Current data shows the type of surgery – lumpectomy or mastectomy – does not appear to impact a patient’s survival rate or possibility of cancer recurrence. Also, these surgical options do not impact the need and/or type of chemotherapy and/or hormone therapy a doctor recommends.

A lumpectomy almost always:

  • Allows the patient to preserve more of their breast, which can give the patient comfort and an obvious feeling of normalcy.
  • Involves a less extensive surgery in which the patient can go home the same day.
  • Requires radiation as part of the therapy to treat the breast cancer.
  • Does not involve placement of an implant.

Lumpectomy with radiation therapy (XRT) is becoming much more common versus a full mastectomy; from a breast conservation perspective and oncologic perspective, this is good. But there are some downsides to choosing lumpectomy/XRT that are rarely mentioned to the patient.

  • Lumpectomies can result in uneven breasts which may not give the patient the look they hoped for.
  • The defect may still leave a significant cosmetic concern, but any surgery to correct this may be considered cosmetic and be more difficult to get covered by insurance.
  • Radiation treatments can cause adverse cosmetic changes such as darkening of the skin at the treatment site.
  • Any surgery that is ever done on the radiated breast for the rest of that patient’s life is at a much higher risk for complications due to the radiation, and, therefore, limits the patient’s options for reconstructive surgery in the future.

The decision to have a lumpectomy or mastectomy is as individual and personal as a surgery can be. Each patient should talk with their plastic surgeon prior to making their final decision so they can be fully informed of the advantages and challenges of each option. Dr. Laura Randolph as a board-certified plastic surgeon has the education and experience to provide effective breast reconstruction consultations and provide patients peace of mind during a stressful time as they reclaim their life and body from this disease.

Dermal Fillers

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Dermal fillers are one of the most popular procedures for achieving a more youthful appearance.  These products are injected into the skin and will soften or even eliminate the look of fine lines and wrinkles around the eyes, nose and mouth. Additionally, fillers can be used to add volume to the cheeks and lips— creating a more contoured look in the process.

While fillers are most commonly used to minimize laugh lines, crow’s feet and frown lines, as well as to plump up lips and cheeks, there are also the following ways that fillers can be used that most people aren’t aware of.

Recessed Scars

One good thing about scars is that they tell a story, but the bad thing is that they can make you feel self-conscious and embarrassed. Fillers can be used to temporarily alleviate the appearance of recessed scars by adding volume to the skin— creating a smoother texture in the process.

Facial Contour Deformities

If you have had a surgical procedure to correct facial deformities that were caused by accident or surgery, facial fillers can be used to help with creating natural looking contours across your face. By injecting fillers around your cheekbones, mouth, nose, and chin, fillers can help you temporarily eliminate facial imperfections.

What About BOTOX?

BOTOX is the most popular injectable available, but it is not a dermal filler.  BOTOX injections work by weakening or paralyzing certain muscles or by blocking certain nerves so that wrinkles are less noticeable.  BOTOX is most commonly used to lift areas like eyebrows, eyes, and forehead.  There is no downtime with BOTOX, meaning you can resume your normal activities right away.  The effects last about three to four months, depending on what is being treated. BOTOX is also used for many other conditions including underarm sweating.

It’s important to realize that dermal fillers and BOTOX are medical procedures, not cosmetic treatments.   These should only be done by a board-certified plastic surgeon or dermatologist who is knowledgeable about injection techniques and product safety. Because there is a wide variety of different types of dermal fillers, and choosing the correct injection site is crucial, only your physician can recommend the specific strategy that will give you the results you are seeking. Dermal fillers are not appropriate for everyone and although the procedure is very safe, there are certain risks.  Your physician will do a complete medical history to make sure that you are a good candidate, explain the procedure in detail, and answer questions that you may have.

Although temporary, facial fillers provide solid results that can help treat some major areas of concern. The results are usually immediate and will last 6 months to over a year depending on the patient and the type of filler used.

Tummy Tuck, Redesigning Your Mid-Section

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Sometimes all of the exercising and dieting in the world cannot get rid of the midsection that results from a lifetime of weight fluctuations or pregnancy.  The body changes that a woman will experience to her midsection with one pregnancy, let alone multiple pregnancies, can lead to unwanted changes such as sagging skin, stretch marks and even muscle separation in the abdominal wall.

What is a tummy tuck?

The tummy tuck is designed to correct several of the changes brought about by pregnancy or massive weight loss in women.  Men also benefit from abdominal wall contouring after weight loss.  The procedure can improve the appearance of excess abdominal fat, skin and tissue in healthy adults, leading to a flatter, more trim waistline.

A full tummy tuck, or abdominoplasty, is defined by an incision that runs from hip to hip along the lower abdominal area.  An additional incision is made around the navel, and excess upper and lower abdominal skin and fat is pulled down and trimmed, creating a flatter, more contoured abdominal wall.  The rectus muscles that shape and provide core strength to the abdominal wall are also repaired and brought back into closer alignment, further contouring the waist.

A full abdominoplasty is a major operation that can take two to four hours in the operating room and it should be performed by a board certified plastic surgeon.  Recovery time is usually four to six weeks and individuals should expect to wait six weeks before returning to their exercise routine.

A mini tummy tuck, which uses a shorter incision in the lower abdomen, is perfect for patients who have a small to moderate amount of skin and fat excess but do not need repair of the upper abdominal muscles.  No incision around the navel is required with a mini tummy tuck.  Liposuction is used in a limited fashion to the lateral hip area in both full and mini tummy tucks.

The Effects of Pregnancy

A tummy tuck is used to correct rectus diastasis, a condition where the abdominal wall muscles have separated.  The most common reason these muscles become weakened is multiple pregnancies.  Many women have some degree of this condition and might not know it.  Women come to our office frustrated at the appearance of their abdomen, despite a great exercise routine and good nutrition.  Abdominoplasty surgery closes the muscle separation and flattens the abdomen in a way that even vigorous exercise cannot, supplementing and enhancing a patient’s goal of a more attractive midsection.

Post-partum women seeking a toned tummy should wait at least 6-12 months after nursing before considering abdominoplasty.  We advise our patients to certainly wait until they are done having children before having this procedure – as the benefits of surgical abdominal wall contouring are lost if a patient were to become pregnant again.

 5 Highlights of Tummy Tuck Surgery:

  • Choose only a doctor certified by the American Board of Plastic Surgery.
  • Agree only to surgery performed in an accredited facility with a board certified anesthesiologist or possibly a certified nurse anesthetist to administer anesthesia and monitor your health.
  • Review before and after photos, understand what a realistic result looks like and what the scars look like. Come with a list of questions for your surgeon about the procedure.
  • Ask specifically where the incision will be and accept that you will have scars. Scars may heal wide, red or raised, even if you follow all the instructions you were given.
  • Accept that your procedure will require a recovery of days to weeks and that, as with any surgery, there are some risks involved.



To Tuck or Not To Tuck

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Local nurse and mom of 8 shares her decision to have a tummy tuck.

By Linda Hankemeier

As the mom of eight, Tere (pronounced “Terri”) knows what it means to work hard to get her figure back after childbirth. However, after her last pregnancy — giving birth to triplets at age 51 — the exercise and diet that had worked so well after her earlier pregnancies wasn’t successful in getting “everything” back to normal this last time.

“I had triplets, which included a C-section. But even with the demands on my body, I was able to restart my exercise routine and managed to get back down to my prepregnancy weight,” Tere shared. “But, even with reaching that goal, I was still surprised that my midsection never went back to normal. The excess skin in my stomach wasn’t going anywhere.”

As all eight of her children grew, Tere continued her active lifestyle and her healthy habits such as exercise and proper diet. But, her midsection never seemed to change. Ten years later, her stomach looked pretty much like it did six months after her last delivery. And the extra weight around her midsection made it difficult for her to run, try on clothing, and maintain the active life she wanted. “I wasn’t worried about having the perfect body or making a spouse happy, as my husband loved me just as I was,” Tere commented. “This surgery was about getting my life back to normal.”

Realizing the shape of her stomach was beyond her control, Tere made the decision to look at medical options. She began researching abdominoplasty, more commonly called a “tummy tuck,” and met with one of the board-certified plastic surgeons of Twin City Plastic Surgery.

As a nurse, Tere was an informed patient. She researched types of procedures, consequences, and recovery times, and had many questions for the doctor and staff that were specific to her health and medical situation. “The number one question on my mind regarding any surgery was risk versus benefit, especially at my age.” Tere shared. “After all, I have eight kids and a husband. I needed to know my options, weigh the pros and cons, and make an informed decision.”

Twin City Plastic Surgery’s doctor and staff worked closely with Tere discussing in depth the surgical procedure itself, the process, recovery, and even recommended to Tere different possible procedures to address her concerns. In the end, she decided the tummy tuck and muscle wall repair would give her the results she wanted, and her surgeon confirmed she was a great candidate for the procedure. She was physically strong and maintained a healthy lifestyle, so a tummy tuck would be a great way to remove the excess skin and fat and return her to the active lifestyle she had prior, which was greatly needed as her triplets were nearing the preteen years.

Even her recovery went well. “Prior to surgery, I spent time exercising my legs to be stronger. Two days after surgery I was up walking, but careful. I walked bent over for about two weeks to make sure I didn’t pull any stomach muscles or loosen my stitches.”

As a part of her procedure, a pain pump tube was inserted in Tere’s stomach along the incision area. The pump provided her round-the-clock pain management. At times the pain was a little more severe, but she was able to manage it with oral pain medication. Within the first week, she found that extra strength over-the-counter pain medication successfully managed the pain. Within two weeks of surgery, she started working part-time again, and could comfortably walk, sit, and drive a car.

Tere resumed her normal exercise routine about two to three months post-surgery, starting first with walking and biking. Six months after her tummy tuck, Tere completed a 100-mile bike ride and was feeling fit again.

One year after her surgery, Tere said she feels amazing. Her stomach is hard and toned, with no lingering side effects of the surgery. Even her scar is hardly noticeable. “I’m so thankful I had a tummy tuck,” Tere shared. “I feel like my stomach is back to normal. But, more importantly, my life is back to normal.”

Call Dr. Randolph (309) 664-6222 for a consultation. Contact Us

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