What to Know About Breast Reconstruction After a Cancer Diagnosis, According to a Main Line Area Expert

As a board-certified plastic surgeon for over 20 years, Dr. Suhail Kanchwala has seen major changes take place in breast cancer treatment. This extends from chemotherapy and the surgical process of removing cancer through mastectomies to the innovative improvements of reconstructive surgery that have led to better outcomes with less pain. 

Just in time for Breast Cancer Awareness Month, we sat down with Dr. Kanchwala, the director of the Penn Medicine Center for Breast Reconstruction, to discuss an oft-overlooked component in the breast cancer treatment process: reconstruction.

Penn Medicine’s new program, RESTORE, is now in full swing. RESTORE is a system dedicated to reconstruction post-cancer that combines everyone a patient could meet on their journey under one umbrella organization. This part of the comprehensive care program at Penn Medicine focuses on treating the patient, not just the cancer. 

MLT: How early after diagnosis should a patient begin planning for reconstructive options?

Dr. Suhail Kanchwala: One of the major changes over the past two decades or so, as treatment and survival of breast cancer patients have greatly improved, is the consideration of the reconstructive process as part of the overall treatment plan for patients. As a part of comprehensive care, breast reconstruction should be discussed from the start as it will allow surgeries to be planned around each patient’s desired goal for reconstruction.

With federal law mandating that insurance companies cover breast reconstruction after cancer, this is a right that patients have and an important part of the holistic care of the patient. 

MLT: Why is it important for women to explore options for reconstruction earlier in their treatment plans?

SK: When patients are diagnosed with breast cancer, it can be a whirlwind of both emotions and visits to different medical providers. This is overwhelming, anxiety-provoking and frankly quite scary.

These are some of the key aspects that can make breast reconstruction so challenging. What I have to do is ask a patient how they are going to feel after the cancer is treated, when all they can focus on at the time is just managing and treating the cancer between chemo and any other treatments they may need. We are incredibly successful at treating most breast cancers, and even advanced breast cancer, so it is important that we can get the patient thinking about what she wants to feel like and look like after her cancer is gone.

When a patient begins to think about reconstruction early, she can be aware of her options and then can then make informed decisions on how she wishes to be treated in order to end with the best possible results.  

MLT: What should breast cancer patients consider when thinking of reconstruction after treatment?

SK: Patients should try to understand their own goals and priorities, and what those will be like in the absence of cancer because that’s what’s going to happen. Cancer is going to be over, and when that’s over, what do you want to look like? What do you want to feel like? And what amount of recovery is going to be worth it in order to achieve those goals?

What I try my best to counsel patients on is to pick a procedure that’s going to work for them, not just for the short term, but for the long term because that’s what these decisions really are, how a patient will feel in the long run. When a patient has a successful reconstruction that makes them feel whole, they are that much more able to give back to their families and other life commitments. When we don’t achieve that result, it detracts from their ability to fully participate in their lives in the state they were in before the cancer diagnosis.

Breast reconstruction is critically important, and there’s a lot of nuance around patient decision-making that is really important to their long-term health and well-being.

MLT: How has the increased five-year survival rate for breast cancer patients changed the way that reconstruction is planned for after diagnosis?

SK: In years past, when breast cancer carried a lower survival rate, the focus was understandably on doing everything possible to prolong that survival rate. The focus was less on reconstruction and more on survival.

However, as treatment options both on the chemotherapy side and on the surgical side have dramatically improved and our survival rate is very high, patients are going to be living longer with their bodies. For many patients, we are able to detect these tumors at a much earlier stage than we ever could in the past.

For some patients, this means that mastectomy can be a surgical cure, and therefore we need to really think about how that patient is going to feel after surgery because they are going to be living with their body for a long, long time.

MLT: In what ways have reconstruction options changed over the years?

SK: This is an amazing time to be a reconstructive surgeon, and the reason for that is the pace of changes in the field of reconstructive surgery. Breast reconstruction specifically has really accelerated over the last few years.

There have been major changes in the implant side of things. We have transitioned from a time where we had to place tissue expanders and implants underneath the muscles of the chest wall to what is called pre-pectoral reconstruction, which is putting implants in the same space where the breast was before the mastectomy, in front of the muscles. Now, what we are able to do with advanced technologies is to bring the implant in the anatomic space where the breast was. This is not only an improvement to the recovery aspects of surgery with decreased pain associated with these procedures, but it also has led to better aesthetic outcomes. There has also been a dramatic improvement in the minimally invasive techniques used in tissue-based reconstructions; many of them have been pioneered at the University of Pennsylvania.

Now we are able to do these surgeries, and even the most complex surgeries that we used to perform can now be done in an almost outpatient manner where patients really don’t have to spend very much time in the hospital. Soon we hope these surgeries will be completely outpatient. On top of that, over 70 percent of patients have not had to use any narcotic pain medication during their care, which is due to the advancements in techniques leading to a less painful recovery. Our emphasis on managing the recovery and simultaneously improving the aesthetics has been incredible. 

MLT: What is the typical timeline for recovery after reconstructive surgery for breast cancer patients?

SK: For breast cancer patients, there are two aspects of the timeline: physical recovery and emotional, psychological recovery.

From a physical standpoint, the reconstructive surgical recovery is anywhere between four to six weeks. Usually, in that timeframe, patients are able to functionally go back to work, back to their lives, and do all the normal things including exercise and lifting that they would have been able to do before surgery.

The emotional, psychological recovery is quite a bit longer. I counsel patients about this so that there isn’t this expectation that everything is going to feel great in six weeks, because that’s not realistic. In my experience, the emotional recovery takes closer to a year, and that happens once a patient is able to internalize that the reconstruction is now a part of them. When a patient is able to go from describing the type of reconstruction they had to using the word breast again, that to me is when they have truly recovered. 

MLT: How has surgical reconstruction impacted breast cancer survivors in your practice?

SK: I think what I am fortunate enough to be able to do is an incredible thing. I meet patients in a horrible time of their lives and watch them go through cancer surgery with enormous grit, determination and resilience. They emerge on the other side whole again, and to have a small part in that is incredibly rewarding. In some cases, we are able to make some dramatic changes and even set patients into a new, more healthful future. Some of the surgeries we do can dramatically change a patient’s body into the body they may have always wanted. The goal for reconstruction is always to get back to normal, but if we can do something that enhances the aesthetics of it, both on the breast and abdomen, then that’s even more powerful. It really is our goal to look at our patients’ needs and goals and get them back to the best life they can live after facing breast cancer. 

Related: These Main Line Area Skincare Brands Help Treat Your Skin Right