WESTFIELD — Baystate Health Systems plastic surgeon Benjamin J. Schalet, M.D., who performs breast reconstruction for cancer patients, said sometimes people think of plastic surgery as cosmetic. He said breast reconstruction is not cosmetic surgery.
“Breast reconstruction is not cosmetic. It is covered by federal law under the Women’s Health and Cancer Rights Act of 1998, which requires insurance companies that cover mastectomies to cover reconstructive services as well,” Schalet said. He said copays may still apply, but the services cannot be denied to patients.
“It minimizes the negative impacts of breast cancer. Most women find it to be very helpful in living a full life,” he said.
Schalet said it is important for people to know that a whole team gets involved in helping to diagnose and put together a treatment plan for breast cancer. It starts with the diagnosis, and there are a lot of ways to test for it, which can be as minimally invasive as a needle.
After diagnosis, he said, it is important to lay out a plan customized for the individual patient before surgery for the best outcome.
Each plan is different in its order and components, Schalet said. Some patients have surgery, and are all done. Others get surgery and radiation. He said chemotherapy can come before or after surgery.
“As part of all of those plans, we try as a team to talk with patients about what the surgery plan is and how it is going to get them to their goal of being cancer-free and being able to live a healthy life.”
Schalet said having some thoughtfulness towards what happens after cancer treatment is helpful, too, which is where reconstruction comes in. The goals for reconstruction are to help people have normal appearing breasts after surgery for breast cancer.
Schalet said many times the breast surgeon, who is the surgical oncologist, is the only person involved. Sometimes it’s a team of surgeons which include the breast surgeon and a reconstructive surgeon.
Breast reconstruction can be done at the same time as the mastectomy, all in one, or spread out over time. He said additional surgeries may be needed as well.
“No surgery is without risk,” Schalet said, but the risks are often typical risks such as infection. He said it’s important to manage breast implants safety, which for him means following up with patients over time, to make sure the implants are behaving properly and don’t need to be removed.
Typically, implants are silicone balloons filled with salt water or silicone gel.
“In my practice, I give patients a choice. Each has their pluses and minutes,” Schalet said.
In response to a question, Schalet said women choose all the time not to get breast reconstruction. In the traditional sense of reconstruction, the breast shape is reconstructed to feel comfortable in clothing or a bra, so the patient does not have to wear an external prosthesis.
“For some people, we just try to have the incisions from the mastectomy look as good as possible as a flatter chest,” he said.
Schalet said some cancers can be successfully treated and cured when only a portion of the breast involved with the cancer is removed. He said sometimes when a small portion is removed, it can leave an indent or shape. Surgeons can do a breast lift or reconstruction which fills in the indent.
“One thing to remember or emphasize; radiation therapy is required when only a portion is removed for breast cancer. You can’t just take a small piece and skip the radiation part,” Schalet said,
“We’re trying to combine surgeries now, and do the lift surgery at the time the small piece is removed, then go on to radiation therapy and still have one surgical event, and end up with a good symmetrical appearance,” he added.
Schalet said there are other ways the breast surgeons can reshape breasts during surgery.
“They’re very sensitive to where scars are placed,” he said. He added that surgeons take care, when possible, to make their cuts “in locations where they are not visible is important, and stitching the insides together to avoid dents — only when larger pieces are removed do they involve a plastic surgeon.”
Asked for advice, Schalet said to make sure to get screening tests when recommended.
“When caught early, breast cancer is very curable,” he said, adding that screening is especially important when there is significant family history of breast or colon cancer. “If you do end up with a diagnosis; make sure you take advantage of being informed about the options of breast reconstruction, so the surgery you get matches the goals you have for afterwards,” Schalet said, adding that the goal is to survive breast cancer in the most comfortable way possible.
October is National Breast Cancer Awareness Month. Every week this month, The Westfield News will partner with Baystate Noble Hospital to share some of the stories of the medical professionals who treat breast cancer patients at Westfield’s community hospital. For more information about the hospital, visit baystatehealth.org or call 413-571-0000.