Dr. Morgan Martin is a plastic surgeon at Seidel Plastic Surgery in Cullman. Here, she answers questions about breast cancer and reconstruction after treatment.
Q: What are your patients' most common concerns when they come to you after cancer treatment?
When a patient receives a diagnosis of breast cancer, it is life changing. The primary concern is making sure the cancer is treated as the top priority. When it comes to breast reconstruction, I work very closely with breast (oncology) surgeons to make sure our plan follows the standard of care for breast cancer treatment. That being said, breast reconstruction takes place in coordination with cancer treatments, such as timing of your lumpectomy or mastectomy, and any possible chemotherapy and radiation.
The next concern is regarding what to expect. What will I look like?
Most women's identities are strongly tied to their breasts. When you suddenly find out you are potentially losing your breasts, it can be devastating. Luckily, there are many options for reconstruction, including breast conservation, implant-based reconstruction (even direct-to-implant, same day as mastectomy), tissue-based and fat grafting - utilizing liposuction to give breast skin a much improved appearance. Nipple reconstruction is also performed to make the final breast look very natural and complete. We can even perform nipple-sparing mastectomy in the right candidate. There will be changes and surgery involved, but I am here to walk you through the entire process and help you achieve your goals.
Q: How does the process work? Aren't reconstructions covered by insurance?
Yes! The Women's Health and Cancer Rights Act (WHCRA) is a federal law that mandates insurance companies that cover mastectomy also cover breast reconstruction for women with breast cancer. This means women have a right to breast reconstruction. Here in Cullman, we have a team of breast cancer doctors who cover all aspects of your cancer care.
After a woman has a detected breast cancer either on physical exam or imaging, she will typically have a biopsy to establish a diagnosis, and she will be referred to one of our breast surgeons to discuss options. A workup will be completed to determine the clinical stage and make a treatment plan. Depending on the planned course, she will meet with me, her breast reconstruction surgeon, our medical oncology team and, if needed, our radiation oncology team.
In terms of breast reconstruction, I typically perform reconstruction the same day as lumpectomy or mastectomy. This I would consider the first stage. Depending on your options, this may be your only surgery, but some women need a tissue expander to stretch the skin, requiring a second surgery to place a permanent implant. Often I tell women to expect at least one minor second surgery to improve the appearance with nipple reconstruction, fat grafting, touchups and implant exchange.
Q: What is some advice you would give a woman who is considering reconstruction?
I would highly recommend at least discussing all options with me. It will seem overwhelming and complex, but my job is to know your options and determine the best route based on your goals and expectations. We have a great group of specialists here in Cullman who allow you to receive expedited care in your hometown with the same options as a university. Currently, there is a huge demand for all reconstruction and cancer care, and it can be difficult getting into a big system. I trained at Emory University with the leading experts in breast reconstruction, and my goal of coming to Cullman was to increase access to complex reconstructive procedures.
Q: In your experience, do you know the signs women should look for when it comes to their breast health?
Yes; women should know their bodies. Don’t be afraid to perform self-breast exams. If you feel a new lump or bump, at least see your primary care physician or OBGYN for an exam. You should also look for changes in the skin such as redness or dimpling and changes to the nipple such as new retraction or drainage. Any of these findings should be examined by a health care provider with likely imaging. The American Cancer Society recommends women start screening for breast cancer with mammograms at age 40.
Q: What inspires you about the work you do?
When patients choose to have reconstructive or cosmetic surgery, I become a huge part of their lives. It really creates a lifelong relationship since I see patients for additional treatments or checkups over time. I become very invested in each case, and it means a lot to me to see patients improve their health over time. The process of breast reconstruction is special; I meet women when they are in a very vulnerable state. They are unsure of what to expect with reconstruction, and I spend a lot of time discussing expectations and options. Being able to create a new breast, a major part of their identity, is very rewarding.
I am also passionate about increasing access to care. There is literature to indicate women who live in rural areas (e.g., Cullman) have lower rates of breast reconstruction. The reasoning is multifactorial, but we can change that by educating women on their options, which include staying in Cullman.
"Being able to stay in your hometown for surgery and cancer treatments really decreases the burden on the patient, since it eliminates excess travel and therefore expense and time off work."