Making strides in breast reconstruction

The term breast cancer is “sort of a misnomer,” says plastic and reconstructive surgeon Jeffrey Feiner.

“It’s a spectrum of diseases. There are a lot of different types of breast cancer,” said Feiner, who moved his practice from Kissimmee to Altamonte Springs last month.

The breast isn’t just all one part, he said.

Each breast has 15 to 20 sections called lobes, which surround the nipple like spokes on a wheel. The lobes are linked by milk ducts with fat filling the space in between. Each breast also contains blood vessels and vessels that transport lymph, a fluid that travels through a network in the body to help fight infections.

Cancer can occur in various parts of the breast, but there are two main treatment options, Feiner said.

The first is known as breast conservation therapy, or lumpectomy, in which only the cancerous cells are removed. It’s typically combined with radiation therapy, he said.

The second is a mastectomy, a procedure in which all breast tissue is removed and which can be done in conjunction with radiation and chemotherapy

Advancements in surgery essentially have eliminated the need for radical mastectomies, which remove all the skin and muscle along with the breast tissue.

Removing the cancer is most important, but breast reconstruction is now part of most treatment plans.

“We always like to meet and discuss options with patients and recommend a (plastic surgery) appointment even if they don’t think they want to do it. And some people ultimately elect not to get the reconstruction” said Feiner, who spent seven years at Orlando Health’s cancer center before going into private practice.

Still, he said, “comprehensive breast care should include a plastic surgeon in the process. They should have a guiding role in what’s being done.”

Most insurance companies cover reconstructive surgery after a mastectomy, thanks to the Women’s Health and Cancer Rights Act of 1998, also known as Janet’s Law.

The law requires group health plans, insurance companies and health maintenance organizations (HMOs) to provide coverage for reconstructive surgery after mastectomy for breast cancer and prohibited “drive through” mastectomies, where a breast cancer patients’ hospital stays were limited by their carriers.

The law protects all stages of breast reconstruction, including surgery on the normal breast to produce a symmetrical appearance. It also covers the treatment of physical complications of the mastectomy, such as lymphedema.

Despite the long-standing federal protections for breast cancer patients, insurance remains one of the most challenging aspects of the job, Feiner said.

However, advancements in surgery and biological materials for implants – now stronger and softer than ever –  have greatly improved over the last 20 years, he said.    

A new technique called nipple sparing is another way surgeons are operating with an eye toward reconstruction.

The next evolution in breast reconstruction surgery is using a patient’s own skin and fat instead of an implant, he said.

“Patients are scared, so you have to be sympathetic and understanding,” he said. As a plastic surgeon, I get to be the light at the end of the tunnel.”