Restoring Lost Curves and Confidence

Last November, at the age of 43, Carol Beebe lost her left breast to cancer. But when she awoke from mastectomy surgery at New York City's Columbia- Presbyterian Medical Center and gazed down at her chest, nothing appeared to be missing. Beebe, an IBM employee from Point Pleasant, N.J., had chosen to have a reconstruction of her breast immediately following the mastectomy. In a single operation, plastic surgeons shaped a new breast from Beebe's own abdominal tissue, moving it into place minutes after the general surgeons had removed the diseased breast. The technique spares the patient the anguish of amputation. "Our basic philosophy is that you don't leave the hospital without a breast," explains Plastic and Reconstructive Surgery chairman Norman Hugo, who performed the operation.

Rebuilding the breast after mastectomy has become increasingly popular in recent years: more than 34,000 U.S. women chose some form of reconstruction in 1988, up 71% from 1981, according to the American Society of Plastic and Reconstructive Surgeons. Younger patients are particularly drawn to the procedure, though Hugo has reconstructed breasts for women of all ages and types, including a nun.

The majority of reconstructions are done with implants, small bags that are inserted under the muscle of the chest wall and filled with either silicone gel or saline solution. The inflation must be done gradually over a period of weeks to allow time for the muscle and skin to stretch, a process that can cause discomfort and sometimes lead to infections.

Linda Lehman, 43, a mother of two from Newville, Pa., received two silicone implants last February, three months after undergoing double mastectomies. That summer she went out and bought a new two-piece swimsuit. "Losing your breasts is a terrible experience," she says. "You mourn the loss. You have the same phantom feelings as when you lose a limb." The implants, she says, have restored her spirit along with her figure. "I wear more revealing clothing than before, and I've never looked better."

Silicone implants are not without drawbacks. Because they sit high on the chest and are compactly curved, the implants most closely reproduce the look of a young woman's breast and can be a poor match for an older patient. They can also make the breast feel hard, interfere with mammography and, on occasion, rupture, causing inflammation if silicone has been used. This spring, as a result of pressure from patient-advocacy groups and members of Congress, the FDA will require implant manufacturers to provide proof of the safety of their products. Still, many surgeons say the risks have been exaggerated.

Reconstruction using a flap of abdominal tissue, as Beebe had, avoids most of the implant problems but is a far more complex operation, lasting upwards of six hours and requiring a longer recovery period. The plastic surgeon must carve a large, almond-shape swath from the belly, about 16 cm by 30 cm (6 in. by 12 in.), carefully lifting up the skin, fat and an underlying muscle, without severing the artery that supplies the tissue. The flap is then fashioned into a new breast. A new nipple can be created later by twisting the tissue and tattooing on an areola. For Beebe, there was abdominal pain at first and cramping of the relocated muscle that continued for several weeks following her surgery. But she has no doubt that she made the right choice. "It feels natural and moves naturally," she says. "I don't even feel like I've lost a breast. It's just a little different now."