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Seven months after a mastectomy saved her life, Tracy Hernandez was ready to be whole again.

"It was strange. When I looked down at my body, for the first time in my life it wasn't symmetrical," said the 33-year-old cancer survivor. "I wanted to bring my body back to what I was used to seeing my whole life."

Breast cancer care once focused solely on the cancer itself, but major centers like Huntsman Cancer Institute at the University of Utah have evolved to acknowledge that, for many women, becoming physically whole is an important part of their treatment plan.

"Breast reconstruction can make a huge impact on quality of life and on a patient's ability to move past the diagnosis," said Jay Agarwal, M.D., chief of plastic surgery at University of Utah Health Care and the doctor who performed Hernandez' reconstruction. "It's a difficult thing for patients to go through — to lose a breast or any body part — so offering them the potential to be whole again can be a life-changing experience."

"Breast reconstruction is a very personal decision, and it's unique to every patient so it really depends on their goals and desires," said Agarwal, noting that about 50% of mastectomy patients get a reconstruction and that the numbers would likely be higher if more patients knew the possibilities.

Hernandez is a fitness buff and competitive weight-lifter so her goals for her body are tied closely to her athletic pursuits.

"Because I'm so young and I still want to do a lot of things sports-wise, I wanted to try to do something that wouldn't impact future CrossFitting and weight-lifting," she said.

Hernandez had two main methods to choose between. Did she want to create a new breast using an implant made of saline or silicone? Or did she want to have tissue transplanted from one area of her body (abdomen, inner thighs, buttocks, back) to create her new breast?

Some women choose to go the implant route because they don't want incisions and scars on other parts of their bodies and because it's a shorter surgery and recovery time. Other women may prefer to use their own tissue because they don't want a foreign object in their body that can potentially become infected or leaky or they are worried about thick scar tissue forming around the implant and changing the breast shape.

Neither technique will restore normal sensation to a breast, but Agarwal said women who use their own tissue often get a slightly better sensation.

"Dr. Agarwal offered all the options and we decided to go with the one that was the least detrimental to any other part of my body," said Hernandez of why she chose to get an implant.

Whichever way a woman chooses, the process begins when a temporary device called a tissue expander is placed beneath the pectoral muscles to create space for the reconstruction. It inflates slowly and is typically left in for at least three months as it stretches the skin and muscles and starts to take the shape of a breast. If a patient knows prior to her mastectomy that she would ultimately like to have her breast reconstructed, she may choose to have a tissue expander placed during her mastectomy surgery.

For most patients, symmetry is the biggest concern, Agarwal said. In unilateral mastectomies, the unaffected side usually needs a lift, reduction or augmentation to look like its counterpart.

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"What happens is the new breast will be high up on your chest and the other one will be wherever your natural breast is sitting," said Herndanez, who had her other side lifted. "I thought Dr. Agarwal did a fantastic job of making them symmetrical."

Breasts change over time so annual visits are necessary to check the health of the breasts and to assess if, say, one side is heading south faster than the other side. It's all part of helping a patient recover following such a harrowing health scare.

"It's no longer a privilege to get breast reconstruction," Agarwal said. "It's part of your complete cancer care."

Would you like to learn more about your breast reconstruction options? Click here or call 801-581-7719.

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