Breast Reconstruction's Modern Look

Aug. 21, 2008 — -- For Heather Fineman, testing positive for the breast cancer gene was one of the most heart-wrenching moments of her life.

"I felt like a sitting duck, just waiting to get cancer," Fineman, 37, said.

So, in November, Fineman decided to take a drastic step: prophylactic mastectomy and reconstruction.

Fineman joined an increasing number of women who've turned to prophylactic mastectomy, which is the removal of breasts in an attempt to prevent or reduce the risk of breast cancer. More than 57,000 reconstructions were performed in 2007, including many breast survivors, up 2 percent from the year before, according to the American Society of Plastic Surgeons.

Actress Christina Applegate told "Good Morning America's" Robin Roberts Aug. 19 [click here for story] that she too will undergo reconstruction in the next eight months, her usual humor in tow.

"I'm gonna have the best boobs in the nursing home, I'm telling ya," Applegate bravely joked with Roberts, who's also a cancer survivor. "I'm gonna be the envy of all the ladies around the bridge table, right?"

Fortunately for Applegate, Fineman and thousands like them, the nature of reconstructive breast surgery has come a long way from the days when the procedure left women with deformed breasts, said Dr. Mia Talmor of the Iris Cantor Women's Health Center at the Weill Cornell Medical College in New York City.

"Twenty years ago our goal was to make a breast mound; it was just something to fill a bra," Talmor said. "Ten years ago we started to move into skin mastectomy, so the breast shape became a little natural. Nowadays, we are going into total skin, nipple and arousal preservation with completely hidden scars."

Fineman had her surgery done nearly a year ago. "I had one step -- mastectomy and reconstruction all in one step."

She said doctors left her nipples intact, making incisions under her breasts to remove tissue. "[It] didn't feel like I had reconstruction," she said. "When I woke up I had breasts, just different stuffing."

The Chicago mother of two had seen her own mother go through a mastectomy. But her mother chose not to have reconstruction, a factor that influenced Fineman's decision.

She said her mother's surgery "looked to be something out of a horror movie. Growing up watching your mother like that, it affected me."

Fineman noted that her scars are hard to see and willingly showed her reconstructed breasts in the hopes that other women pondering such a life-changing decision could see how natural they look.

"I have been more than pleased with the results," Fineman said.

One noticeable difference, however, is that she doesn't have the same sensation in her nipples that she had before the surgery. "My sexual relationship with my husband is not centered around my breasts anymore," she told ABC News.

But, despite the change, Heather says she does not regret her decision.

"The way that my body looks now is an improvement from what it was before," Fineman said. "The fact that I have implants instead of real breast tissue doesn't make that much of an impact to me."

Dr. Elisa Port, a breast surgeon at Memorial Sloan-Kettering Cancer Center in New York City, told "GMA's" Roberts that there are two kinds of reconstructive surgeries available to breast cancer patients.

One kind of reconstruction involves tissue expanders that are implanted after tissue is removed. Tissue expanders inflate over a period of time, then are replaced with long-term implants. Unlike Fineman's surgery, this kind of reconstruction involves more than one operation.

The other kind of reconstruction removes implantable tissue from another area of the patient's body (like the stomach) and usually doesn't involve a second surgery.

Patients may decide to forego reconstruction altogether, but Port said that expense shouldn't be the determining factor. Under the Women's Health and Cancer Rights Act , signed into law in 1998, insurance plans "must also provide coverage for reconstructive surgery in a manner determined in consultation with the attending physician and the patient," according to the U.S. Department of Labor's Employee Benefits Security Administration.

Both Roberts and Port stressed the importance of trust between the patient and her doctor in making the appropriate choice.

Roberts, pulling from her own experience as a cancer survivor, mentioned that each case is "highly personalized" and needs individual support, care and attention from the medical team, as well as the family.

"We have to support each other," Roberts said, "no matter what."