There was no way to explain it other than the sheer joy of finally being whole, as a woman named Margaret raced into my office and promptly showed my staff her finished reconstruction. She was laughing and talking a mile a minute and we stood in awe as she explained how exciting it was to finally be done with cancer. Her cancer surgery was over a year ago, but her breast reconstruction and the resulting other interventions to make this complete had taken the rest of the year. She was ecstatic, and rightfully so. She had done it and we were the lucky ones who got to celebrate that day with her.

Women with breast cancer now have so many options when it comes to breast reconstruction after having a mastectomy. Reconstruction is now available in all different forms and types. Eighteen years ago, when I started caring for women after breast cancer surgery, there were not as many choices. Now there are so many choices and decisions to make, it can often be difficult to know what to do. Do you reconstruct and use your own tissue, like a tram flap or DIEP flap, or do you do implants, saline or silicone?

So often, the answer lies in understanding a woman's unique needs and the stage of life she is in. Only the woman in need can actually decide what is best for her. She must ask herself, does she want to have another surgery or possibly multiple procedures? Does she have a support system that is willing to assist her in this process? Does she need to have chemo and radiation? Will the radiated tissue be a problem if she chooses to do a certain type of reconstruction?

Some of the different types of reconstruction procedures are the tram flap, SIEA flap, TUG flap, DIEP flap, hip flap, nipple-sparing mastectomy and implant procedures where they stabilize the implant inferiorly with a small latissimus dorsi flap. As you can see, the techniques are numerous and sometimes overwhelming.

There is a great app that can help you choose what is best for you. Go online and pull up the Breast Cancer App - it's free. In this app, they have a section called the Procedure Wizard. Click on this tool bar and then follow the steps by answering questions that will help you to choose what surgical procedure is best for you. They don't list all of them, but it is a good free tool to use for education. It takes into an account your height, weight, cup size previous to surgery, and then asks you other questions regarding your history to help you make the best choice. Then click on the tool bar for reconstructive options, and read and see the pictures of the different procedures. There is also a tool bar called What to Ask, where numerous questions are answered about reconstruction. I think this section is particularly beneficial because you need to educate yourself on what is the best direction of care for you.

Of course, your surgeons and family MDs are also very knowledgeable, so feel free to ask them as many things as you can before you move forward with your procedures. Your breast cancer physical therapists can also be of great assistance in this matter. They work with people after surgery with all of the different procedures and can help you understand the rehabilitative stages.

Breast cancer bilateral mastectomies and reconstruction has had a lot of press lately from famous celebrities like Angelina Jolie, Christina Applegate, Sharon Osbourne, and Kathy Bates, but don't just assume that's what you should do. There are lumpectomy procedures that are just as effective as mastectomies, in regards to long-term outcomes. This is where you and your MD must be able to talk through what is best for you.

Do the research to investigate what you need to know and if you are not sure, just ask. You need to be informed and educated because the success of your outcomes after reconstruction depend on it.

Sheree DiBiase, PT, can be reached at Lake City Physical Therapy in Coeur d'Alene at (208) 667-1988, and in the Spokane Valley at (509) 891-2623. She is a breast cancer specialist and is Stanford-certified in lymphedema care.