Reconstruction of the breast is one of the most rewarding surgical procedures available to women today. Newer techniques and procedures make it possible to create a breast that is similar in form and appearance to a natural breast.
Breast reconstruction can help:
- Balance the size and shape of the breasts
- Permanently restore the contour of the breast(s)
- Eliminate the need for a prothesis
Although you can see the difference between a reconstructed and nonreconstructed breast, the breasts should appear even in shape and size when you are wearing a bra, bathing suit, and clothing.
Although breast reconstruction can be performed at any time after partial or full mastectomy, it is most often performed immediately after the removal of a tumor. This approach enables the patient to awaken from mastectomy surgery with a breast mound in place. Almost any woman who must lose a breast to cancer is a candidate for reconstructive breast surgery.
Reconstruction has no known effect on the recurrence of breast cancer, nor does it impair or prevent the detection of recurrent disease. Breast reconstruction also does not generally interfere with postoperative chemotherapy or radiation treatments.
Consultation for breast reconstruction usually includes other physicians involved in treating your breast cancer, including your primary care physician, surgeon, and oncologist.
Your consultation will include a thorough discussion of your medical history, expectations, and concerns. You also will have a physical examination, including a careful evaluation of your breasts. Your surgeon will discuss reconstructive options, with consideration for your overall health, age, height, weight, body shape, and size and shape of your breasts. He or she also will explain advantages and disadvantages of the options and tell you what you can expect before, during, and after the surgery. Limits and risks of the surgery also will be discussed and you may see pictures to better understand the procedure and results.
Implant and Expander Reconstruction
Implant reconstruction involves inserting a temporary balloon expander beneath the chest muscle to gently stretch the muscle and skin over several weeks or months. The size of the expander will be increased at regular intervals in the office through a tiny valve beneath the skin. After the skin over the breast area has stretched enough, the temporary expander will be removed in a second operation and a more permanent implant will be inserted.
If you are planning to undergo implant reconstruction, you should expect to stay in the hospital overnight after your mastectomy and expander placement. You are likely to have some drainage tubes after surgery.
Most implant reconstruction patients can return to normal activities after several weeks, depending on possible additional therapy and at the advice of the surgeon.
The second procedure to remove the temporary tissue expander and place a permanent silicone implant is usually performed as an outpatient.
TRAM and Latissimus Flap Reconstruction
Flap reconstruction involves creating a breast mound with a patient's tissue and, therefore, does not require an implant. The tissue may come from the patient's back or, more commonly, abdomen. The tissue stays healthy because it remains attached to its blood supply. When a woman's abdominal tissue is used to reconstruct the breast, it is referred to as a transverse rectus abdominus muscle (TRAM) flap. A TRAM flap consists of skin, fat, and muscle with its blood supply from the abdomen, which are tunneled beneath the skin to the chest to create a breast mound. The abdominal wound is then closed with a procedure like that of a tummy tuck.
A back flap procedure using tissue from the upper back (the latissimus dorsi flap) is usually used in conjunction with an implant. It involves moving skin, fat, muscle, and blood vessels that are then tunneled under the skin to the front of the chest to create and implant pocket.
The hospital stay and recovery after these procedures are typically longer than with implant reconstruction.
Partial Mastectomy Reconstruction
There are effective options to restore the breast after partial mastectomy, including local tissue reconfiguration, augmentation, lifts, and reduction.
Bilateral reconstruction involves reconstructing both breasts sot hat they are as symmetrical as possible. Most breast reconstruction involves a series of procedures that occur over time. Usually, the initial reconstructive operation is the most complex. The final stage of reconstruction often involves creating a new nipple and areola. In some cases, the surgeon will recommend an additional procedure to enlarge, reduce, or lift the natural breast to match the reconstructed breast.
Breast reconstruction after mastectomy is not a simple procedure; however, there are many options you and your doctor can explore to determine what is best for you. Because it improves a patient's appearance, breast reconstruction can dramatically improve the quality of life for mastectomy patients.
All stages of reconstruction are covered by most insurance plans.