About Breast Reconstruction
Breast reconstruction is achieved through several plastic surgery techniques that attempt to restore a breast to near normal shape, appearance and size. Following a mastectomy and depending on the individual patient’s circumstances – such as whether radiation therapy is required as a part of the treatment protocol – saline-filled or silicone gel implants or tissue from other areas of the body (also known as an “autologous reconstruction”) – and sometimes a combination of the two – may be used. Nipple and Areola Reconstruction is often required, as well, and can be performed alongside or following breast reconstruction.
Breast Reconstruction Considerations:
Many factors should be considered when deciding on breast reconstruction following a mastectomy. There are a wide range of variables based on your individual circumstances and preferences. The best way to make an informed, thoughtful choice about breast reconstruction is by working with the members of your health care team. Learn as much as you can about your options, sort through all the details, and decide what’s right for you. Because breast reconstruction is an optional procedure and done for personal reasons, it’s important to carefully consider your preferences when deciding whether to have the surgery. For example, age is a consideration for many women. Younger women tend to have reconstruction after mastectomy more often than women who are older. Activity is also an issue that many women take into account. If you are active and enjoy hobbies like running, swimming or biking, breast reconstruction may be a better fit for your lifestyle than a prosthesis. In addition, breast size may be a consideration. If you have large breasts, it may be difficult for reconstruction to match your other breast. Some women in this situation opt to have surgery on both breasts, so the size is comparable on both sides. The size and shape of your breasts after surgery depends heavily on their appearance prior to reconstruction. Some breast shapes are easier to reconstruct than others. These are just a few examples of the many factors you need to consider before having breast reconstruction. You don’t have to figure it out by yourself. Consult with your doctor about resources that are available to help you learn more. Many healthcare facilities have professionals who specialize in educating women about breast reconstruction.
Breast Reconstruction Options:
Breast reconstruction is similar to breast enhancement; it is, however, more extensive and almost always consists of more than one procedure.
BREAST MOUND RECONSTRUCTION:
The first stage of breast reconstruction surgery involves recreating the breast mound. This can sometimes be done during the same procedure as the mastectomy, or it can be performed separately. One of the first issues that must be addressed during breast reconstruction is the loss of skin due to the mastectomy. Some women may have sufficient skin available, but for most, the first step involves recreating sufficient skin to cover the reconstructed breast. This is done using either skin expansion or flap reconstruction, both of which are described below.
This is the most commonly used technique for breast reconstruction surgery involves allowing the skin to slowly regrow using an expandable implant placed under the skin, which is slowly expanded to allow the covering skin to stretch. Some expanders can be simply left in to serve as a final implant, while others must be removed later and replaced with permanent breast implants, in a procedure similar to breast augmentation.
Flap reconstruction is an alternative to skin expansion. This technique involves transferring skin from another part of the body – usually the abdomen or the back. Flap reconstruction surgery is far more complicated than skin expansion surgery, requires more recovery time, and leaves more extensive scarring, to both the breast and to the donor site, but some patients believe that it produces more natural looking results.
In many cases, the breast mound reconstruction is followed up with procedures to complete reconstruction of the breast. These procedures might include one or more of the following:
• Reconstruction of the nipple and areola.
• Replacement of a tissue expander with a permanent implant.
• Breast lift or enhancement performed on the other breast to create symmetry.
Your surgeon will discuss your options for reconstructive surgery with you in detail so that you’ll know just what to expect before you begin the process.
What to expect:
The final results of breast reconstruction following mastectomy can help lessen the physical and emotional impact of mastectomy. Over time, some breast sensation may return and scar lines will improve, although they will never completely disappear. There are trade-offs, but most women feel these are small compared to the large improvement in their quality of life and the ability to look and feel whole. Careful monitoring of breast health through self-exam, mammography and other diagnostic techniques is essential to your long-term health. In a breast reconstruction, your surgeon’s goal is to do everything within reason to recreate the natural appearance of your pre-mastectomy breast. The extent to which this is possible depends on the procedure you plan to have done, the lengths to which are willing to go, and your unique anatomical factors. You should discuss this in detail with your surgeon prior to surgery so you know what to expect beforehand. Patients should arrange to have friends, family members, or other caregivers available to help during the first week after surgery. A drainage tube will remove fluids for several days and you may experience pain and discomfort during the first few weeks of recovery. You should avoid having sex or performing strenuous exercise and/or heavy lifting for at least 4-6 weeks after surgery.
Breast Reconstruction Risks:
Each year thousands of women undergo successful breast reconstruction procedures, experience no major problems and are happy with the results. Significant complications from a breast reconstruction are infrequent. However, make sure you understand what surgery involves, including possible risks, complications and follow-up care. Breast reconstruction surgery poses various risks, including:
• Poor wound healing.
• Implant rupture or deflation.
• Protrusion of the implant through the skin.
• Increased risk of future breast surgery to replace or remove the breast implant.
• Changes in breast sensation.
• Scar tissue that forms and compresses the implant and tissue into a hard, unnatural shape (capsular contracture).
Like any major surgery, a breast reconstruction poses a risk of bleeding, infection and an adverse reaction to anesthesia. It’s also possible to have an allergic reaction to the surgical tape or other materials used during or after the procedure. You can help minimize certain risks by following the advice and instructions of your surgeon, both before and after your breast reconstruction surgery. If you have any concerns about the risks involved with a breast reconstruction surgery, please consult your surgeon.