If you’re considering breast reconstruction…Reconstruction of a breast that has been removed due to cancer or other disease is one of the most rewarding surgical procedures available today. New medical techniques and devices have made it possible for surgeons to create a breast that can come close in form and appearing to matching a natural breast. Frequently, reconstruction is possible immediately following breast removal (mastectomy), so the patient wakes up with a breast mound already in place, having been spared the experience of seeing herself with no breast at all. But bear in mind, post-mastectomy breast reconstruction is not a simple procedure. There are often many options to consider as you and your doctor explore what’s best for you.
The best candidates for breast reconstruction Most mastectomy patients are medically appropriate for reconstruction, many at the same time that the breast is removed. The best candidates however are women whose cancer, as far as can be determined, seems to be eliminated by mastectomy. |
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Still, there are legitimate reasons to wait. Many women aren’t comfortable weighing
all the options while they’re struggling to cope with a diagnosis of cancer. Others
simply don’t want to have more surgery than is absolutely necessary. Some patients
may be advised by their surgeons to wait, particularly if the breast is being
rebuilt in a more complicated procedure using flaps of skin and underlying tissue.
Women with other health conditions, such as obesity, high blood pressure, or smoking,
may also be advised to wait. In any case, being informed of your reconstruction options before surgery can help you prepare for a mastectomy with a more positive outlook for the future. Types of implants If your surgeon recommends the use of an implant, you’ll want to discuss what type of implant should be used. A breast implant is a silicone shell filled with either silicone gel or salt-water solution known as saline. The Surgery While there are many options available in post-mastectomy reconstruction, you and your surgeon should discuss the one that’s best for you. Skin Expansion The most common technique combines skin expansion and the subsequent insertion of an implant. Following mastectomy, your surgeon will insert your balloon expander beneath your skin and chest muscle. Through a tiny valve mechanism buried beneath the skin, he or she will periodically inject a salt-water solution to gradually fill the expander over several weeks or months. After the skin over the breast area has stretched enough, the expander may be removed in a second operation and a more permanent implant will be inserted. Some expanders are designed to be left in place as the final implant. The nipple and the dark skin surrounding it, called the areola, are reconstructed in a subsequent procedure. (For more information on tissue expansion, ask your surgeon for the ASPRS brochure on those procedures.) Some patients do not require preliminary tissue expansion before receiving an implant. For these women, the surgeon will proceed with inserting an implant as the first step. Flap Reconstruction An alternative approach to implant reconstruction involves creation of a skin flap using tissue taken from other parts of the body, such as the back, abdomen, or buttocks. In one type of flap surgery, the tissue remains attached to its original site, retaining its blood supply. The flap, consisting of the skin, fat, and muscle with its blood supply, are tunneled beneath the skin to the chest, creating a pocket for an implant or, in some cases, creating the breast mound itself, without the need for an implant. Regardless of whether the tissue is tunneled beneath the skin on a pedicle or transplanted to the chest as a micro vascular flap, this type of surgery is more complex than skin expansion. Scars will be left at both the tissue donor site and at the reconstructed breast, and recovery will take longer than with an implant. On the other hand, when the breast is reconstructed entirely with your own tissue, the results are generally more natural and there are no concerns about a silicone implant. In some cases, you may have the added benefit of an improved abdominal contour. .Follow-Up Procedure Most breast reconstruction involves a series of procedures that occur over time. Usually, the initial reconstructive operation is the most complex. Follow-up surgery may be required to replace a tissue expander with an implant or to reconstruct the nipple and the areola. Many surgeons recommend an additional operation to enlarge, reduce or lift the natural breast to match the reconstructed breast. But keep in mind; this procedure may leave scars on an otherwise normal breast. Your New Look Your reconstructed breast may feel firmer and look rounder or flatter than your natural breast. It may not match your opposite breast exactly but these differences will be only apparent to you. For most mastectomy patients, breast reconstruction improves their appearance and quality of life following surgery dramatically. | |||||||||||||
