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 appearance to
matching a natural breast.
WHO ARE THE BEST CANDIDATES FOR
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 have been eliminated by mastectomy.
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
any 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
ALL SURGERY CARRIES SOME RISK
Virtually any woman who
must have mastectomy can undergo reconstructive surgery.
But there are risks associated with any surgery and
specific complications associated with this procedure.
In general, the usual
problems of surgery, such as bleeding, fluid collection,
excessive scar tissue, or difficulties with anesthesia,
can occur although they're relatively uncommon. If an
implant is used, a scar or capsular contracture may
form around the implant and cause the breast to feel
hard. Capsular contracture can be treated in several
ways, and sometimes requires either removal or "scoring"
of the scar tissue, or perhaps removal or replacement
of the implant.
Reconstruction has no
known effect on the recurrence of disease in the breast,
nor does it generally interfere with chemotherapy or
radiation treatment, should cancer recur. Periodic mammogram
on both the reconstructed and the remaining normal breast
is not a problem. If your reconstruction involves an
implant, be sure to go to a radiology center where technicians
are experienced in the special techniques required to
get a reliable x-ray of a breast reconstructed with
PLANNING YOUR SURGERY
You can begin talking
about reconstruction as soon as you're diagnosed with
cancer. Ideally, you'll want your breast surgeon and
your plastic surgeon to work together to develop a strategy
that will put you in the best possible condition for
After evaluating your
health, we will explain which reconstructive options
are most appropriate for your age, health, anatomy,
tissues, and goals. Risks and limitations of each will
also be discussed in detail. Post-mastectomy reconstruction
can improve your appearance and renew your self-confidence.
Breast reconstruction usually involves
more than one operation. The first stage, whether done
at the same time as the mastectomy or later on, is usually
performed as an inpatient procedure. Any follow-up procedures
may also be done in the hospital, or depending on the
extent of surgery required, the patient may be discharged
the same day.
The first stage of reconstruction, the
creation of the breast mound, is almost always performed
using general anesthesia. Follow-up procedures may require
only local anesthesia, combined with a sedative.
If the use of a breast implant is required,
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 a salt-water solution known as
There are many options available in post-mastectomy
Skin expansion: The
most common technique combines skin expansion and subsequent
insertion of an implant.
Following mastectomy, a balloon expander
is inserted beneath your skin and chest muscle. Through
a tiny valve mechanism buried beneath the skin, salt
water solution will be periodically injected to gradually
fill the expander over several weeks. 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.
Some patients do not require
preliminary tissue expansion before receiving an implant.
For these women, an implant can be inserted as the first
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 need for an implant.
Another flap technique
called microvascular free flap, uses tissue that is
surgically removed from the abdomen, thighs, or buttocks
and then transplanted to the chest by reconnecting the
blood vessels to new ones in that region.
Flap surgery is more complex
than skin expansion and scars will be left at both the
tissue donor site and at the reconstructed breast. Recovery
will also 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.
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. An additional operation to
enlarge, reduce, or lift the opposite natural breast
to match the reconstructed breast may be required.
WHAT WILL MY RECOVERY BE LIKE?
You are likely
to feel tired and sore for a week or two after reconstruction.
Most of your discomfort can be controlled by medication.
Depending on the extent of your surgery, you'll probably
be released from the hospital in two to five days. Most
stitches are removed in a week to 10 days.
It may take
you up to six weeks to recover from a combined mastectomy
and reconstruction or from a flap reconstruction alone.
If implants are used without flaps and reconstruction
is done apart from the mastectomy, your recovery time
may be less.
cannot restore normal sensation to your breast, but
in time, some feeling may return. Most scars will fade
substantially over time, though it may take as long
as one to two years. As a general rule, you'll want
to refrain from any overhead lifting or strenuous sports,
for three to six weeks.
YOUR NEW LOOK
Chances are your reconstructed
breast may feel firmer and look rounder or flatter than
your natural breast. It may not have the same contour
as your breast before mastectomy, nor will it exactly
match your opposite breast. You may require procedure
on the opposite breast to restore symmetry. For most
mastectomy patients, breast reconstruction dramatically
improves their appearance and quality of life following