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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 appearance to matching a natural breast.

WHO ARE 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 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 to wait.

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 an implant.

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 reconstruction.

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.

THE PROCEDURE

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 saline.
There are many options available in post-mastectomy reconstruction:

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 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 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.


Follow-up procedures

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.

Reconstruction 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 surgery.

 
 

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