Back |
Breast Reconstruction
Breast reconstruction is a physically and emotionally rewarding procedure for a woman who has lost a breast due to cancer. Reconstruction can create a new breast and dramatically improve a woman’s self-image, self-confidence and quality of life. The results of breast reconstruction can be relatively natural in appearance and feel; however, a reconstructed breast will never look or feel exactly the same as the breast that was removed.
Breast reconstruction typically involves several procedures performed in multiple stages. It can begin at the same time as the mastectomy or may be delayed until the patient has healed from the mastectomy and recovered from any additional adjuvant cancer treatments that may be necessary.
Breast reconstruction is achieved through several reconstructive plastic surgical techniques that attempt to restore a breast to near normal shape, appearance and size following the mastectomy. These may include:
- Flap techniques that reposition a woman’s own muscle, fat and skin to create a breast mound
- Tissue expansion that stretches healthy skin to provide coverage for a breast implant
- Surgical placement of a breast implant to create a breast mound
- Grafting and other specialized techniques to create a nipple and areola
While breast reconstruction can effectively rebuild a woman’s breast, the results are highly variable. A reconstructed breast will not have the same sensation and feel as the breast it replaces. Visible incision lines will always be present on the breast, whether from reconstruction or mastectomy. In addition, flap techniques will leave incision lines at the donor site, commonly located in less exposed areas of the body such as the back, abdomen or buttocks. In addition, a breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry.
Techniques
Breast reconstruction is a highly individualized procedure. Techniques vary depending upon the patient’s anatomy, size of the opposite breast and the availability of donor sites.
Flap techniques may result in a more natural feeling breast and are necessary when little tissue or muscle remains following the mastectomy. A latissimus dorsi flap uses muscle, fat and skin tunneled under the skin and tissue of a woman’s back to the reconstructed breast, and remains attached to its donor site, leaving it’s blood supply intact. Occasionally the flap can reconstruct a complete breast mound, but more commonly it provides the muscle and tissue necessary to cover and support a breast implant.
A TRAM Flap uses donor muscle, fat and skin from a woman’s abdomen to reconstruct the breast. The flap may either remain tethered to the original blood supply and be tunneled up through the chest wall, or it is completely detached and formed into a breast mound using microsurgical techniques.
Sometimes a mastectomy leaves insufficient tissue on the chest wall to cover and support a breast implant. Reconstruction with tissue expansion allows easier recovery than the flap procedures, but it is a more lengthy reconstructive process. Office visits over several months after placement of the expander are necessary to slowly fill the device through an internal valve to expand the skin and create adequate healthy tissue. A second surgical procedure will then be needed to replace the expander with a permanent implant.
Breast reconstruction is completed through techniques that reconstruct the nipple and areola. Complete reconstruction generally occurs in multiple procedures over several months’ time.
Possible risks of breast reconstruction include bleeding, infection or poor healing. Flap surgery includes the risk of extreme tissue loss and a loss of sensation at both the donor and reconstructive site. The use of implants carries the risk of breast firmness (capsular contracture) and implant rupture.
It is important to understand that breast reconstruction can produce remarkable results; however, it cannot exactly match a breast lost to mastectomy. Even with revision procedures on the opposite breast, symmetry between the breasts will not be perfect.
The surgical procedures involved in breast reconstruction are most often performed in a hospital setting, possibly requiring a hospital stay. Initial reconstruction procedures are most commonly performed under general anesthesia. Some procedures may be performed on an outpatient basis, and local anesthesia with sedation may be used for certain follow-up procedures.
Following Surgery
Following surgery, gauze or bandages will be applied to your incisions. A small thin tube may be temporarily placed under the skin to drain any excess blood or fluid.
Initial healing from breast reconstruction will include swelling and discomfort at the donor site for flap techniques. Medication may be prescribed to control the discomfort. In many cases, non-removable, absorbable sutures are used for closure in flap techniques or with implant insertion. If removable sutures are used, these will be removed within two weeks following surgery. Healing will continue for several weeks as swelling dissipates and breast shape and position refine.
Over time, some breast sensation may return and scar lines will improve, although never disappear completely. 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 again. Careful monitoring of breast health through self-exam, mammography and other diagnostic techniques is essential to a patient’s long-term health.
Back |