Breast Reconstruction

Breast reconstruction patients are most often women who have undergone a Mastectomy, or the removal of a breast, due to cancer. Advances in technology have allowed surgeons to reconstruct a breast that is almost identical to the patient’s natural breast. It will never be exactly the same, but human features are rarely symmetrical to begin with.

Breast reconstruction, while almost always used after mastectomies, can also be used for those women who suffer birth defects or other abnormalities that hinder normal breast development. It is important for all patients to remember that reconstructive surgery is a complicated process that oftentimes involves multiple surgeries and several months of recovery time. However, those who undergo the process have been overjoyed with their results.

Planning

For all breast reconstruction patients, a lot of thinking and planning will go into the procedure. Many women diagnosed with breast cancer start thinking about reconstructive surgery right away. Most patients will have their breast surgeon and their plastic surgeon working together to ensure that after the mastectomy, immediate reconstruction can begin. Many patients are even combining their mastectomy and the first stage of breast reconstruction into the same surgery.

For those patients suffering birth or other growth defects, it is important to sit down with a doctor and talk through all of your options. Determining the shape and size you want to achieve will help to decide which method of reconstruction will be best for you. Knowing all your options will help you make the best decision possible.

The Procedures

There are two main procedures that surgeon’s use to perform breast reconstruction. Both can be very beneficial depending on the patient and their desired outcome. The two procedures are tissue expansion and flap reconstruction.

Tissue Expansion

Tissue expansion is a procedure that enables the body to grow extra skin that can be used to reconstruct almost any part of the body. This procedure stretches the skin much like a pregnancy stretches a woman’s abdomen. The surgeon will make a small incision in the skin very near to the breast that is in need of repair. The skin will be lifted in order to create a pocket. A silicone bag, or balloon expander, is then placed inside the pocket under the skin. This expander includes a tiny tube and a self sealing valve. Sometimes the tube will stick out from the incision, and other times it will be directly under the skin.

After the incision is healed, the patient will be allowed to return home, but will continue regular visits to the surgeon. Over a period of weeks or months, the silicone bag will be gradually filled with a saline solution. As the bag slowly gets larger, the skin will expand to accommodate it. Once the new skin has grown large enough, the surgeon can move on to the second part of the surgery which involves removing the bag and replacing it with a surgical implant.

Flap Reconstruction

This procedure involves creating a skin flap of tissue that is taken from another part of the body. Surgeon’s most often use the back, abdomen or buttocks. Flap surgery transfers skin along with underlying blood vessels, nerve endings, fat and sometimes even muscle from a healthy part of the body to the breast. The new vessels are reattached to the vessels under the breast using microvascular techniques in order to reinstate microcirculation. The new skin creates a pocket for which an implant can be inserted.

This procedure does leave more scaring than the tissue expansion procedure. It leaves scars at the donor site as well as at all reconnective sites surrounding the breast. This procedure can be more beneficial to some patients however, because it does provide quicker results.

Follow-ups

Breast reconstruction almost always involves more than one operation. Many patients will undergo the initial tissue expansion or flap reconstruction surgeries in order to reconstitute the breast’s shape. Once the skin and surrounding areas have healed, patients will then go in for a second surgery that will reconstruct the areola and nipple on the breast. Some will even undergo a third procedure which will enlarge, reduce or lift the natural breast so that it can more evenly match the reconstructed breast.

Will It Hurt?

Reconstructive surgeries will almost always be performed in the hospital. After the procedure, the surgeon may place small tubes in the reconstructed breast for up to a week to drain excess blood and fluids. Most patients are released from the hospital anywhere from 2 to 5 days after the surgery. The stitches will either dissolve or be removed in a week to 10 days afterward.

Patients will feel pain and discomfort for up to 6 weeks after surgery but surgeons will prescribe medication that can reduce this. Strenuous movement, coughing, lifting and other actions will cause pain and may inhibit healing. It is important to take it easy for a while in order to allow the tissue to heal. Reconstruction procedures cannot restore sensations to the breast, but in time, some patients have had some feeling return. Scars will fade over time but healing process can take as long as 2 years.

Risks

Like any surgical procedure, there are several risks involved in reconstructive breast surgery. When dealing with tissue expansion and implants, the risks include:

Surgery can be performed to loosen tightened scar tissue, and implants can always be replaced, but that involves more surgery and more down time. When dealing with flap reconstruction, the risks include:

If the reconstructed skin and tissue die, the patient will need to undergo a second flap surgery to either try again or remove the dead skin. Tissue expansion can be a better alternative because the skin grown is already attached to muscle, fat and vessels.

Results

Your reconstructed breast will never be the same as your natural breast. The reconstructed breast will almost always feel firmer or look either rounder or flatter; never exactly matching your opposite breast. These changes are nothing to worry about because they will almost always be apparent only to you. For most mastectomy patients as well as those with physical deformities, breast reconstruction surgery can dramatically improve appearance and overall quality of life.