Breast Reconstruction

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 appearance to matching a natural breast. Frequently, reconstruction can be begun at the same operation as the breast removal (mastectomy), so the patient wakes up with a tissue expander or implant already in place.

But bear in mind, post-mastectomy breast reconstruction is not a simple procedure. It takes a series of steps to attempt to restore a breast to near normal shape, appearance and size following mastectomy.

Although Breast Reconstruction can rebuild your 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.
• Certain surgical 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.

A note about symmetry: If only one breast is affected, it alone may be reconstructed. In addition, a breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry of the size and position of both breasts. In any case the two breasts will never be mirror images of each other.

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.

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.

All Surgery Carries Some Uncertainty and Risk

Virtually any woman who must lose her breast to cancer can have it rebuilt through 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, wound healing problems, or difficulties with anesthesia, can occur although they're relatively uncommon. And, as with any surgery, smokers should be advised that nicotine can delay healing, resulting in conspicuous scars and prolonged recovery. Occasionally, these complications are severe enough to require a second operation.

If an implant is used, there is a remote possibility that an infection will develop, usually within the first two weeks following surgery. In some of these cases, the implant may need to be removed for several months until the infection clears. A new implant can later be inserted.
The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can 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. Your surgeon may recommend continuation of periodic mammograms on both the reconstructed and the remaining normal breast. 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.

Women who postpone reconstruction may go through a period of emotional readjustment. Just as it took time to get used to the loss of a breast, a woman may feel anxious and confused as she begins to think of the reconstructed breast as her own.

Planning Your Surgery

You can begin talking about reconstruction as soon as you're diagnosed with cancer. Your breast surgeon and Dr. Sholar will work together to develop a surgery plan just for you.
After evaluating your health, Dr.Sholar will explain which reconstructive options are most appropriate for your age, health, anatomy, tissues, and goals. She will be frank with you, describing your options and the risks and limitations of each kind of reconstruction.

Post-mastectomy reconstruction can improve your appearance and renew your self-confidence -- but keep in mind that the desired result is improvement, not perfection.

Preparing For Your Surgery

Your oncologist and Dr. Sholar will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications.

While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.

Where Your Surgery Will Be Performed

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 in a hospital. Follow-up procedures may also be done in the hospital. Or, depending on the extent of surgery required, your surgeon may prefer an outpatient facility.

The Surgery

Skin Expansion & Implant

The most common technique combines skin expansion and subsequent insertion of an implant. Following mastectomy, your surgeon will insert a balloon expander beneath your skin and chest muscle. Through a tiny valve mechanism buried beneath the skin, Dr. Sholar 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.  The nipple and the dark skin surrounding it, called the areola, are reconstructed in  subsequent smaller procedures.

Implant Reconstruction

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 or abdomen.  This is often used if the chest tissue has had radiation treatments.

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. 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 and may not ensure complete symmetry.

After Your Surgery

You are likely to feel tired and sore for a week or two after reconstruction. Most of your discomfort can be controlled by medication prescribed by your doctor.

Depending on the extent of your surgery, you'll probably be released from the hospital in one to five days. Many reconstruction options require a surgical drain to remove excess fluids from surgical sites immediately following the operation, but these are removed within the first week or two after surgery.

Getting Back to Normal

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, but they'll never disappear entirely. The better the quality of your overall reconstruction, the less distracting you'll find those scars.

Follow your surgeon's advice on when to begin stretching exercises and normal activities. As a general rule, you'll want to refrain from any overhead lifting, strenuous sports, and sexual activity for three to six weeks following reconstruction.

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. But these differences will be apparent only to you. For most mastectomy patients, breast reconstruction dramatically improves their appearance and quality of life following surgery.

 

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