Breast Reconstruction following Mastectomy
Breast reconstruction is a physically and emotionally rewarding procedure for a woman who has lost a breast due to cancer or other disease. Reconstruction of a breast that has been partially or completely removed is possible through a combination of plastic surgery techniques that not only creates a new breast but also can 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 mastectomy or may be delayed until a patient has healed from mastectomy and recovered from any additional cancer treatments that may be necessary. It is important that a woman feel ready for the emotional adjustment involved; much like losing a breast, it takes some time for a woman to accept the results of breast reconstructive surgery.
Breast surgery types:
What is breast reconstruction?
Breast reconstruction is achieved through several reconstructive plastic surgery techniques that attempt to restore a breast to near normal shape, appearance and size following mastectomy and may include:
- Flap techniques that reposition a woman’s own muscle, fat and skin to create or cover the 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.
Where only one breast is affected, it alone may be reconstructed. In addition, a breast lift, breast reconstruction or breast augmentation may be recommended for the opposite breast to improve symmetry in the size and position of both breasts.
Through the advocacy efforts of the American Society of Plastic Surgeons® (ASPS Surgeons®) and breast cancer support groups, insurance companies are now required by law to provide coverage for breast reconstruction and related procedures to adjust the opposite breast. Pre-certification may be required.
Good candidates for breast reconstruction are women who are:
- Able to cope well with their diagnosis and treatment
- Do not have additional medical conditions or other illnesses that may impair healing
- Individuals with a positive outlook and realistic goals for restoring their breast and body image
Flap procedures may not be appropriate for some women with conditions such as obesity, heart disease and diabetes.
Your breast reconstruction
Breast reconstruction is a highly individualized procedure. Techniques offer varying advantages and choosing the appropriate course of treatment requires careful consideration of patient anatomy, patient and surgeon preference and desired, realistic outcomes.
Flap techniques may result in a more natural feeling breast and are necessary when little tissue or muscle remains following mastectomy. Incision lines appear at both the donor and reconstruction sites and a lengthy recovery follows. There is also a remove chance of partial or full loss of the flap due to poor healing.
Sometimes a mastectomy initially leaves insufficient tissue on the chest wall to cover and support a breast implant. The use of a breast implant for reconstruction almost always requires either a flap technique or tissue expansion. Reconstruction with tissue expansion allows an easier recovery than flap procedures, but it is a more lengthy reconstruction process. Many office visits over 4-6 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 be needed to replace the expander if it is not designed to serve as a permanent implant.
Breast reconstruction is completed through techniques that reconstruct the nipple and areola (the darker skin surrounding the nipple). Breast reconstruction may be performed at one time or over an extended period, depending on the techniques used, your breast cancer treatment, and the pace at which you wish to achieve your results. Complete reconstruction generally occurs in multiple procedures occurring over several months’ times.