Click Here to View GalleryBreast reconstruction is a physically and emotionally rewarding procedure for a woman who has lost a breast due to cancer or other condition. The creation of a new breast can dramatically improve your self-image, self-confidence and quality of life. 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. To find out what options are available to you, a consultation at Advanced Plastic Surgery Center with one of our board certified plastic surgeons will provide you the answers.
A consultation with one of our board certified plastic surgeon is the first step to learn how breast reconstruction can restore the breast’s appearance. A consultation is designed to fully educate you about your options for breast reconstruction in a supportive environment and will include:
- A discussion of patient goals and an evaluation of the individual case
- The options available in breast reconstruction surgery
- The likely outcomes of breast reconstruction and any risks or potential complications
- The course of treatment recommended
Breast Reconstruction Options
It is important to understand that breast reconstruction is a highly individualized procedure. In addition, 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 a patient has healed from the mastectomy and recovered from any additional cancer treatments that may be necessary.
Techniques offer varying advantages, and choosing the appropriate course of treatment requires careful consideration of patient anatomy, patient and surgeon preference and desired, realistic outcome. Since there are many different body types and many different types of surgery for treatment of breast cancer, there are many options in reconstruction.
- Deformity of the breast may be treated by local surgery to rearrange the remaining tissue.
- If a patient is large breasted, a breast reduction may be performed.
- If a patient is small breasted, an implant may be placed to fill the defect.
- A defect may be filled by fat transfer (fat grafting) where fat is removed from one area and filled back into the breast.
- If significant injury or deformity is present (especially with significant radiation,) a muscle flap may be needed borrowing healthy tissue from the back (latissimus dorsi muscle flap) or abdomen (transverse abdominus muscle flap.)
- Reconstruction may be coordinated at same time as the mastectomy.
- Reconstruction may be done in a delayed fashion, at any point after the mastectomy has been performed, from perhaps 3 months later, to as far as 20 years later. It’s never really too late.
- Sometimes a mastectomy initially leaves insufficient tissue on the chest wall to cover and support a breast implant, and therefore an acellular dermal matrix (donated human tissue from which the cells have been removed), flap technique, or tissue expansion may be needed. Reconstruction with tissue expansion requires follow-up offices visits over a 4-6 month period to allow slow filling of the expander through an internal valve to expand the skin and create adequate healthy tissue. Expansion begins once the surgical site is well healed, typically at week three, and occurs either weekly or every other week. In some cases, a permanent implant can be placed instead of a tissue expander, which will be decided by your surgeon.
- Certain cases will require healthy muscle and skin to be transferred from the back (latissimus dorsi muscle flap) or abdomen (transverse abdominus muscle flap), with or without the use of an implant. Flap techniques are necessary when little tissue or muscle remains following mastectomy. Incision lines appear at both the donor (where the tissue was taken from) and reconstruction sites. There is also a remote chance of partial or full loss of the flap due to poor healing.
Matching the opposite breast:
With many of our reconstruction techniques, there is not a way to create a near identical match to the opposite side, especially when that breast may be very large or exhibit a fair bit of ptosis (sagginess). Therefore, we will often incorporate surgery on the opposite breast at the same time.
- This surgery may be simply a lift procedure if the size is right.
- If the breast is very large, it may be reduced and lifted at the same time.
- If the breast is small, it may be complemented with an implant to enhance the size.
It is important to understand that all surgeries on the opposite breast are designed to create ideal symmetry and are NOT absolutely necessary but often simply recommended for optimal results. Additionally any tissue removed is always sent for pathology to ensure that tissue is checked for cancer as well. In addition, since these matching procedures allow for breast symmetry, they are considered part of the breast reconstruction process and therefore covered by your insurance.
The surgical techniques involved in breast reconstruction are most often performed in a hospital setting, either as an outpatient, 23 hour stay, or short hospital stay dependent on the chosen procedure.
Following breast reconstruction, one or multiple drainage tubes, which are placed under the skin, are used to drain any excess blood or fluid. These tubes are maintained for approximately 7-14 days after surgery and are removed in the office at a follow-up visit. Oral antibiotics are continued while the drains are in place.
It is important to understand that recovery is different for every individual. Initial healing from breast reconstruction will include swelling and discomfort. Healing will continue for several weeks as swelling dissipates and breast shape and position refine.
While breast reconstruction can effectively rebuild a woman’s breast, the results are highly variable. Although surgery can give you a relatively natural-looking breast, a reconstructed breast will never look or feel exactly the same as the breast that was removed. 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, either from the reconstruction or mastectomy.
Rest assured that you will be well informed and well taken care of at Advanced Plastic Surgery Center with our board certified plastic surgeons, Dr. Thornton and Dr. Chang. Please call today to find out how we can help you feel whole once again as you are living with your breast cancer. If you have just been diagnosed, we can help lay out a plan that will often begin the day of your cancer surgery treatment. Or perhaps it has been months or even years since your treatment and now you’re ready to get your body and breast back after cancer.