Besides skin cancer, breast cancer is the most commonly diagnosed cancer among U.S. women, with an incidence of 1 in 8 women…a whopping 13%. Hearing a diagnosis of cancer is frightening and the concern for your health can overshadow the emotions that come with losing a breast. Living a cancer-free life is the most important goal, however wanting to hold onto your femininity is just as essential to your well being. If your breast surgeon recommends a mastectomy (removal of breast tissue to treat the cancer) then in most cases breast reconstruction is an option.
Breast reconstruction is a physically and emotionally rewarding procedure for a woman who has lost a breast due to cancer. In creating a new breast, one’s self-image, self-confidence, and quality of life can dramatically improve.
Breast reconstruction is achieved through several plastic surgery techniques that attempt to restore a breast to near normal shape, appearance, and size following mastectomy. It can be performed at the same time as the mastectomy (“Immediate”) or after (“Delayed”). The timing of reconstruction depends on your situation and the treatment plan you will have after surgery decided upon by your breast surgeon and oncologist.
Regardless of whether an immediate or delayed technique is utilized, the approach to breast reconstruction will be tailored to the individual needs and medical history of the patient. It is important to understand that it may take multiple surgeries over several months to achieve the final aesthetic result that is desired. The ultimate goal is to create a natural looking breast, lessening the physical and emotional impact of the mastectomy.
Breast Reconstruction with Breast Implants
The surgeon places a temporary implant between layers of chest muscle and skin, forming a skin-muscle envelope. Over a period of months, saline solution is injected to slowly expand the overlaying skin until the desired size of the final implant is reached. Once achieved, as an outpatient surgery, the expander is removed and replaced with a permanent implant, either saline-filled or silicone-filled.
Acellular Dermal Matrix
This technique creates a “hammock” under the envelope from donated tissue (acellular dermal matrix) with the chest muscles to hold the implant or expander in place, allowing a larger breast mound to be created at the time of the mastectomy. Under ideal conditions, an expander is not needed and the final implant can be placed in to the created “hammock” and no further surgery is needed.
This form of reconstruction uses tissue from other parts of the body to rebuild the breast mound requiring two surgical sites; the donor site and the mastectomy site.
Latissimus Dorsi Muscle Flap
This procedure removes a large back muscle, latissimus dorsi, skin, and underlying fatty tissue to reconstruct the breast. It is tunneled into the breast tissue beneath the armpit will remaining attached to its blood supply. The flap itself is only one inch thick, therefore, an implant is usually required to make the reconstructed breast match the size of the opposite breast.
Transverse Rectus Abdominis Myocutaneous Flap (TRAM)
This procedure uses skin, muscle tissue, and fat from the lower abdomen to reconstruct the breast. The flap may either remain attached to its original blood supply and tunneled under the skin to the breast area or be completely detached (free flap) and formed into a breast mound. This procedure typically does not require an implant.
In contrary to a TRAM flap, a DIEP (Deep Epigastric Artery Perforator) flap uses skin and fatty tissue from the lower abdomen, however sparing the abdominal muscles.
Nipple Areola Reconstruction
Nipple and areola reconstruction is the final phase of the long journey of breast reconstruction. It is usually done after the new breast has had time to heal. This tissue used to rebuild the nipple is taken from the newly created breast. Tattooing may be done to match the color of the other breast to create the areola.
Although breast reconstruction can rebuild a breast, the results are highly variable. A reconstructed breast will not have the same sensation and feels as the breast it replaces. In addition, a reconstructed breast will never look exactly the same as the breast removed. If only one breast is affected, it alone may be reconstructed, often leading to asymmetry. Therefore, a breast lift, reduction, or augmentation may be recommended for the opposite breast to improve symmetry of the size and position of both breasts.
Breast reconstruction can help a woman feel more comfortable, improving her self-esteem and body image, while maintaining here sense of self and femininity.