A surgical procedure designed to restore the shape and appearance of a breast or both breast following its removal, frequently as a result of breast cancer.
The objective of breast reconstruction is to restore one or both breasts to a condition that closely resembles normal shape, appearance, symmetry, and size following procedures such as mastectomy, lumpectomy, or in cases of congenital deformities.
Breast reconstruction typically involves multiple procedures conducted in stages and may either commence concurrently with the mastectomy or be deferred to a later date.
This reconstructive process is generally classified into two primary categories: implant-based reconstruction and flap reconstruction. Implant-based reconstruction utilizes breast implants to create a new breast mound, whereas flap reconstruction, also referred to as autologous reconstruction, employs the patient’s own tissue harvested from another area of the body to form a new breast.
Several factors must be considered when determining the most appropriate reconstructive option:
– Type of mastectomy
– Cancer treatments received
– The patient’s body type
In instances where only one breast is affected, reconstruction may be performed solely on that breast. Additionally, procedures such as breast lift, breast reduction, or breast augmentation may be recommended for the contralateral breast to enhance the symmetry of size, shape, and positioning of both breasts.
Breast reconstruction is a personal procedure that should be pursued for your own reasons rather than to meet external expectations or ideals. Good candidates for breast reconstruction typically cope well with their diagnosis and treatment and do not have other medical conditions that could hinder healing. A positive attitude and realistic goals regarding the restoration of breast and body image are also important.
It’s important to note that while breast reconstruction can restore the appearance of a breast, the results can vary significantly. Additionally, reconstructed breasts may lack the same sensation as natural breasts, and visible incision lines will remain, whether from the reconstruction itself or a prior mastectomy.
– Breast reconstruction aids in restoring body image and self-esteem after breast cancer.
– Significantly boosts confidence in women undergoing the procedure and clothes fit better
– The primary goal is to achieve symmetry, particularly for those with unilateral mastectomy and eliminate prosthetics.
– Positively impacts overall well-being and self-perception.
– General surgical risks: infection, bleeding, pain, and anesthesia-related issues
– Specific complications: implant rupture and flap failure. Multiple surgeries may be required, particularly with flap techniques
– Potential for extended hospital stays and recovery periods
– Delays in returning to daily activities, work, and exercise
– Individual recovery timelines can vary significantly
Anesthesia
Breast reconstruction involves a series of important steps, starting with anesthesia to ensure patient comfort, which may include intravenous sedation or general anesthesia as recommended by the doctor.
Flap/ Tissue coverage
In cases where a mastectomy or radiation therapy has left inadequate tissue on the chest wall, flap techniques or tissue expansion are typically employed to create or cover the breast mound.
Flap methods:
Tissue flaps often provide a more natural look and feel compared to implants. They can change size in response to the body’s natural fluctuations, unlike implants. For patients who have undergone unilateral mastectomy, tissue flaps can better match the appearance of the natural breast and age in a manner similar to natural breasts and assist in achieving a desirable breast contour, eliminating the need for an external prosthesis.
Tissue expansion
Tissue expansion is a method employed to stretch healthy skin in order to provide adequate coverage for a breast implant. For women who do not require radiotherapy for breast cancer and wish to avoid an additional donor site, implant-based reconstruction presents a viable option. While reconstruction utilizing tissue expansion typically allows for a more straightforward recovery compared to flap procedures, it may entail a more protracted overall reconstruction process.
This technique generally necessitates several office visits over a period of one to two months following the placement of the expander. During these visits, the device is gradually filled with saline through an internal valve to facilitate skin expansion. Recent advancements have introduced air-filled devices that may enable patient-controlled expansion at home via a remote dosage controller.
Should the expander not be designed as a permanent implant, a subsequent surgical procedure will be required to replace it.
Placement of a Breast Implant
The surgical placement of a breast implant serves to create a breast mound. An implant can be utilized as an adjunct or alternative to flap techniques. Surgeons may also opt to use an implant as a temporary solution during other breast cancer treatments until the patient is prepared for more complex flap reconstruction techniques. Both saline and silicone implants are available for reconstruction purposes.
Your surgeon will provide guidance to determine the most appropriate option for your specific circumstances. Reconstruction utilizing solely an implant typically necessitates tissue expansion, although direct-to-implant breast reconstruction may be a suitable alternative for certain women undergoing mastectomy, particularly those with specific tumor characteristics and breast shapes.
Reconstruction of the Nipple and Areola
For women who are not suitable candidates for nipple-sparing mastectomy, breast reconstruction is completed through a variety of techniques aimed at reconstructing the nipple and areola. These techniques often involve folding skin to create a nipple shape, followed by tattooing. Three-dimensional nipple-areolar tattooing may be employed independently to simulate the appearance of a realistic nipple with the illusion of projection.
Moreover, the outcomes of breast reconstruction can frequently be enhanced through staged revision procedures that improve symmetry, incorporate liposuction with fat grafting, and refine the appearance of the donor site.
After your breast reconstruction surgery involving flap techniques or breast implants, gauze or bandages will likely be placed over your incisions. To reduce swelling and provide support, an elastic bandage or support bra will be used.
A small tube may also be inserted temporarily to drain excess blood or fluid. You’ll receive detailed instructions on caring for your surgical site, medications for healing and infection prevention, and signs to monitor for concerning changes.
It’s important to ask your plastic surgeon any questions about your recovery, as healing will take several weeks while swelling decreases and breast shape improves; make sure to follow their guidance and attend follow-up appointments.
Breast reconstruction results after mastectomy can significantly reduce both the physical and emotional effects of the procedure. While some sensation in the breast skin may gradually return and scars may fade over time, they will not completely disappear.
Many women find the trade-offs associated with reconstruction to be minimal compared to the substantial enhancement in their quality of life and sense of wholeness.
It is crucial to maintain vigilant monitoring of breast health through self-examinations and other diagnostic methods. This careful approach is vital for ensuring long-term well-being.
Choosing to undergo breast reconstruction does not alter the likelihood of breast cancer returning. Patients should be informed of various risks associated with the procedure, such as bleeding, infection, poor incision healing, and anesthesia complications.
Flap surgery may result in partial or complete loss of the flap and diminished sensation at both the donor and reconstruction sites.
Breast implants carry specific risks:
Breast reconstruction surgery typically takes place in a hospital and may require a brief hospital stay. General anesthesia is commonly used during the procedure. Some follow-up treatments can be done on an outpatient basis, potentially utilizing local anesthesia with sedation. The choice of anesthesia and setting will depend on the specifics of your procedure. Ultimately, these decisions will reflect your personal preferences and your doctor’s professional assessment.
The Women’s Health and Cancer Rights Act, enacted in 1998, mandates that all group health plans covering mastectomies must also include coverage for reconstructive surgery and other related benefits, such as external breast prostheses and lymphedema treatment.
Breast reconstruction following a mastectomy is recognized as a reconstructive procedure that should be covered by health insurance. However, it’s important to note that insurance coverage may only cover a portion of the total costs associated with the procedure. To avoid unexpected expenses, it is advisable to consult with your insurance company before undergoing any surgery. Understanding your coverage will help you navigate the financial aspects of your treatment effectively.
