A woman who must undergo total or partial removal of a breast as a result of cancer simultaneously faces the threat of the disease and the loss of an important part of her feminine self-image. However, new medical techniques make it possible for surgeons to create a breast that comes close in form and appearance to a natural breast. Post-mastectomy reconstruction, a remarkable surgical procedure, cannot only restore the form and appearance of a woman’s breasts but can also dramatically improve self-esteem and self-confidence.
If you anticipate undergoing a mastectomy, you may want to discuss the possibility of having reconstructive surgery performed at the same time. In some cases it may be necessary, however, to delay the surgery for several months after the mastectomy. Discuss the most favorable time to perform reconstructive breast surgery with your doctors. Ideally, you want your oncologist and your plastic surgeon to work together to formulate a strategy that puts you in the best possible condition for reconstruction.
About the Procedure
Breast reconstruction is usually performed in a hospital setting under general anesthesia.
Skin expansion is the most common technique used in post-mastectomy reconstruction. A tissue expander, or plastic balloon, is placed beneath the chest wall muscles. This technique combines skin expansion and the subsequent insertion of an implant (a silicone shell filled with either silicone gel or with saline).
Through a tiny valve mechanism buried beneath the skin, a salt-water solution is injected to gradually fill the tissue expander over a period of several weeks or months. When the skin over the breast area has stretched enough, the expander is removed in a second procedure and a more permanent implant inserted. Some patients do not require preliminary tissue expansion before receiving an implant. In that case, your surgeon will insert an implant at a single setting.
In another approach, for the patient whose skin is too tight or thin to accommodate an implant, the surgeon creates a skin flap using tissue taken from other parts of the body, such as the back, abdomen, or buttocks. This is then inset into the breast area.
In one type of flap surgery, the tissue remains attached to its original blood supply. The flap, which includes skin and muscle, is taken from either the back or the abdomen and tunneled through to the chest wall to reconstruct the breast. An implant may also be used to add additional volume.
Muscle and skin taken from the abdomen, thighs or buttocks may also be used as a “free” flap. In this procedure, the flap is completely detached from it original site, placed in the breast area, and connected to the breast blood vessels. This procedure requires a plastic surgeon that is experienced in microvascular surgery as well as breast reconstruction.
Flap surgery is more complex than skin expansion. Scars will be left at both the tissue donor site and the reconstructed breast. Recovery usually takes longer, and there are increased risks and complications. However, the results may seem more natural, and it does eliminate concerns about using a silicone implant. In some instances, you may have the added benefit of an improved abdominal contour.
For the patient who has adequate skin cover, an implant may be all that is necessary. With this procedure, part of the mastectomy incision is usually re-opened and a pocket is created beneath the chest wall muscles. A breast implant is then inserted, and sutures are used to close the incision.
Most breast reconstruction involves a series of procedures occurring over time. For example, reconstruction of the nipple is done at a later time. Skin and tissue from the nipple and areola (dark, pink skin surrounding the nipple) of the other breast, the thigh or other parts of the body may be used.
Recovery and Healing
Depending on the type of procedure you have, you may go home the day of surgery or it may require two to five days’ hospitalization with bed rest and limited activities. Recovery from a combined mastectomy and breast reconstruction or from a flap reconstruction alone may take up to six weeks. If implants are used without flaps and the reconstruction is done separately from the mastectomy, your recovery time will be shortened.
You may experience minimal to moderate pain in both the breast and donor areas. This discomfort can normally be controlled with oral medication prescribed by your doctor. Antibiotics may be used to prevent infection. There are certain inherent risks associated with every surgical procedure. These should be thoroughly discussed with you prior to surgery. Patients can minimize complications by carefully following their physician’s directions.