Orange County, California
Breast Reconstruction
Reconstruction of a breast that has been removed due to cancer or other disease can help improve your appearance and renew your self-confidence.
New medical techniques have made it possible for surgeons to create a breast that closely matches the existing natural breast. Frequently, reconstruction is possible immediately following breast removal (mastectomy). The patient can wake up with a breast mound already in place and spare herself the experience of seeing no breast at all.
Who’s a Candidate?
The best candidates are women whose cancer, as far as can be determined, has been eliminated by mastectomy. The surgeon may advise you to wait on reconstruction, particularly if the breast is being rebuilt in a more complicated procedure using flaps of skin and underlying tissue.
What Are the Risks of Breast Reconstruction?
Although fairly uncommon, general surgical complications can include bleeding, fluid collection, excessive scar tissue or difficulties with anesthesia.
If implants are used, there is the possibility that an infection may develop. In these cases, the implant may need to be removed. The most common problem is capsular contracture, when the scar around the implant begins to tighten.
Reconstruction has no known effect on the recurrence of disease in the breast, nor does it interfere with chemotherapy or radiation treatment should cancer recur. If your reconstruction involves an implant, be sure to go to a radiology center where technicians are experienced in techniques required to get a reliable X-ray of a breast with an implant.
Read more about Breast Implant Safety
Preparing for Surgery
You can begin talking about reconstruction as soon as you have been diagnosed with cancer. Ideally, your surgical oncologist and plastic surgeon should work together to develop a strategy that will put you in the best possible condition for reconstruction.
After evaluating your health, your surgeon will explain which reconstructive options are most appropriate for your age, health, anatomy and tissues. The surgeon should describe your options, including the risks and limitations of each. In most cases, health insurance will cover most or all of the cost of post-mastectomy reconstruction. Check your policy to see if there are any limitations on what types of reconstruction are covered.
If your surgeon recommends the use of an implant, you’ll want to discuss what type of implant should be used.
Types of Breast Reconstruction Procedures
Breast reconstruction typically involves more than one operation. The first stage, whether done at the same time as the mastectomy or not, will be performed in a hospital under general anesthesia depending on the requirements. Follow-up procedures may be done at an outpatient facility with only local anesthesia.
There are two types of reconstruction—skin expansion and flap reconstruction.
Skin Expansion
Following mastectomy, the surgeon will insert a balloon expander beneath your skin and chest muscle. Through a tiny valve mechanism buried under the skin, a salt-water solution is periodically injected, gradually filling the expander over the course of several weeks or months. The balloon stretches the skin over the breast area, creating a pocket for a breast implant. Once the skin has stretched enough, the expander is removed and the implant is inserted. Some specially designed expanders can be left in place as the final implant. A third procedure is required to reconstruct the nipple and the dark skin surrounding it, called the areola.
Some patients do not require preliminary tissue expansion before receiving an implant. For these women, the surgeon will proceed with inserting the implant as the first step.
Flap Reconstruction
An alternative to implants, flap reconstruction creates a skin flap using tissue taken from other parts of the body such as the back, abdomen or buttocks.
In one type of flap surgery, the tissue remains attached to its original blood supply. The flap, consisting of skin, muscle and fat, is tunneled beneath the skin to the chest, creating a pocket for an implant, or in some cases, creating the breast mound itself.
Another flap technique uses tissue that is surgically removed and then transplanted to the chest by reconnecting the blood vessels to new ones in that region. This procedure requires a plastic surgeon that is skilled in microsurgical techniques.
Flap reconstruction is more complex than skin expansion. Scars will be left at both the tissue donor site and the reconstructed breast, and recovery will take longer than with an implant. However, using your own tissue produces more natural results without the concern of implant rupture.
Most breast reconstruction involves a series of procedures over time. The initial reconstruction is usually the most complex. Follow-up surgery may be required to reconstruct the nipple and areola and to contour the new breast to the approximate size and shape of the natural breast.
After Your Surgery
Depending on the extent of your surgery, you can expect to spend approximately two to five days in the hospital. Many reconstruction options require a surgical drain to remove excess fluids from surgical sites immediately following the operation. These are typically removed a week or two after surgery. Most stitches are removed in seven to 10 days.
It may take up to six weeks to recover from breast reconstruction when combined with a mastectomy. If implants are used without flaps or reconstruction is done alone, your recovery time may be less. Reconstruction cannot restore normal sensation to the breast, but in time, some feeling may return. Most scars fade over time, although it may take as long as one or two years.
©2009