Breast reconstruction is one of the most rewarding surgical procedures available to patients who have had a breast removed due to cancer. New techniques and procedures have made it possible to create a natural looking breast. Reconstruction is possible immediately following a mastectomy, or breast removal.
Best candidates for breast reconstruction
Most mastectomy patients are good candidates for reconstruction; however, there are several reasons to postpone breast reconstruction. Many patients need to first cope with the diagnosis of cancer. Surgeons often advise patients to wait to have breast reconstructive surgery, especially if the surgery requires complicated procedures. Patients who have other health conditions, such as obesity, high blood pressure, or who smoke, may also be advised to wait.
Risks and complications
Any woman who must undergo a mastectomy to remove cancer can have a breast rebuilt through reconstructive surgery. But there are risks and possible complications associated with this type of surgery.
General problems may occur with surgery including bleeding, fluid collection, excessive scar tissue, or difficulties with anesthesia, but these problems are relatively uncommon. As with any surgery, smokers are advised that nicotine may delay healing, resulting in scars and prolonged recovery. At times, these complications are severe enough to require a second operation.
Infection may occur within the first two weeks after surgery if an implant is used. In some of these cases, the implant may need to be removed for several months until the infection goes away. A new implant can be inserted at a later date.
The most common problem with breast reconstruction is when the scar or capsule around the implant begins to tighten. The tightening of the soft implant may cause the breast to feel hard. This can be treated in several ways, by either removing the scar tissue, or replacing the implant.
Breast reconstruction has no known effect on the recurrence of breast cancer, nor does it generally interfere with chemotherapy or radiation treatment. Periodic mammograms are recommended by your surgeon on both the reconstructed and the remaining normal breast.
Planning your surgery
As soon as you are diagnosed with breast cancer, you may also consider breast reconstruction. The best option would be to discuss both surgeries with your breast surgeon and plastic surgeon to develop a strategy for reconstruction. Reconstructive options are determined by age, health, anatomy, and tissues. Your surgeon will describe your options, the risks and limitations involved, and expected results. The main goal of post-mastectomy reconstruction is improvement, not perfection.
Your surgeon will explain the type of anesthesia that will be used, the facility where the surgery will be performed, and the costs. Health insurance policies will cover most or all of the cost of post-mastectomy reconstruction.
Preparing for surgery
You will receive guidelines about how to prepare for surgery, including eating and drinking, smoking cessation, vitamins and medications. Plan to have a friend or relative drive you to and from the clinic or hospital where you will have surgery.
The first step for breast reconstruction is creating the breast mound. This procedure is usually performed under general anesthesia which will allow you to sleep through the entire operation.
Post surgical procedures may only require local anesthesia, combined with a sedative to help you feel drowsy. You will be awake during the procedure; however, the sedative will help you feel relaxed.
Types of implants
Your surgeon will recommend a certain type of breast implant if an implant is required for reconstruction. A breast implant is a silicone shell filled with either a salt water solution called saline or a silicone gel.
The Food & Drug Administration (FDA) supports the safety of both saline-filled and silicone gel-filled breast implants for women undergoing breast reconstruction.
The day of surgery
While there are several types of post-mastectomy reconstruction, your surgeon will help you decide which one is best for you.
Skin expansion is the most common technique which combines skin expansion and insertion of an implant.
Following your mastectomy, the surgeon will insert a balloon expander beneath your skin and chest muscle. A small valve is buried beneath the skin and salt-water solution is gradually added to fill the expander over several weeks or months. After the skin over the breast has stretched enough, the expander may be removed in a second operation and a more permanent implant will be inserted. Some expanders are designed to be left in place as the final implant. Some patients do not require tissue expansion before receiving an implant. For these patients, the surgeon will begin by inserting the implant without expanding the tissue.
The nipple and the dark skin surrounding it, called the areola, are reconstructed in a subsequent procedure.
An alternative approach to implant reconstruction involves flap reconstruction; the creation of a skin flap using tissue taken from other parts of the body such as the back, abdomen, or buttocks.
One type of flap surgery involves tissue that remains attached to its original site. The flap consists of skin, fat, and muscle. The blood supply remains beneath the skin within the chest, creating a pocket for an implant or the breast mound itself, without any need for an implant.
Another flap technique uses tissue that is surgically removed from the abdomen, thighs, or buttocks. The tissue is transplanted to the chest by reconnecting the blood vessels. This procedure requires experience with microvascular surgery.
Flap surgery is more complex than skin expansion. Scars will be present at both the tissue site and on the reconstructed breast. The recovery process will take longer than with an implant. However, when breast tissue is used from your own tissue, the results are more natural.
Additional procedures may be necessary over time. The initial reconstructive surgery is the most complex. Follow-up surgery may be required to replace a tissue expander with an implant or to reconstruct the nipple and the areola. Many surgeons recommend additional surgery to match the natural breast to the reconstructed breast. In some cases, this procedure may leave scars on an otherwise normal breast and may not be covered by insurance.
After the surgery
After the surgery, you may feel tired and sore for a week or two. Most discomfort can be controlled by medication prescribed by your doctor.
You will most likely be released from the hospital within the next two to five days, depending on the extent of your surgery. Many reconstruction surgeries require a surgical drain to remove excess fluids, but these are removed within the first week or two after surgery. Stitches are removed in a week to ten days.
Resuming regular activities
It may take up to six weeks to recover from a mastectomy and breast reconstruction. If implants are used without flaps and reconstruction is done at a different time from the mastectomy, the recovery time may be less.
Breast reconstruction cannot restore normal sensation to your breast, but in time, some feeling may return. Scars will fade substantially over time, although it may take one to two years to fully disappear.
Follow the guidelines from your surgeon as far as when to begin stretching exercises and resuming normal activities. As a rule, you will need to refrain from any overhead lifting, strenuous exercise, and sexual activity for three to six weeks following breast reconstruction.