Breast Reconstruction is a surgical procedure or a series of staged procedures designed to reconstruct the appearance of one or both breasts that have been removed due to cancer or other disease. The patient and the surgeon must evaluate the details in each individual case and choose a surgical plan that best suits the situation and provides a reasonable balance of anticipated benefits versus possible risks. Unfortunately, there is always the possibility of complications or even total failure.
Breast Reconstruction, by whatever method, should be viewed as a staged effort, usually requiring two to three stages, directed towards achieving an attractive symmetrical outcome.
- The first stage is equivalent to a rough draft of the reconstruction
- The second stage is aimed at improving symmetry and refining the reconstructed breast in terms of size, shape and location.
- Typically, during the second or later stages, nipple reconstruction may be recommended
- The third stage involves a tattoo of the nipple/areola to obtain reasonable color match and to help camouflage scars.
Although the results of breast reconstruction are rarely perfect, they are generally effective at recreating a breast while helping to restore a woman’s self-esteem. There are several surgical options in breast reconstruction, all methods involve either or a combination of:
- Expander and Implant
- Tram or Latissmus Flap
Expanders and Implants (Prosthetic Reconstruction)
The simplest approach to breast reconstruction involves placing a saline or gel-filled implant beneath the skin and muscles of the chest wall in the location of the normal breast. A temporary device called a “tissue expander” may be implanted prior to the placement of permanent breast prosthesis when additional volume is needed to match the size of the remaining breast. This expansion device is an implant with an easily accessible valve that allows for fluid volume to be incrementally added during the postoperative period, thus, stretching the overlying tissues. A “permanent” breast implant usually replaces the expander at a later date when an adequate amount of healing and expansion has taken place. “Permanent” breast implants have a limited lifespan of uncertain length and may need to be replaced during your lifetime. This procedure is best suited for women who have not lost too much tissue with their mastectomy and who have a modest size breast on the other side (A or B cup). This surgery does not work as well for women who have a larger breast (C or D cup), a sagging (ptotic) breast or who are overweight. A matching procedure on the remaining breast can improve the balance of the two breasts, and may include a lift, reduction and/or augmentation. This surgery requires approximately one to two hours and can be performed at the time of the mastectomy or as a delayed procedure through the pre-existing scars.
Generally, this type of operation provides very good cosmetic results in breast reconstruction. This procedure is best suited for women who are either large breasted (C or D cup), have lost a great deal of tissue with their mastectomy, have very pendulous breasts, are moderately overweight, or are “tummy tuck” candidates. This operation requires approximately four hours, produces a lengthy horizontal abdominal scar and requires the use of one or both rectus abdominus muscles in the transfer of skin and fat from the lower abdomen to the site of breast reconstruction. Drawbacks of the procedure include a longer operation, an additional abdominal scar, a three to five-day hospital admission and longer recovery time.
This procedure uses a portion of the skin, fat and muscle of the back to replace the skin that has been removed during a mastectomy. This is generally done in conjunction with placement of a prosthesis (expander or implant) to reconstruct the breast. The operation requires approximately two to three hours and involves the sacrifice of a portion of the latissimus muscle in order to transfer the tissue. A drawback of this procedure is that there will be a scar on the back.
Timing of Breast Reconstruction
Breast reconstruction may be performed immediately at the time of initial surgical treatment or mastectomy, or in a delayed manner. Optimal timing of breast reconstruction depends on a number of factors and is an individual decision that requires the consideration of the patient, general/oncologic surgeon, and reconstructive surgeon. If a patient wishes to have breast reconstruction, it is recommended that immediate reconstruction be performed if possible. In general, the same methods mentioned previously for all breast reconstructions also apply to immediate reconstruction. Currently, there is no evidence that immediate reconstruction detracts from the effectiveness of the curative cancer surgery.
Breast Reconstruction – American Society of Plastic Surgeons