Sum T. Tran, MD
Cosmetic Plastic Surgery
Breast Reconstruction
Reconstruction of breast is one of the most rewarding surgical procedures available today. New surgical techniques and devices have made it possible for surgeons to create a breast that can come close in form and appearance to matching a natural breast. Virtually any woman who must lose her breast to cancer can have it rebuilt through reconstructive surgery. In any case, being informed of your reconstruction options before surgery can help you prepare for a mastectomy with a more positive outlook for the future.
Most mastectomy patients are medically appropriate for reconstruction, many at the same time that the breast is removed. The best candidates, however, are women whose cancer, as far as can be determined, seems to have been eliminated by mastectomy. Reconstruction has no known effect on the recurrence of disease in the breast, nor does it generally interfere with chemotherapy or radiation treatment, should cancer recur.
Still, there are legitimate reasons to wait. Many women aren't comfortable weighing all the options while they're struggling to cope with a diagnosis of cancer. Others simply don't want to have any more surgery than is absolutely necessary. Some patients may be advised by their surgeons to wait, particularly if the breast is being rebuilt in a more complicated procedure using flaps of skin and underlying tissue. Women with other health conditions, such as obesity, high blood pressure, diabetes or smoking, may also be advised to wait. Women who postpone reconstruction may go through a period of emotional readjustment. Just as it took time to get used to the loss of a breast, a woman may feel anxious and confused as she begins to think of the reconstructed breast as her own.
ConsultationYou can begin talking about reconstruction as soon as you're diagnosed with cancer. Ideally, you'll want your family doctor, your breast surgeon, your oncologist and Dr Tran to work together as a team to develop a strategy that will put you in the best possible condition for reconstruction.
After evaluating your health in a personal consultation, Dr Tran will explain frankly which reconstructive options and the limitations and risks are most appropriate for your age, health, anatomy, tissues, and goals.
Most breast reconstruction involves a series of procedures that occur over time. The first or initial stage for creation of the breast mound is almost always performed using general anesthesia. Whether done at the same time as the mastectomy or later on, this stage is usually performed in a hospital. Follow-up procedures may be done in an outpatient facility to replace a tissue expander with an implant or to reconstruct the nipple and the areola. Sometime an additional operation to enlarge, reduce, or lift the natural breast to match the reconstructed breast is required.
In most cases, health insurance policies will cover most or all of the cost of post-mastectomy reconstruction.
OptionsWhile there are many options available in post-mastectomy reconstruction, you and Dr Tran will explore the one that's best for you.
Tissue Expansion - The most common technique combines skin expansion and the subsequent insertion of a permanent implant. Following mastectomy, Dr Tran will insert a balloon expander beneath your skin and chest muscle. Through a tiny valve mechanism buried beneath the skin, Dr Tran will periodically inject a salt-water solution to gradually fill the expander over several weeks or months. After the skin over the breast area has stretched enough, the expander may be removed in a second operation and a more permanent implant will be inserted. A breast implant is a silicone shell filled with either silicone gel or a salt-water solution known as saline. Dr Tran will discuss the pros and cons of each type of implant for you to choose.
Some patients do not require preliminary tissue expansion before receiving an implant. For these women who choose immediate reconstruction after mastectomy. Dr Tran will proceed with inserting an adjustable implant as the first step.
Flap Reconstruction - An alternative approach to implant reconstruction involves creation of a skin flap using tissue taken from other parts of the body, such as the back, abdomen.
In one type of flap surgery, the tissue remains attached to its original site. The flap, consisting of the skin, fat, and muscle with its blood supply, are tunneled beneath the skin to the chest, creating a pocket for an implant or, in some cases, creating the breast mound itself, without need for an implant.
Another flap technique uses the tissue from the abdomen,
thighs, or buttocks and then transplant to the chest by reconnecting the blood
vessels of the breast area with micro-vascular surgery.
Regardless of whether
the tissue is tunneled beneath the skin on a pedicle or transplanted to the
chest as a micro-vascular flap, this type of surgery is more complex than skin
expansion. The nipple and the areola are
reconstructed in a subsequent procedure.
The most common procedure of flap surgery is from abdomen as called TRAM flap. On the other hand, when the breast is reconstructed entirely with your own tissue, the results are generally more natural and there are no concerns about an implant. In some cases, you may have the added benefit of an improved abdominal contour.
RisksThere are risks associated with any surgery and specific complications associated with this procedure. In general, the usual problems of surgery, such as bleeding, fluid collection, excessive scar tissue, or difficulties with anesthesia, can occur although they're relatively uncommon. And, as with any surgery, smokers should be advised that nicotine can delay healing, resulting in conspicuous scars and prolonged recovery.
Occasionally, these complications are severe enough to require a second operation.
If an implant is used, there is a remote possibility that an infection will develop, usually within the first two weeks following surgery. In some of these cases, the implant may need to be removed for several months until the infection clears. A new implant can later be inserted. The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or "scoring" of the scar tissue, or perhaps removal or replacement of the implant. Hernia of abdominal wall or flap necrosis could be occurred.
Chances are your reconstructed breast may feel firmer and look rounder or flatter than your natural breast. It may not have the same contour as your breast before mastectomy, nor will it exactly match your opposite breast. But these differences will be apparent only to you. For most mastectomy patients, breast reconstruction dramatically improves their appearance and quality of life following surgery.
Expectations
Usually, the initial reconstructive operation is the most
complex. Follow-up surgery is much easier on you. You are likely to feel tired
and sore for a week or two after reconstruction. It may take you up to six weeks
to recover from a combined mastectomy and reconstruction or from a flap
reconstruction alone. If implants are used without flaps and reconstruction is
done apart from the mastectomy, your recovery time may be less. Most of your
discomfort can be controlled by medication. A surgical drain to remove excess
fluids from surgical sites immediately following the operation is removed within
the first week after surgery. Most stitches are removed in a week to 10
days.
Scars at the breast,
nipple and abdomen will fade substantially with time, though it may
take as long as one to two years but may never disappear entirely. Reconstruction
cannot restore normal sensation to your breast, but in time,
some feeling may return.
As a general rule, you'll want to refrain from any overhead lifting, strenuous sports, and sexual activity for three to six weeks following reconstruction. Post-mastectomy reconstruction can improve your appearance and renew your self-confidence - but keep in mind that the desired result is improvement, not perfection.