Breast reconstructive surgery
Advances in breast reconstructive surgery have allowed even more women undergoing breast removal to choose to have their breast or breasts rebuilt. This surgery involves creating a breast mound that comes as close as possible to the form and appearance of the natural breast. Surgeons work to create a breast mound that matches the opposite breast and to achieve symmetry. If both breasts have been removed, they work to have both breast mounds approximate the size of the patient's natural breasts.
What are the criteria for breast reconstruction surgery?
In general, all women undergoing a mastectomy are candidates for immediate or delayed breast reconstruction. However, your doctor will look at a number of criteria when making recommendations:
- Size and location of the cancer, which determines the amount of skin and tissue to be removed in the mastectomy
- Whether tissue has been damaged by radiation therapy or aging and is not sufficiently healthy to withstand surgery
- Potential for complications
- Patient's desires
- Amount of tissue removed from the breast
- Whether radiation therapy is a part of treatment
- Patient's general health and physique
- Past medical history
- Co-existing illnesses
- Other risk factors like cardiac disease, diabetes, smoking and obesity
When is breast reconstruction surgery performed?
You will be educated and counseled in your breast reconstructive possibilities prior to mastectomy. Based on your personal medical history, a recommendation may be made for either:
- Immediate reconstruction, which is performed at the same time as mastectomy
- Delayed reconstruction, which is performed as a separate surgery after recovery from mastectomy is complete. If radiation therapy is part of your treatment plan, your surgeon will likely recommend delayed reconstruction
What complications are commonly associated with breast reconstructive surgery?
Any type of surgery carries some risk because of differences in people’s anatomy and ability to heal. Some complications from breast reconstruction may include:
- Anesthesia problems
- Fluid collection
- Excessive scar tissue
- Loss of viable tissue at the graft site
- Capsular contracture, a common complication which occurs if the scar or capsule around the implant begins to tighten.
Occasionally, complications may be severe enough to require a second operation.
What are the different types of breast reconstructive surgery?
The two most effective approaches available for both monolateral (one breast) and bilateral (both breasts) reconstruction are:
- Expander/implant reconstruction - The use of an expander to create a breast mound, followed by the placement of a permanently filled breast implant. Expanders are empty silicone "envelopes" placed under the pectoralis muscle, located between the breast and the chest wall. To enable the skin and soft tissues of the breast to grow, the expander is gradually filled with saline solution over a period of several weeks. The saline is injected into the expander through a valve or port in the expander. Once the expander has been completely filled, it is left in for several more weeks or months, allowing for maximal skin and soft tissue growth.
Implants are sacs filled with liquid that are implanted into the breast tissue and are used to form the shape of the breast. Implants may be filled with saline or silicone gel. Each type of implant has advantages and disadvantages. Your physician will discuss the types of implants with you and seek your input about which type to use.
- Autologous tissue reconstruction - The use of your own tissues to reconstruct a new breast mound. The common technique is the TRAM (transverse rectus abdominous muscle) flap. A TRAM flap involves removing an area of fat, skin, and muscle from the abdomen and stitching it in place to the mastectomy wound.
Probable length of procedure:
- When performed at the time of a mastectomy, reconstruction adds about an hour or so to the surgery. Drains are put in place and recovery time is longer due to the additional surgery, but the care afterward is the same as for mastectomy alone.
- Delayed reconstruction, a second surgery, requires more than an hour, but drains are not routinely inserted. The recovery is much quicker than immediate reconstruction because the mastectomy wound has already healed.