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Breast reconstruction is an elective procedure that is performed after a mastectomy (removal of the breast) or large lumpectomy (removal of a large piece of breast tissue) to treat breast cancer. Most patients who decide to undergo reconstruction find that having the procedure makes it easier for them to restore their body image, resume normal dress and activities, and recover faster psychologically.
Many patients have reconstruction done at the time of the mastectomy, but reconstruction can be performed at any time later. In general, the results are superior when cancer surgery and reconstruction are done at the same time. Patients who have reconstruction at the time of mastectomy usually feel better about their recovery. However, for some patients it may be better to delay the reconstruction due to the extent of the cancer.
Before you consider breast reconstruction, you must first speak with your breast surgeon. You should then make an appointment with a plastic and reconstructive surgeon.
Options for Reconstruction
There are multiple options for breast reconstruction. Some require an implant while others use only your own body tissue in what is called a “flap” procedure. The implant option is often considered the “easiest” option because the surgery is the shortest and does not take tissue from other areas of your body. However, this option requires more than one procedure. Some of the flap procedures take longer but only require one surgery. There is no best option; every patient has different issues to consider. Your surgeon may suggest you contact other patients who have undergone these procedures for more information.
All breast reconstructive procedures can be performed safely if your general health is good, even if you need chemotherapy. Your surgeon will discuss with you your overall health, your breast size and shape, activity level, and expectations. It is important for you to tell your doctor if you smoke or have diabetes or heart disease. Your doctor will then discuss which option(s) might be best for you.
All of the following breast reconstruction options can be performed on one or both breasts at once. Flap surgery on two breasts can be more complicated than on one breast and should be discussed in detail with your surgeon.
Tissue expansion with implants: Implant reconstruction often requires more than one procedure in order to make enough space for the implant. Implant reconstruction is usually combined with a procedure called tissue expansion, during which saline (salt water) is slowly added over a period of time to a type of implant called an expander implant. When the space is large enough to fit an implant that will match the natural breast, a permanent implant then replaces the expander one. The procedures for placing expanders and implants are usually short and do not require overnight stays in the hospital.
We are often asked if implants are safe. Most implants used today are made of saline (salt water), which is harmless. If a saline implant leaks, the fluid is absorbed by the patient’s body with no harm. Silicone is also used to fill an implant. A silicone implant feels more like a natural breast. Most recent studies show that silicone is not associated with autoimmune disorders such as lupus. If you are considering a silicone implant, your doctor will discuss it with you in detail.
Flap surgery: Flap reconstruction uses a piece of body tissue — usually skin, fat, and muscle — that is transferred to the breast area to recreate a soft, natural-looking breast. Although flap surgery takes longer than implant surgery, the procedure can be finished during one surgery and the risk of complications is minimal. Most patients will spend no more than four to five days in the hospital. You will be walking and eating within a day or two. Blood transfusions are rarely required, although your surgeon may ask that you donate a unit of your own blood several weeks prior to the procedure. The most common type of flap used in breast reconstruction is a TRAM (transposition of the rectus abdominus muscle) flap. A TRAM flap is taken from the abdomen.
Nipple reconstruction: Most patients undergo nipple reconstruction after breast reconstruction. This is usually a separate outpatient procedure that can be performed with minimal anesthesia. Recovery is not difficult, although the final outcome may require a tattoo for a better match in color.
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