Breast reconstruction after mastectomy due to cancer or other condition is one of the currently available techniques. Modern implants and techniques help surgeons to create breasts with near natural shape and appearance. The reconstruction is often possible right after mastectomy. A patient recovering from general anesthesia will feel the reconstructed breast in place instead of experiencing the total absence of a breast. Breast reconstruction after mastectomy is not an easy process. There are several techniques available which should be discussed thoroughly with your surgeon.
The following information will give you a basic understanding of the procedure:
- when it could be performed,
- how it is performed and
- what kind of results you should expect.
It cannot answer all your questions, because breast reconstruction is a highly individualized procedure.
The best candidates for breast reconstruction
Most of the patients are medically suitable for breast reconstruction after a mastectomy, while many of them can undergo both procedures at the same time. However, the best candidates are women whose cancer seems to be completely removed (to the extent this can be specified) after the mastectomy. There are several reasons to delay breast reconstruction. Many women are not ready to discuss reconstruction options while coping with a cancer diagnosis. Others, simply, do not want to undergo any operation which is not absolutely necessary. Surgeons may encourage some patients to wait, especially if the selected technique is highly complex. Women with additional medical conditions like obesity, high blood pressure or smokers, could also have to wait. In any case, thorough information on the potential of breast reconstruction and its available techniques, can give a mastectomy candidate a more positive outlook.
Every operation carries risks
Practically every woman who loses her breast due to cancer can restore it through a reconstructive surgical operation. However, there are risks connected to every surgical operation and there are complications connected to the specific procedure.
Although uncommon to this procedure, all the usual problems of a surgical operation can occur (e.g. hemorrhaging, fluid accumulation, unsightly scars or difficulties with the anesthesia). Smokers should know that, as in every surgery, nicotine can delay the healing process and can cause more pronounced scars and longer post-operative period. Occasionally, the above complications are grave and a new operation is necessary.
If a silicone implant is used, there is a small possibility of infection usually in the first two weeks after surgery. In some of these cases the implant must be removed for several months until the infection subsides and a new implant can be put in place. The most common complication is the formation of a capsule of tight scar tissue around the implant. This formation puts pressure on the implant and you might feel your breast hardening. The problem can be addressed in various ways, one of which is the removal of the capsule and the replacement of the implant. Implant replacement cannot be connected to any relapse of the disease. If, for other reasons, there is cancer relapse the implant replacement does not set back the progress of chemotherapy or radiotherapy in any way.
Your surgeon could recommend continuing mammography tests on the reconstructed and the natural breast. If the reconstruction involves implant placement, your radiologist must be specialized in the techniques required to depict a reconstructed breast with an implant.
Arranging your operation
The patient could start thinking about reconstruction as early as the first cancer diagnosis. A collaboration between the breast surgeon and the plastic surgeon in order to plan the best possible reconstruction procedure is the ideal situation. The surgeon, after evaluating the state of health of the patient, will explain thoroughly the available options according to her age, her state of health, her anatomy and her goals concerning the operation. The expectations of the patient, along with the potential solutions that science can offer, should be discussed honestly and thoroughly with the surgeon. Post-mastectomy reconstruction can dramatically improve your looks and renew your self-confidence. You should know that the aim of the procedure is improvement, not perfection. The surgeon will explain the procedure and the anesthesia you will receive, the potential of the hospital where the procedure will take place and the cost of the operation. In most cases, health insurance policies cover the best part or all the costs of a post mastectomy breast reconstruction.
Preparation for surgery
Your surgeon shall provide you with specific instructions for your operation regarding what to eat & drink, smoking, taking or not certain vitamins and medication. Make sure there is a friend or member of the family who can drive you back home after the operation is over and the doctor discharges you from the hospital. You might also need somebody to stay with you at home and help you for a few days.
Where does the procedure take place?
Breast reconstruction usually involves more operations than one. The first operation, either performed at the same time with the mastectomy or later on, is performed in a hospital. Following stages can also be performed in a hospital without the need of hospitalization in most of the cases.
Anesthesia
General anesthesia is almost always the preferred solution. The surgeon and the patient can decide if the application of a local anesthetic could be a suitable solution for some of the following procedures.
Types of breast implants
If a breast implant is recommended, it will usually be a silicone implant. Extensive research of the American Food and Drug Administration (FDA) could not establish any connection between silicone breast implants and cancer, the relapse of this disease or any other disease whatsoever.
The operation
There are many available options in breast reconstruction. The surgeon will discuss the most suitable for the patient.
Tissue expansion
It is the most common technique and combines the initial tissue expansion with the following insertion of an implant. After the mastectomy, the surgeon places an expander under the pectoral muscles. Fluid is gradually inserted inside the expander through a valve mechanism under the skin. The filling procedure can take several weeks or months. The expander can be removed, in a second operation, after the skin is fully stretched, and a permanent implant put in place. The nipple and areola are recreated in following procedures.
Flap techniques
An alternative approach to breast reconstruction is the repositioning of tissues taken from other areas of a woman’s body, like the back, the abdomen and the thighs. This a more complex surgical procedure than the expansion and leaves scars in the donor areas. The postoperative period is longer but the long term results are better and the resulting breasts have a more natural shape.
Additional procedures
Procedures like the replacement of the expander with a permanent implant, the recreation of the areola and nipple and the breast lift or breast reduction of the opposite breast to achieve a symmetrical overall result are simpler than the initial operation.
After the operation
Your breast might ache and you will probably feel tired for one or two weeks after the reconstruction, but all this can be taken care of with the suitable medication. The patient is usually discharged after two days, depending on the extent of the operation. The sutures are removed after 10 to 14 days.
Back to everyday activities
It might take the patient several weeks to return fully to her everyday activities. Exercising and lifting of heavy or largre objects should be avoided initially. Although most scars will fade considerably over time, it can take up to two years and they will never disappear completely.
Your new look
Maybe the new breast will not have the same contour with the breast before the mastectomy or it will not match the opposite breast exactly. However, only the patient can see these differences. For the majority of mastectomy patients, breast reconstruction dramatically improves their quality of life and looks.