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After mastectomy or significant breast resection for breast cancer or other disease process, the resulting defect can leave a woman with a permanent reminder of their disease. Even for those who see their wounds as victorious battle scars, often there is a sense of loss or incompleteness. Breast reconstruction is a procedure to restore one or both breasts, and to help restore wholeness in a woman.
If only one breast needs reconstruction, a breast lift, breast reduction, or breast augmentation can be performed on the opposite breast to make the breasts as symmetrical as possible.
Breast reconstruction can help reduce the physical and emotional effects of having partial or all breast tissue removed by restoring a more feminine shape to the breast and improving the woman’s self-image.
Choosing to undergo breast reconstruction is a highly personal decision, and patients should decide based on their own desires rather than outside influences.
Breast reconstruction is usually a series of staged procedures regardless of the type of the of breast reconstruction. Symmetry procedures and adjustments are often required to give the best aesthetic outcome. It is important that women undergoing breast reconstruction understand that depending on their individual circumstances the process can sometimes take as much as a year or more.
Reasons for Breast Reconstruction
Mastectomy is one of the most common treatments for breast cancer, and it involves the surgical removal of breast tissue. Patients who are at a high risk of developing breast cancer may also undergo this procedure as a preventive measure. Depending on the patient’s needs and treatment plan, breast reconstruction may be performed at the same time as the mastectomy, or reconstruction may be delayed until after the patient has healed and/or additional cancer treatments have been performed.
Various techniques are available to preserve or reconstruct the nipple and areola. During your consultation, your surgeon will explain all of the options available to you.
Implant vs. Tissue Flap
Expander and Implant Reconstruction
A tissue expander is temporarily inserted into the breast pocket to stretch the soft tissues so that it can adequately cover an implant. Over the course of several weeks, the expander is progressively filled with a saline solution through an internal valve. Once the soft tissue is sufficiently stretched, the expander is replaced by a breast implant. This technique takes longer to achieve the final breast reconstruction than the tissue flap method, but it allows for an easier recovery.
Recently a new type of tissue expander has been developed that is self expanding and there is no longer a need to fill the expander with saline which can prevent needle sticks for patients. This option may not be for everyone.
Tissue Flap Reconstruction
The breast can be reconstructed by rearranging local tissues in particular from the abdomen. These type of procedures are known as pedicled flaps. With pedicled flaps, blood vessels do not need to be reattached for the flap to survive.
Free tissue transfer involves taking tissue from another part of the body and transplanting it to the chest to reconstruct the breast. During this process blood vessels are disconnected from their native location and sewn to vessels in the chest.
While free tissue transfer is an excellent choice for some women, it is a much more involved operation. Even though it does recreate the breast mound in a single operation, revision operations are often required. Nipple reconstruction is often performed at a later stage as well.