The reconstruction of the breast after it´s removal due to breast cancer or another illness ( mastectomy ) is one of the most gratifying procedures within the range of plastic surgery procedures. The development of new techniques and materials allows the plastic surgeon to create a breast similair in shape, texture, and characteristics to an unoperated breast.
The objectives of breast reconstruction are:
- To create a breast with a natural look, includin, if the patient desires, the areola and nipple.
- To eliminate the need to wear filling prothesis, enabling the patient to wear clothes that would be difficult to wear without reconstruction (swimwear, low necklines, etc).
- To fill the hole that remains in the thorax and restore the body image, improve the quality of life and give satisfaction to the patient.
Nearly all women who have a mastectomy can, from the medical point of view, consider breast reconstruction. Usually this can be done at the same time as the mastectomy. The ideal candidate is when the tumor can be completely removed during the mastectomy. When the reconstruction is done at the same time as the mastectomy the patient awakes after the procedure with minimal change in body shape and avoids the discomfort of seeing the amputated breast, the psychological benefits of this are obvious.
In some cases, reconstruction can be postponed. Some women don´t feel comfortable talking about reconstruction while trying to deal with the diagnosis of breast cancer. Other women simply don´t want to undergo more surgical procedures than necessary to cure the illness. Other times, the use of more complex reconstruction techniques makes it advisable to delay the procedure so as not to lengthen the time of the mastectomy. Other problems such as obesity, hypertension or other conditions may make the delay of reconstruction advisable.
Immediate reconstruction calls for the collaboration between the surgeon who removes the breast and the plastic surgeon, as both will be present during the procedure. This is not possible in hospitals where there is no plastic surgeon ( provincial hospitals, for example ) and will require the delay of the reconstruction.
In both cases, it´s important to have all the information about the options of reconstruction before making a decision.
Risks of breast reconstruction
Nearly all women who have a mastectomy can have breast reconstruction. Nevertheless, there are certain risks that should be known before making a decision. These risks are those of any surgical procedure such as haematomas, scars or anaesthetic problems. Smokers must keep in mind that tobacco can slow down the healing process.
If implants are used in the reconstruction, there is a small possibility of infection, especially in the first or second week after surgery. In some cases it´s advisable to remove the implant and replace it at a later time. The most common problem with implants is capsular contraction, when the organism forms a capsular scar around the implant which can make the breast feel harder than normal. This is nothing more than the bodies response to an unknown object. There are various ways of dealing with this, from massaging of the breast to surgery.
It must be clear that breast reconstruction does not affect the recurrence of breast cancer or interfere with treatmants such as chemotherapy or radio therapy. Neither does it interfere with any studies or tests which may be done in revisions. If your breast has been reconstructed using implants and your surgeon recommends regular breast scans, they should be done in a radiology centre with experience in the use of techniques for implants.
As soon as a woman is diagnosed with breast cancer, she should be informed about the possibilities of reconstruction. The surgeon who does the mastectomy, the oncologist and the plastic surgeon should coordinate to develop a strategy which will give the best results.
The plastic surgeon is the specialist who, with his or her training, has the technical resources available to reconstruct a breast with a natural appearance. After evaluating the patients general health, the surgeon will explain the best optins according to age, health, physical and anatomical characteristics and future expectations.
Breast reconstruction is included in the procedures covered by the public health service, but the hospital must have a plastic surgery team. The majority of private health insurance companies also cover this procedure.
These days breast reconstruction can be done using only fatty tissue but you must keep in mind a few things. There needs to be enough excess fat on other parts of the body, two surgeries will be needed and there will be excess skin.
Normally one time will be to reconstruct the volume of the breast and another time to perfect it and reconstruct the nipple. The areola is normally done with micropigmentation.
There are many different types of operation to reconstruct the breast and they will use one of two techniques:
1. Skin expansion technique: This is the most used technique and involves expanding the skin and then inserting a prothesis. After the mastectomy the surgeon places an inflatable balloon below the skin and muscle of the breast. Using a valve system implanted below the skin, a saline solution is introduced once a week for a number of weeks until the expander is full. Once the skin in the breast area has relaxed enough, the expander balloon is removed and replaced with a breast implant of either silicon or a saline solution. There are some expanders available which are designed to work as permanent implants as well. Both procedures are done under general anaesthetic with a stay in hospital of between 24 and 72 hours.
If the breast that has not undergone a mastectomy is too big, too small or is sagging, it may be necessary to reduce, enlarge or lift it at the same time as the reconstruction in order to maintain symmetry. The nipple and areola will be reconstructed later, with a local anaesthetic and as an outpatient.
The implants used in this type of reconstruction contain medical silicon, similair to the materials used in other surgical fields ( testicular or facial implants ). No connection has been found between breast cancer and the use of implants and neither has any connection been found with rheumatological or immunological illnesses. Their use is approved in all European countries.
2. Technique using patients own body tissue: This technique uses body tissue to create a natural breast and consists in the transplant of tissue from other parts of the body such as the abdomen, the back or buttocks.
In some cases these tissues or ” flaps ” as they are called, stay attached to their original blood supply and are transferred to the breast via a tunnel which runs under the skin.
In other cases these tissues or flaps are detached from their original place, usually the abdomen, buttocks or thighs, and are transplanted to the breast using the blood vessels in this area. This type of procedure must be done by a plastic surgeon with experience in micro surgery.
Both of these techniques are more complex than the skin expansion technique. They leave more scars and the recovery tine is longer than that of implants. However, the result is better aesthetically, only one procedure is needed and there are none of the possible problems assosciated with implants ( capsular contraction, infection ). In some cases, when tissue from the abdomen is used, there is the added benefit of an improved stomach shape ( similair to a tummy tuck ). This procedure is done under general anaesthetic and the stay in hospital will be between 4 and 7 days.
3. Breast reconstruction using wide dorsal flap.
4. Breast reconstruction using TRAM flap.
The result obtained after a breast reconstruction is permanent and allows for a totally normal life. In some cases the new breast can look firmer and rounder than the other breast. The shape may not be exactly the same as before the mastectomy and there may be some differences in symmetry between the two breasts. Usually the differences are only noticeable to the patient and not to anyone else.
For the majority of women who have undergone a mastectomy, breast reconstruction means a big improvement in appearance and helps them to lead a complete life, socially and sexually, and to forget about the illness that led to the need for reconstruction.
The information on this page in no way substitutes the personal advice from your plastic surgeon. If in any doubt, your surgeon will be able to explain things clearly. If you are thinking about undergoing a procedure of plastic or cosmetic surgery speak to a plastic, reconstructive, cosmetic surgery specialist.
Candidates: Those patients who have had removed either the complete breast (mastectomy) or a part of the breast (tumorectomy).
Type of pain: Depends on the technique used.
Scars: If using an implant, the scar will be the same as that of the mastectomy and if using body tissue, it will depend on where the tissue is taken from.
Consequences: Depends on the technique used.
When to operate: At the same time as the mastectomy or at the end of the oncological treatment (chemotherapy or radiotherapy).
Keep in mind: When deciding on the type of reconstruction these things must be considered: body type, desires of the patient and whether the patient has undergone radiotherapy or not.
Types of reconstruction: With implants or with patients own body tissue
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