Breast Reconstruction

Reconstruction of a breast that has been removed due to cancer or other disease is one of the most rewarding surgical procedures available today. New medical techniques and devices have made it possible for surgeons to create a breast that can come close in form and appearance to matching a natural breast. Frequently, reconstruction is possible immediately following breast removal (mastectomy) so the patient wakes up with a breast mound already in place, having been spared the experience of seeing herself with no breast at all.

But bear in mind, post-mastectomy breast reconstruction is not a simple procedure. There are often many options to consider as you and your doctor explore what’s best for you.

The Best Candidates for Breast Reconstruction

Most mastectomy patients are medically appropriate for reconstruction, many at the same time that the breast is removed. The best candidates, however, are women whose cancer, as far as can be determined, seems to have been eliminated by mastectomy.

Still, there are legitimate reasons to wait. Many women aren’t comfortable weighing all the options while they’re struggling to cope with a diagnosis of cancer. Others simply don’t want to have any more surgery than is absolutely necessary. Some patients may be advised by their surgeons to wait, particularly if the breast is being rebuilt in a more complicated procedure using flaps of skin and underlying tissue. Women with other health conditions such as obesity, high blood pressure or smoking may also be advised to wait.

In any case, being informed of your reconstruction options before surgery can help you prepare for a mastectomy with a more positive outlook for the future.

All Surgery Carries Some Uncertainty and Risk

Virtually any woman who must lose her breast to cancer can have it rebuilt through reconstructive surgery. But there are risks associated with any surgery and specific complications associated with this procedure.

In general, the usual problems of surgery, such as bleeding, fluid collection, excessive scar tissue or difficulties with anesthesia, can occur, although they’re relatively uncommon. And, as with any surgery, smokers should be advised that nicotine can delay healing, resulting in conspicuous scars and prolonged recovery. Occasionally, these complications are severe enough to require a second operation.

If an implant is used, there is a remote possibility that an infection will develop, usually within the first two weeks following surgery. In some of these cases, the implant may need to be removed for several months until the infection clears. A new implant can later be inserted.

The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways and sometimes requires either removal or “scoring” of the scar tissue or perhaps removal or replacement of the implant.

Reconstruction has no known effect on the recurrence of disease in the breast, nor does it generally interfere with chemotherapy or radiation treatment, should cancer recur. Your surgeon may recommend continuation of periodic mammograms on both the reconstructed and the remaining normal breast. If your reconstruction involves an implant, be sure to go to a radiology center where technicians are experienced in the special techniques required to get a reliable x-ray of a breast reconstructed with an implant.

Women who postpone reconstruction may go through a period of emotional readjustment. Just as it took time to get used to the loss of a breast, a woman may feel anxious and confused as she begins to think of the reconstructed breast as her own.

Planning Your Surgery

You can begin talking about reconstruction as soon as you’re diagnosed with cancer. Ideally, you’ll want your breast surgeon and your plastic surgeon to work together to develop a strategy that will put you in the best possible condition for reconstruction.

After evaluating your health, your surgeon will explain which reconstructive options are most appropriate for your age, health, anatomy, tissues and goals. Be sure to discuss your expectations frankly with your surgeon. He or she should be equally frank with you, describing your options and the risks and limitations of each. Post-mastectomy reconstruction can improve your appearance and renew your self-confidence – but keep in mind that the desired result is improvement, not perfection.

Your surgeon should also explain the anesthesia he or she will use, the facility where the surgery will be performed, and the costs. In most cases, health insurance policies will cover most or all of the cost of post-mastectomy reconstruction. Check your policy to make sure you’re covered and to see if there are any limitations on what types of reconstruction are covered.

Preparing for your surgery

Your oncologist and your plastic surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications.

While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.

Where Your Surgery Will Be Performed

Breast reconstruction usually involves more than one operation. The first stage, whether done at the same time as the mastectomy or later on, is usually performed in a hospital.

Follow-up procedures may also be done in the hospital. Or, depending on the extent of surgery required, your surgeon may prefer an outpatient facility.

Types of anesthesia

The first stage of reconstruction, creation of the breast mound, is almost always performed using general anesthesia, so you’ll sleep through the entire operation.

Follow-up procedures may require only a local anesthesia combined with a sedative to make you drowsy. You’ll be awake but relaxed, and may feel some discomfort.

IMPLANT OPTIONS

Dr. Balderrama uses either saline or silicone cohesive gel implants from Mentor.

Each type of implant has its own unique set of benefits and shortcomings. The outer shell of both types of implants are made from solid silicone, and the distinction between a saline and silicone implant is based on material used to fill it.

Saline implants come deflated and are filled during surgery which allows for fine adjustments in size. When saline implants rupture, the saline in the implant is absorbed by the body with no ill effects other than deflation of the affected side. While the lack of significant side effects in the event of a rupture may seem to make saline an ideal implant filler, the feel and consistency is less natural than a silicone implant and may be more likely to thin and stretch the overlying skin.

The silicone in breast implants used currently are filled with a form of silicone referred to as cohesive gel. This means that the filling is more like a soft solid than a liquid and tends to stay together in the event of a rupture. The development of cohesive gel implants has prompted the FDA to approve them for wide spread use for augmentation in 2007. Silicone implants tend to be more natural feeling even with thin overlying tissue coverage. Silicone implants are prefilled and the exact size of the implant is chosen prior to surgery. Rupture of a silicone implant may go unnoticed since the breast will not deflate as seen with a saline implant. However, rupture of a silicone implant may stimulate an inflammatory response or progressive hardening of the breast from contracture of the capsule the body naturally forms around the implant.

* Source American Society of Plastic Surgeons

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