The goal of breast reconstruction is to create a soft, natural-looking breast for a woman who must undergo breast removal due to cancer or other disease. Whether it is performed immediately following mastectomy or at a later time, breast reconstruction can dramatically improve a woman’s appearance, self-confidence and overall quality of life.
Almost every woman who has lost a breast to cancer can have her body restored with breast reconstruction. However, the following conditions are desirable:
You clearly understand that although your figure will be markedly improved, your reconstructed breast will not look or feel exactly the same as the breast that was removed.
Your oncologist has advised you that reconstruction is appropriate for you with regard to your stage of cancer or treatment. (Should cancer recur, your reconstructed breast will not interfere with further treatment. However, such treatment may affect the appearance of your reconstructed breast.)
A consultation with Dr. Han is the first step to learn how breast reconstruction can enhance your body image. The doctor will assess your physical and emotional health and discuss your specific cosmetic goals for surgery..
You should arrive ready to provide complete information about:
- Previous surgical procedures
- Past and present medical conditions
- Medications you are taking, including herbal remedies or nutritional supplements
- The results of mammograms you have had
As part of the consultation, your breasts will be examined and perhaps photographed for your medical record.
The doctor will carefully explain the surgical procedure recommended for your specific case. Prior to surgery, you will be given specific instructions that may include:
- Avoiding certain medications that may complicate surgery or recovery
- Stopping smoking for a period of time before and after surgery
- Arranging for help or special care following surgery
- Pre-surgical considerations, diagnostic testing and medications
- Day of surgery instructions and medications
- Specific information related to the use of anesthesia
- Postoperative care and follow-up
You will be asked to sign consent forms to assure that you fully understand the procedure and any risks or potential complications.
It is natural to feel some anxiety, whether excitement for the anticipated outcome or preoperative stress. It’s very important to address all your questions and concerns directly with the doctor.
There are many options available in breast reconstruction. Your anatomy, the doctor’s preferences and your desired results will help determine which method is best for you.
Skin Expansion with a Breast Implant
This is the most common method of reconstructing a breast. Following mastectomy, a balloon expander is inserted beneath the skin and chest muscle. Over several weeks, the expander balloon is gradually filled with a salt-water solution, causing the overlying skin to stretch. When the skin has stretched sufficiently, the expander is surgically replaced with a more permanent implant or left in place as the final implant. The nipple and the skin surrounding it, called the areola, are reconstructed in a later procedure.
In rare cases, when a sufficient amount of skin is available, an implant can be placed without the preliminary skin-expansion step.
Flap Reconstruction
Although flap reconstruction is more involved at the initial procedure then reconstruction with an implant, many women prefer it because it may allow the breast to be rebuilt with natural tissue. Also, unlike the tissue-expander method the breast mound is completed at the initial operation, without the need for expansion over an extended time period.
In one method, the breast is reconstructed using a tissue flap-consisting of a portion of skin, fat and muscle-that is taken from the back, or abdomen. Sometimes an implant will be inserted as well.
In a more complex flap technique, tissue that is removed from the abdomen is surgically transplanted to the chest by reconnecting the flap’s blood vessels to vessels in the chest region. Although more complicated, this microsurgical reconstruction may provide a more natural and less traumatic reconstruction in many women.
Although recovery from flap reconstruction may take longer than with implant reconstruction at the initial procedure, it does not require a secondary procedure for placing a permanent implant, nor does it require the weekly office visits needed for tissue expansion.
All of these procedures have advantages and disadvantages, and many times the choice of procedures is limited by other health factors, such as weight, other medical conditions and previous cancer therapy. Dr. Han will help you to determine which is the best procedure for you.
Follow-up Procedures
Once the breast mound is restored in the initial procedure, one or more follow-up procedures will be performed to replace a tissue expander with a permanent implant or to reconstruct the nipple and areola. The doctor may also recommend an additional operation to lift or reduce the opposite breast to match the appearance of the reconstructed breast.
When surgery is complete, you’ll be taken to a recovery area. Small drainage tubes may have been placed beneath the skin near the surgical sites to help prevent fluids from accumulating.
On the day of surgery, you will be encouraged to get out of bed for short periods of time. Most of the discomfort you feel in the days following the procedure can be controlled with prescribed medications.
Recovering from a combined mastectomy and reconstruction or from a flap reconstruction typically takes longer than recovery from an implant reconstruction or a reconstruction performed apart from the mastectomy. Although everyone heals at a different rate, your recovery may follow this general timeline:
- Surgical drains (if used) will be removed and dressing will be changed.
- Your stitches will be removed
- Any lingering soreness at the surgical sites will diminish
- You will feel less fatigued and have more energy
- You may return to most of your normal activities, including sports and sexual activity
- You may begin stretching exercises recommended by your plastic surgeon.
- Your scars will begin to fade, although it may take many months to see substantial fading.
If you are like most women who undergo breast reconstruction, you will find that the procedure provides both physical and emotional rewards. For many women, breast reconstruction represents a new start, the chance to put breast cancer behind them and get on with their lives. You should expect to go through a period of adjustment to your new look. However, any concerns about your new shape are likely to pass within a few months as you begin to think of the reconstructed breast as your own.
