Breast reconstruction is a physically and emotionally rewarding procedure for a woman who has lost a breast due to cancer or other disease. Reconstruction of a breast that has been partially or completely removed is possible through a combination of plastic surgery techniques that not only can dramatically improve a woman’s self-image, self-confidence and quality of life. Breast reconstruction typically involves several procedures performed in multiple stages. It can begin at the same time as mastectomy or may be delayed until a patient has healed from mastectomy and recovered from any additional cancer treatments that may be necessary, like radiotherapy and / or chemotherapy.
What is breast reconstruction?The goal of breast reconstruction is to restore one or both breasts to near normal shape, appearance, symmetry and size following mastectomy, lumpectomy or congenital deformities.
Breast reconstruction is achieved through several reconstructive plastic surgery techniques and may include:
When only one breast is affected, it alone may be reconstructed. In addition, a breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry in the size and position of both breasts.
Insurance companies are required by law to provide coverage for breast reconstruction and related procedures to adjust the opposite breast.
The medical consultation is the first step to know the options available in breast reconstruction surgery, according to each individual case. In the consultation, the patient can understand the goal of the procedures, individually evaluate the best surgical options, likely outcomes and any risks or potential complications.
Overall health and personal outlook can greatly impact the outcome of breast reconstruction surgery. The success of your procedure, safety and overall satisfaction requires that the patient honestly share her expectations and understand the likely outcomes of the surgery. Other diseases or medical conditions may impact the final result, such as tobacco use, diabetes and obesity, all of these impairs the healing process.
Breast reconstruction is a highly individualizes procedure. Techniques offer varying advantages and choosing the appropriate course of treatment requires careful consideration of patient anatomy, patient and surgeon preference and desired, realistic outcomes.
Flap techniques may result in a more natural feeling breast. It is used when little tissue or muscle remains following mastectomy. Incision lines appear at both the donor and reconstruction sites.
Breast reconstruction if completed through techniques that reconstruct the nipple and areola, in case it is necessary. It may be achieved with surgical techniques or even with the use of tattoos, increasingly evolving and capable of mimicking almost perfectly the appearance of a normal breast’s nipple and areola.
Breast reconstruction may be performed at one time or over an extended period, depending on the techniques used, the treatment of the cancer, and the availability of the patient. Complete reconstruction generally occurs in multiple procedures occurring at varying intervals.
The main surgical options are:
Breast reduction techniques: In situations where the patient has enough breast tissue, total mastectomy will not be performed and depending on the location of the lesion to be removed, the breast can be “reshaped” using the patient’s own local tissues, without the need for distant flaps or breast implants, using techniques which resemble breast reduction surgery (reduction mammaplasty) most commonly used in cosmetic procedures.
TRAM flap (Transverse Rectus Abdominus Musculocutaneous flap): It uses donor muscle, fat and skin from a woman’s abdomen to reconstruct the breast. It is suitable for patients with available abdominal donor area who do not wish to use breast implants. It is not indicated in obese, diabetic and smoker patients. Less currently used, since it may have a significant postoperative impairment on the abdominal donor area, such as the appearance of abdominal bulging and restriction to some activities.
Latissimus dorsi flap: It uses skin, fat and muscle from the back. It is usually used in combination with a silicone implant. It is indicated in cases where there is little remaining skin and muscle and when there is previous history of radiotherapy. The flap is released from the back, passed through a tunnel that is made underneath the axilla and into the anterior chest to fill the mastectomy defect site. The muscle is placed and sutured to the chest wall. An implant is then placed behind this flap and in front of the chest.
Tissue expanders: When mastectomy surgery leaves insufficient tissue to cover a breast implant, tissue expanders can be used. Tissue expanders are nothing more than empty implants, filled with sterile saline solution over many weeks, creating enough healthy tissue to cover the breast mound. This technique does not require donor areas of other body regions; however, it necessarily requires a second surgical procedure to replace the temporary expander to the definitive silicone implant.
Breast Implants: The evolution in the treatment of breast cancer has increasingly allowed more conservative surgical procedures to be performed while maintaining oncologic safety. Therefore, the possibility of use of breast implants in the first procedure combined or not with breast lift techniques, is becoming more frequent. This possibility accelerates the treatment and often results in the positioning of scars in a more similar fashion to those usually performed in aesthetic surgeries. Therefore reduces the stigma of the mastectomy and minimizes the impact on the patient’s body image, already unsettled by the cancer treatment.
Possible risks of breast reconstruction include bleeding, infection of poor healing. Flap surgery includes the risk of tissue loss and a loss of sensation at both the donor and reconstruction site. The use of implants carries the risk of breast firmness (capsular contracture) and implant rupture. All surgery carries the risk associated with anesthesia. These risks and others will be bully discussed during your medical appointment.
It is important to understand that breast reconstruction can produce remarkable results, however it cannot exactly match a breast lost to mastectomy. Even with revision procedures on the opposite breast, symmetry between the breasts will not be perfect. However, the appearance under most clothing and swimsuits can be quite natural and balanced.
It is important that you address all your questions directly during the consultation. It is natural to feel some anxiety, whether anticipation for the outcome of breast reconstruction or preoperative stress.
Initial reconstruction procedures are most commonly performed under general anesthesia and include a short hospital stay. Some follow-up procedures may be performed under local anesthesia with sedation. Each case should be analyzed individually and the decision will be based both on the procedure itself and patient’s considerations.
Support bra should be used in the recovery time in all cases, as it minimizes swelling and supports the reconstructed breast. Small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid.
The final results of breast reconstruction following mastectomy can help the patient feel physically and emotionally fulfilled.
Over time, some breast sensation may return, and scar lines will improve, although never disappear completely. Some adaptation is necessary, but most women feel these are small compared to the large improvement in their quality of life and the ability to look and feel whole again.
Source: www.plasticsurgery.org
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