Breast
Reconstruction
Breast reconstruction is a surgical procedure that
utilizes different techniques to create a breast that
closely matches the shape, size and feel of the breast
that was removed. There are two alternatives to consider:
immediate breast reconstruction and delayed breast reconstruction.
Immediate breast reconstruction is performed at the
same time as the mastectomy, while delayed breast reconstruction
is postponed until a later post-surgery date.
Breast
reconstruction is most often recommended for patients
who have undergone a mastectomy (surgical removal of
a breast) due to cancer or a pre-cancerous condition,
although these techniques may also be used to correct
any type of breast abnormality.
Many women feel insecure about breast abnormalities,
especially after a mastectomy. Breast reconstruction
offers women an opportunity in renewing a normal appearance
to their breasts. This will create a sense of confidence
as well as assist the woman in regaining her femininity.
Immediate Reconstruction
During immediate reconstruction the general surgeon,
who removes the breast, teams up with a plastic surgeon,
creating the new breast. Immediate reconstruction has
several potential emotional and aesthetic advantages.
Some patients find that waking up from a mastectomy
with two normal breasts helps to alleviate the grief
caused by losing a breast. Immediate reconstruction
can also preserve a greater amount of skin and reduce
scarring. Scars are easier to conceal when less skin
is removed during the mastectomy. And, of course, when
the reconstruction is performed immediately following
the surgery, there is only one recovery to deal with.
Delayed
Reconstruction
Though immediate reconstruction offers many benefits,
it is not for everyone. Some patients do not want the
added stress of researching different reconstruction
techniques while they are coping with a cancer diagnosis.
Since breast reconstruction can be performed weeks or
even years after having a mastectomy, choosing a delayed
reconstruction allows patients to take their time exploring
their choices. Delayed reconstructions also allow patients
to complete other treatments such as chemotherapy or
radiation before thinking about breast reconstruction.
If you are considering breast reconstruction, the following
information will provide you with a good introduction
to the procedure. For more detailed information about
how this procedure may help you, we recommend that you
consult a plastic surgeon who is board certified or
who has completed a residency program that includes
instruction in this procedure.
How is a Breast Reconstruction procedure
performed?
There are two major types of breast reconstruction:
breast implants and flap reconstruction:
Breast implants
The most common breast reconstruction technique, implants
are rubber shells filled with either silicone gel or
a saline solution. Breast implants are typically inserted
through the use of a tissue expander. In this technique,
a silicone balloon or bag is surgically placed beneath
the chest muscle.
Through a valve buried under the skin, the surgeon
injects a sterile saline solution into the bag, expanding
it. The "expander" stays in place for several
weeks or months, during which time weekly or bi-weekly
injections are administered. Once the skin has expanded
sufficiently, the bag is replaced with a permanent implant
during a second surgery.
A third surgery may be recommended to reconstruct the
nipple and areola. In order to ensure proper placement
of the nipple, this operation is normally performed
at least three weeks after implant surgery, giving time
for the new breast time to settle into its permanent
position. The nipple is usually fashioned from a small
piece of skin drawn from the breast mound. A separate
skin graft forms the areola. About six weeks later,
the nipple and areola will be colored to match the other
side using a medical tattoo technique.
Flap reconstruction
This technique creates a new breast using a section
of muscle, skin and fat taken from another area of the
body. It requires a longer hospital stay and more recovery
time than implant reconstruction, and it also leaves
scars at both the breast site and the donor site. But
because the new breast is made of natural tissue, it
looks, feels and ages more like a normal breast -- which
many patients prefer. In addition, the use of natural
tissue eliminates the complications that can arise when
foreign objects such as implants are inserted into the
body. Flap reconstruction may also be recommended when
the skin won't expand enough to cover an implant.
Flap reconstruction may be performed using a pedicle
flap or a free flap. The pedicle flap allows the tissue
used in reconstruction to remain attached to its original
blood source. The tissue is moved to the breast area
through a tunnel under the skin. In the free flap technique,
the flap tissue is completely removed and reattached
to the breast area, where its blood vessels are connected
to those in the chest area through microsurgical techniques.
Types of flap reconstruction:
Transverse abdominus musculocutaneous flap
The TRAM procedure can be performed as either a pedicle
flap or a free flap. A section of muscle, fat and skin
is surgically removed from the abdomen and used to form
the new breast. Sometimes referred to as "tummy-tuck"
reconstruction, this procedure flattens the stomach
andreconstructs the breast simultaneously. After the
surgery, the abdominal muscles are temporarily weakened,
and in rare cases, this weakness becomes permanent.
If you are considering future pregnancy, be sure to
tell your doctor because this sort of abdominal weakness
can affect future pregnancy.
Latissimus Flap
In this technique, a section of the latissimus dorsi
(the back muscle arising from the top of the hip to
the arm just below the shoulder) is removed to form
a new breast. This tissue is often quite thin, so a
small implant may be required as well.
Other flaps
If the abdominal or latissimus tissue is unsatisfactory,
a flap can be taken from the upper, middle or lower
part of the buttock. However, this technique tends to
weaken the gluteal muscle, restricting an athletic patient's
activities. It also requires the surgical removal of
a vein from one leg, since the gluteal blood vessels
often aren't long enough to stretch from the chest area
to the armpit where they must be reattached. If all
other methods are unsatisfactory, tissue can be taken
from the upper hip or "love handle" area.
This technique is usually a last resort, since this
tissue does not lend itself well to shaping a breast.
Taking a flap from this area can also leave the hips
uneven
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How long does a Breast Reconstruction procedure
take?
Generally, each of the surgeries in the implant process
takes from one to two hours. Flap reconstruction surgeries
may take two to four hours and the TRAM flap operation
could take up to six hours. Free flap procedures are
often longer than pedicle flap procedures because of
the careful microsurgery needed to reconnect the blood
vessels.
What type of anesthesia is used?
Breast reconstruction is performed using general anesthesia
causing you to be asleep during the whole procedure.
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Where is the procedure performed?
Breast reconstruction is usually performed on an outpatient
basis, in the surgeon's office-based surgical suite,
an outpatient surgical facility, or hospital.
When can I return home and
resume normal activities?
Tissue expansion and implants are often done on an
outpatient basis, allowing the patient to return home
immediately. On rare occasions, patients may be slow
to recover from anesthesia or have complications that
require them to stay overnight in the hospital.
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How do I prepare for a Breast Reconstruction
procedure?
During your initial consultation, your surgeon will
discuss the changes that you would like to make to your
appearance. Since the appearance of your breasts is
a matter of personal perception and preference, you
will need to discuss your concerns in detail so your
surgeon can determine the appropriate alternatives.
You also should make arrangements ahead of time for
someone to drive you to and from your procedure and
to assist you with your daily activities during your
recovery period.
Prior to your surgical procedure, the surgeon will
perform a complete health history and physical. Depending
on your age and state of health, your surgeon may order
tests including, but not limited to, an electrocardiograph
(ECG), chest x-ray and spirometry (lung function test).
Knowledge of your allergies, medications and previous
surgeries should be brought to your surgeon's attention
at this time. Specific instructions to assist you in
preparing for this procedure will be given to you after
the health history and physical is complete. Depending
on your individual health status, the instructions may
include guidelines regarding your diet, alcohol intake,
smoking and which medications.
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What precautions are necessary during recovery?
Recovery time varies depending on the type of procedure,
but usually takes between four and six weeks. Recovery
from flap procedures generally takes longer than recovery
from implant procedures. You should be able to do light
activities by the end of the first week, including taking
short walks to reduce the risk of blood clots in the
legs. Refrain from heavy lifting, sexual activity and
rigorous sports for three to six weeks. Patients who
have had the TRAM flap procedure should refrain from
heavy lifting for at least three months, since the abdominal
wall is weaken by the procedure and further strain could
result in a hernia.
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What are the possible complications after
a Breast Reconstruction procedure?
The most common problem following implant surgery is
capsular contraction, a tightening of the scars around
the implant. In this situation, a second surgery can
be performed to loosen the scar tissue. Other complications
associated with implants include infection around the
implant, necessitating its removal, and leaking, hardening,
or shifting of the implant.
You should know that implants deteriorate over time
and may eventually need to be replaced. With all free
flap procedures there is a risk that the blood vessels
will not reattach sufficiently, constricting blood flow
and causing the death of the flap tissue. Flaps taken
from the buttocks can result in a weakened gluteal muscle,
and flaps taken from the hips can result in noticeable
asymmetry. TRAM flap procedures can result in abdominal
hernia, loss of feeling in the skin below the navel,
and a permanent weakening of the abdominal muscles.
As with most surgeries, the risks of swelling, bleeding,
infection, fluid collection, drug reactions, keloid
scarring, and numbness exist. No procedure is without
risks; however, the majority of complications known
to be associated with a breast reconstruction are minor
when the procedure is performed by an experienced board
certified plastic surgeon. It is always important to
be informed about the possible complications before
any surgery. Be sure to discuss any concerns you may
have with your surgeon.
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What results can I expect after a Breast
Reconstruction procedure?
Your breasts will be wrapped with gauze bandage, plus
a tighter bandage for protection and support. You also
may have small drainage tubes coming out of the incisions,
to help drain some of the excess fluid. It is important
to take the medication prescribed to you by your doctor.
Someone will need to drive you home, and you may need
assistance at home over the next couple of days.
If your breast skin is very dry following surgery,
you can apply a moisturizer, but be sure to keep the
sutures (stitches) area dry.
Breast Reconstruction can help clothes to fit better
as well as improve the overall contour by balancing
the breasts. Remember, though, that as with breasts
in general, the pull of gravity will affect a surgically
corrected breast over time. However, since the breasts
are now more equal in size and weight, they may undergo
such changes more evenly.
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Choosing the right surgeon
To obtain further information regarding Breast Reconstruction,
we advise you to consult with a qualified and experienced
board-certified plastic surgeon. Regardless of the type
of procedure you are considering, it is crucial to choose
the right surgeon for your individual goals. To receive
a complimentary consultation with a specialist in your
area, simply fill out our Online Referral
Form or call Toll Free 800.449.1884.
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