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If you are facing the loss of a breast due to cancer
or other disease, you may have the option of breast reconstruction. Breast
reconstruction is a surgical procedure to recreate the natural contour of
your breast, using either a prosthesis or your own tissues.
The Timing of Your Breast Reconstruction
The breast reconstruction process may begin at the time of
your mastectomy (immediate) or weeks to years afterwards (delayed).
Immediate reconstruction means that the procedure begins at the
same time as the mastectomy. It is important to know that any type of surgical
breast reconstruction may take several steps to complete.
Two potential advantages to immediate reconstruction are that
your reconstruction process is already underway when you wake up from the
mastectomy, and there may be a cost savings in combining the mastectomy procedure
with the first stage of the reconstruction.
A potential advantage to delayed reconstruction is that you can
delay your reconstruction decision and surgery until other treatments, such
as radiation therapy and chemotherapy, are completed.
Choices in Reconstruction Procedures
Breast reconstruction can be accomplished
by the use of a prosthesis (a breast implant) or your own tissues (a tissue
flap). A breast implant is a fluid—filled breast form which is surgically
implanted under your chest tissues to create a new breast. A tissue flap is
a section of skin, fat and muscle which is moved from your stomach, back or
other area of your body, to the chest area, and shaped into a new breast.
How are Implants Used in Breast Reconstruction?
Breast reconstruction with a saline—filled
breast implant usually occurs as a staged procedure, beginning with the placement
of a breast tissue expander, which is replaced several months later with a
breast implant.
Stage 1: Tissue Expansion
The tissue expander is a balloon—like device made from elastic
silicone rubber. It is inserted unfilled, and over time, small amounts of
sterile saline are added by inserting a small needle through the skin to the
filling port of the device. The tissue expander creates a new breast shaped
pocket for a breast implant.
During the first stage of implant reconstruction, the plastic
surgeon ensures that the pocket created by the tissue expander is positioned
correctly and is the desired shape and size.
Stage 2: Placing the Breast Implant
After the tissue expander is removed,
the unfilled breast implant is placed in the pocket, and then filled with
sterile saline.
The type of breast implant used will be determined by you and
your plastic surgeon by evaluating the dimensions and shape of your desired
breast.
Reconstruction With Tissue Flaps
The breast can also be reconstructed by surgically moving
a section of skin, fat and muscle from one area of your body to another. The
section of tissue may be taken from such areas as your abdomen, upper back,
upper hip, or buttocks. The reconstructed breast may be made from the tissue
flap alone, or from the tissue flap plus a breast implant.
Flap surgery is a major operation. It requires a hospital
stay of several days, and a longer recovery time than implant reconstruction.
Flap surgery also creates scars at the site where the flap was taken, and
possibly additional scars on the reconstructed breast. However, flap surgery
has the advantage of being able to replace tissue in the chest area. This
may be useful when the chest tissues have been damaged and are not suitable
for tissue expansion, when extra tissue is desired to recreate a large breast
without a breast implant, or when extra tissue coverage is needed over a breast
implant.
Who is a Candidate for Tissue Flap Surgery?
If the remaining tissues on your chest are insufficient
or inadequate to allow breast reconstruction with a tissue expander, you may
be a good candidate for flap surgery. It is important for you to be aware
that flap surgery, particularly with TRAM flap, is a major operation, more
extensive than your mastectomy. It requires good general health and strong
emotional motivation. Often, surgery is indicated on
the opposite breast in order to improve symmetry.
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