Breast Reconstruction Surgery

Breast reconstruction surgery is a type of surgery that is aimed at reconstructing a breast which has been removed as a result of cancer or other diseases. Among the medical procedures which are available today, it is one of the most gratifying. Using new medical devices and techniques, surgeons are now able to create a breast that almost resembles the form and appearance of a natural breast. In most cases, reconstruction can be done immediately after the breast removal, making it possible for a patient to wake up to a new breast mound. As a result, such a patient is spared from seeing herself without a breast. It is important to point out that breast reconstruction after mastectomy is not usually a simple procedure.

Nevertheless, there are several options that need to be considered by a patient and her doctor before making this decision. The information provided in this article is aimed at giving prospective candidates a basic understanding of this procedure. In this case, the article discusses when and how it is done, as well as the expected outcomes. However, it is not possible to answer all the patients’ questions, since most aspects of the surgery depend on an individual’s circumstances. It is therefore important for patients to consult with their breast reconstruction surgeons if there is anything they do not understand regarding the procedure.

IDEAL CANDIDATES

The majority of the mastectomy patients are medically eligible for this procedure, immediately after the removal of the breast. However, the best candidates are women in whom cancer appears to have been eliminated through mastectomy, as far as doctors can determine. All the same, there are various reasons why women should wait before undergoing this procedure. In most cases, women find it difficult to weigh their options when they are still grappling with a cancer diagnosis. Still, others only want surgery only if it is absolutely necessary.

Surgeons may also advise their patients to wait, particularly if the reconstruction is being conducted using a complicated procedure such as using skin flaps and underlying tissue. At the same time, women who smoke and those with certain health conditions such as high blood pressure or obesity may also have to wait. Whatever the case maybe, informing patients about their reconstruction options prior to surgery is always advisable. This is because it helps them to look forward to life after the mastectomy with a positive attitude.

RISKS

Nearly all women who have to lose their breasts to cancer can have it reconstructed through surgery. All the same, there are certain risks that characterize any surgery, as well as complications that are specific to this procedure. Some of the problems usually associated with surgery are bleeding, excessive scar tissue or fluid collection, though they are not common. Smokers ought to know that nicotine may delay healing, causing noticeable scars and protracted recovery. In some cases, the resultant complications may be severe enough to warrant a second operation.

In cases where implants are used, there is a remote probability that an infection might develop, normally within two weeks after the surgery. Some cases may require the removal of the implant for a few months until the infection has cleared, after which a new implant can be inserted. Capsular contracture is one of the common problems, which occurs when the scar surrounding the implant starts to tighten. In this case, the breast may feel hard as a result of the squeezed soft implant. This condition can be treated in various ways such as the removal of the scar tissue, while the implant may also be removed or replaced.

Currently, reconstruction has no proven effects on the recurrence of any disease in the breast. Further, it does not normally interfere with radiation or chemotherapy treatment if cancer should recur. Surgeons normally recommend the continuation of periodic mammograms on both the remaining normal breast and the reconstructed one. If one’s reconstruction involves an implant, one needs to visit radiology centers whose technicians have experience in x-raying reconstructed breasts with implants. Postponing reconstruction may provide a woman with a period of emotional adjustment. Since it takes time for a woman to adapt to the loss of her breast, she may also feel confused and anxious as she begins to consider the prospect of having a reconstructed breast.

PLANNING FOR THE SURGERY AND ANESTHESIA

It is usually advisable to talk about a breast reconstruction procedure the moment a person is diagnosed with cancer. Ideally, the patient’s breast and plastic surgeon should work together, in order to develop a strategy that puts her in the best condition possible for reconstruction. Upon evaluating a patient’s health, the surgeon normally explains the reconstructive options that are most suitable for the patient. Such options are usually determined on the basis of one’s health, age, tissues, anatomy and goals. It is important for patients to frankly discuss their expectations with the surgeon. The surgeon should also be frank with the patient, clearly describing her options as well as the limitations and risks of each. It is important for the patient to keep in mind that though the reconstruction can improve her appearance and renew self-confidence, it is not perfect. In any case, the desired result of the procedure is improvement, rather than perfection.

The surgeon should also explain to the patient the anesthesia that he or she will use, the cost of the surgery and the facility in which it will be performed. In most cases, most or all of the reconstruction costs will be covered by health insurance policies. Patients are required to check their policies in order to ascertain whether they are covered, and to identify any limitations on the types of reconstruction covered.

SURGERY PREPARATIONS

A patient’s oncologist and plastic surgeon will give her specific instructions regarding the preparations for surgery. These will include guidelines on drinking and eating, smoking and using or avoiding certain medications or vitamins. When it comes to breast construction, more than one operation is involved. The first stage, which can be done immediately after the mastectomy or later, is usually carried out in a hospital. The follow-up procedures can also be conducted in the hospital or an outpatient facility, based on the extent of surgery needed. The first reconstruction stage involves the formation of the breast mound. In most cases, it is carried out using general anesthesia, so patients normally sleep through the whole operation. On the other hand, follow-up procedures only require a local anesthesia, which is normally combined with an aesthesia to make a person drowsy. In this case, the patient will be awake though relaxed, thus she may experience some discomfort.

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TYPE OF IMPLANTS

If the surgeon recommends an implant, it is important that the patient discusses with the surgeon on the type of implant to be used. A breast implant refers to a silicone shell that can either be filled with silicone gel or salt-water solution, also known as saline. Presently, there are concerns that there is inadequate information that demonstrates the safety of breast implants filled with silicone gel. As a result, the Food & Drug Administration (FDA) has decided that such implants should only be availed to women taking part in approved studies. Currently, this includes women already having tissue expanders or those who opt for immediate reconstruction following mastectomy. It also includes women who already have gel-filled implants and who need a replacement for medical reasons. Ultimately, all the women who have appropriate medical indications could have similar access to such implants.

However, the saline-filled implants are available without any restrictions.

THE SURGERY

There are many options which are available in breast reconstruction, thus the patient and the surgeon should settle on what is best for her. The most common surgery technique is referred to as skin expansion. After the mastectomy, the surgeon inserts a balloon expander beneath a person’s skin and chest muscle. Using a valve mechanism that is buried under the skin, the surgeon periodically injects salt-water solution into the expander, gradually filling it over several months or weeks. Once the skin over the patient’s breast area has stretched sufficiently, a second operation may be performed to remove the expander. Afterwards, an implant that is more permanent will be inserted. However, there are expanders that are designed to act as final implants. The nipple and the areola are usually reconstructed in subsequent procedures. Not all patients require tissue expansion prior to receiving an implant. In this case, the surgeon inserts an implant as the initial step.

Flap breast reconstruction is the other approach to implant reconstruction. It entails the creation of a skin flap, whereby the surgeon uses tissue that is taken from certain parts of the body such as the buttocks, abdomen or back. In one type of this form of surgery, the tissue remains in its original site, thus ‘preserving its blood supply. The flap, which consists of the skin, muscle, fat and blood supply, is tunneled beneath the patient’s skin to the chest. Such a flap may create a pocket for the implant, or it may create the breast mound without the need for an implant. The other flap technique utilizes tissue that has been surgically removed from the buttocks, thighs or abdomen. The tissue is then transplanted to a patient’s chest, through reconnecting its blood vessels to new ones in the region. This procedure requires a plastic surgeon who is also skilled in micro-vascular surgery. Regardless of the approach used, this form of surgery is more complicated than skin expansion. There will be scars both at the tissue donor site and reconstructed breast, while recovery takes longer than with implants. However, since the breast is entirely reconstructed with a person’s tissue, it has more natural results, while there will be no concerns regarding silicone implants.

In most cases, breast reconstruction involves several procedures that normally occur over time, whereby the initial reconstructive operation is usually the most complex. Follow-up surgery may be needed to replace tissue expanders with implants, or to reconstruct the patient’s nipple and areola. Most surgeons may recommend an additional operation, aimed at enlarging, reducing or lifting the patient’s natural breast in order to match with the reconstructed one. Patients should keep in mind that this procedure may leave scars on their normal breast, while it may not be covered by health insurance.

AFTER THE SURGERY

A patient is likely to be tired and sore during the first week or two after the reconstruction. Any discomforts during this period can be managed using medications prescribed by the doctor. The patient may be released from hospital in two to five days, depending on the extent of her surgery. Most reconstruction alternatives require surgical drains to remove the excess fluids from the surgical sites after the operation. These are normally removed within the first two weeks following the surgery. In most cases, stitches are taken out within a week to ten days.

RECOVERY

Recovery from a combination of mastectomy and reconstruction may take up to six weeks. Patients may also take the same duration to recover from flap reconstruction, but people whose implants do not have flaps will take less time to recover. Additionally, people whose reconstruction is not performed together with mastectomy also take a short time to recover. Normal sensation may not be fully restored to a patient’s breast, though some feeling may be restored with time. The scars will also fade considerably over time, though they may never disappear completely. Patients should seek the surgeon’s advice before engaging in any exercises or normal activities. Some of the activities that patients should avoid are strenuous sports, overhead lifting and sexual activity during the first three to six weeks after reconstruction

NEW LOOK

It is highly likely that a patient’s reconstructed breast will feel firmer, while it may also seem rounder or flatter than one’s natural breast. It will not match the opposite breast, nor will it have the same contour as one’s breast prior to mastectomy. The good news is that these differences will only be apparent to the patient. All things considered, breast reconstruction greatly helps to improve the appearance of mastectomy patients, while also enhancing the quality of their lives. Dr. Hall and Dr. Wrye are experts in breast reconstruction surgery located in Reno, Nevada, call us now for consultation 775-284-8296.

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