Breast reconstruction is a physically and emotionally rewarding procedure for women who have lost one or both breasts due to genetic susceptibility or breast cancer. When faced with a mastectomy, it’s normal to feel anxious, sad and uncertain about giving up a part of your body. Your breasts may be closely tied to your sense of femininity, your sexuality, your confidence, your self-image and your motherhood experience in case of breastfeeding.
If you choose to undergo breast reconstruction, you also need to decide when the procedure will take place. Breast reconstruction can be performed either at the time of the mastectomy (immediate reconstruction) or sometime afterward (delayed reconstruction).
Reconstruction with implants
Following a mastectomy, the reconstruction process begins either by immediate insertion of breast implant at the time of mastectomy or later on by placing a tissue expander beneath the muscles of the chest wall, the patient then receives a series of injections of saline into the expander as an outpatient until the desired breast size is achieved. The expander is then removed and a permanent implant, either silicone or saline, is placed. This procedure can take up 1 year to complete.
Reconstruction with the patient’s tissue
Breasts can also be reconstructed using a patient’s tissue. Usually, the transverse rectus abdominis cutaneous muscle is used with the overlying abdominal tissue. The TRAM is rotated into position or may require a free flap of a microvascular connection of the vessels for positioning. Other tissues that can also be used include the latissimus dorsi from the back or the gluteal muscles from the buttocks.
Reconstruction of the nipple and areola
After initial surgery with either an implant or the patient’s tissue, the nipple and areola can be reconstructed. A mound of tissue is made from nearby skin to create a nipple, which is then surrounded by tattooed coloration.
● A subsequent surgery and recovery period are avoided. ● Scar tissue has not formed from the mastectomy. ● Remaining breast skin is still available in the size and shape of the original breast. ● The patient does not have to see herself without any breast at all. ● Postoperative chemotherapy or radiation therapy does not usually need to be delayed.
In some cases, such as intermediate or advanced breast cancer, your surgeon will probably recommend choosing delayed reconstruction to allow time to control the cancer. Delayed reconstruction is also advantageous for patients who need time to think through their options thoroughly.
It’s extremely important that you fill out your paperwork correctly regarding any medications or supplements you take as they might interfere with the smoothness and safety of your surgery. Also, if you’re a smoker, you should stop smoking at least 15 days prior to your procedure.
The length and difficulty of your breast reconstruction recovery will vary based on the type of procedure being performed and the extent of work performed. Swelling, pain, and bruising are to be expected. Pain and discomfort can be managed with medication. Most women can start to get back to normal activities within 6 to 8 weeks. If implants are used without flaps, your recovery time may be shorter.
If you have had a single mastectomy, your surgeon will create a new breast that matches your natural breast as much as possible. In some cases, surgery on the unaffected breast can improve symmetry of the size, shape and position of both breasts. This can be achieved through breast augmentation, breast reduction, breast lift or repositioning of the nipple on the natural breast.
A reconstructed breast may look and feel similar to natural breast tissue, but the sensation you experience may be quite different. You may have little to no sensation in a breast that has been recreated with any reconstructive technique.