Breast Reconstruction Surgery
Women who undergo breast cancer surgery can choose breast reconstruction surgery for rebuilding the shape and look of their breast.
The procedure can be done several months or even years after going through surgery for breast cancer. Breast reconstruction can be of various types.
Purpose
Women consider breast reconstruction for various reasons:
- To make her chest look more balanced while she is wearing a bra or swimsuit.
- To help her clothes fit better.
- To regain her breast shape permanently.
- To feel better and more confident about her body.
Though this procedure often leaves scars, they can fade over time. There are newer techniques which have reduced the amount of scarring. While wearing a bra, a woman’s breasts should look alike in size and shape, helping her feel confident and comfortable in most types of clothing.
However, it is noteworthy that the reconstructed breast is generally not a perfect match or substitute for a natural breast.
If tissue from your back, tummy, or buttocks were used as part of your reconstruction procedure, then it is likely that those areas will look different after your surgery. It is important to talk to your surgeon about scars and changes in shape or contour.
Types
Breast reconstruction is generally of two types-
- Implants – Implants are generally made out of silicone or saline or sometimes a combination of both. They are generally placed underneath the chest muscle.
- Flaps- Flap procedures are performed by plastic and reconstructive surgeons specializing in microsurgery. During this procedure, a breast is created using tissue taken from other body parts. This can be your abdomen, back, thigh, or buttocks. The tissue is then transplanted to the chest by reconnecting the blood vessels to any new ones in your chest region.
Preparation
If you have decided to go for breast reconstruction, you need to consider several things, as you and your doctors talk about which kind of reconstruction is going to be best for you. Some factors you and your doctors need to think about while considering your options include:
- Your overall health
- Your breast size
- The location and size of your breast cancer
- Your breast cancer surgery (lumpectomy or mastectomy)
- Whether you had any other treatments other than surgery for your cancer
- The amount of tissue that is available
- Your insurance coverage
- Whether you want reconstructive surgery on one or both breasts
- How quickly you want to be able to recover from surgery
- How different types of reconstructive surgery might affect other body parts
- Whether you are willing to have more than one surgery as part of the reconstruction
Your surgeon will need to review your medical history as well as your overall health. Then he/she will decide and will explain which reconstructive options might be best for you based on your age, health, body type, as well as other factors.
You will need to discuss with your surgeon openly about your preferences. Be sure to voice any concerns if you have any.
Your breast surgeon and your plastic surgeon will likely give you instructions on how you can prepare for your surgery. It will probably include:
- Help with quitting smoking if you smoke regularly
- Instructions on consuming food and drink before surgery
- Instructions for taking or avoiding certain kinds of vitamins, medicines, as well as dietary or herbal supplements for some time prior to your surgery
Arrange for someone for taking you home or book a cab after your stay at the hospital. You might also need someone to help you out for a few days after the surgery.
Procedure
Generally, the first stage of reconstruction is done using general anesthesia. This means you will be given sedatives and will be asleep during the entire procedure.
During the follow-up procedures, you will likely need only local anesthesia. This means that only the area where the doctor is working on is going to be numbed. A sedative drug might also be used for making you feel relaxed but awake.
Implants
When a breast is being reconstructed with implants, a surgeon will first need to insert silicone or saline implants underneath your skin or muscle, in the place of the previous breast tissue.
This can be a two stage procedure for most people. During the first stage, your surgeon will place a tissue expander underneath the remaining breast skin or pectoralis muscles. This expander will be serving as a temporary saline implant which will gradually stretch your remaining tissue.
After the person has healed completely after the surgery, your surgeon will need to inject sterile saline or saltwater through your skin into the tissue expander weekly. This balloon grows over time, stretching the overlying skin and muscle until the breast can reach a size that is comfortable for you.
When the chest tissues heal and enough saline has been added to the tissue expander in preparation for the implants, the second procedure will be performed for inserting the implants.
Next, your surgeon will remove the tissue expanders and replace them with either a silicone or saline implant.
Skin flap surgery
In a skin flap surgery, your surgeon will be taking tissue from another part of the body, and then he/she will be moving it to the chest for rebuilding the breast.
The surgeon will usually remove this tissue from various places of your body, which can include the buttock, back or thigh. Skin flap surgery might be highly complex, as it involves transferring tissue from one area of the body to another.
Skin flap surgery is also of two types.
Free flap surgery
In free flap surgery, a surgeon will completely remove the tissue and the blood vessels, for placement in the breast. In this method, they stitch those blood vessels into your other blood vessels in your chest at the intended site of placement. These blood vessels are generally quite small and therefore, the surgeon will be using a microscope for sewing them together. This method is known as microsurgery.
Pedicle flap surgery
In pedicle flap surgery, your surgeon will not entirely remove your transplanted tissue from its blood vessels. Instead, the tissue is going to remain attached to the body and the surgeon will be rotating this into the chest to form the breast.
In this method, your surgeon may use tissue from the abdomen or back for pedicle flap surgery.
Aftercare
Since breast reconstruction is major surgery, a person might need to spend a few days at the hospital, whether it was implant reconstruction or flap reconstruction.
Sometimes, people might need more than one single surgery for fully reconstructing the breast(s). Generally, skin flap surgery usually has a longer recovery time than implant reconstruction.
In both types of surgery, you will be unable to perform most of your daily activities for around two months. There might be a psychological impact of losing one or both of your breasts as well.
In the first two months of recovery, people generally experience:
- fatigue
- restrictions on movement
- pain, swelling, bruising, or soreness in the breasts and at the site from which the surgeon removed tissue
Following the surgery, you will most likely require stitches and drainage tubes. Within time, though some sensation will return, reconstructed breasts will not be providing the same level of sensation.
Nipple reconstruction might also be required. During this procedure, a surgeon will be sewing together small pieces of skin on the reconstructed breast to create a bump that will resemble a nipple.
Risks and complications
The risks and complications which can occur during the procedure include:
- extreme fatigue
- bleeding or blood clots
- fluid buildup in the breast or at the donor site (for skin flap surgery)
- infection
- slow or disrupted wound healing
- potential complications with anesthesia
After surgery, there might be some additional complications such as:
- tissue death or necrosis, which might occur in the skin, fat or tissue flap
- a loss of muscle strength at your donor site, if skin flap surgery was performed
- changes in breast or nipple sensation
- need for more surgical procedures in case of complications
- uneven breasts
- problems with the implant, such as movement, leakage, rupture or scar tissue
- a need to remove the implants