Breast Reconstruction and Nipple Areola Reconstruction
When a woman is diagnosed with breast cancer, the possibility of losing a breast and how that will affect their body image can be devastating. The most important decision is to ensure all cancer is removed and the necessary treatment modalities are being used. A plastic surgeon can offer advice regarding reconstruction before and after breast cancer surgery. There are several breast reconstruction options that can decrease the anxiety and limit the negative body image impact breast cancer traditionally caused. Reconstruction can be performed at the time of mastectomy or delayed to after mastectomy. Many oncoplastic procedures exist for women who are choosing breast conserving therapies like lumpectomy or partial mastectomy or have asymmetry after radiation.
Breast reconstruction is achieved through several plastic surgery techniques. These techniques try to restore the breast to their normal shape, appearance and size following mastectomy. Breast reconstruction can rebuild your breast, but the results can be variable. A reconstructed breast will not have the same sensation and feel as the breast it replaces. Incision lines will always be present and incision lines at the donor site, may also be visible.
Breast reconstruction is a good option for:
- Individuals who are able to cope well with their diagnosis and treatment
- Individuals who do not have additional medical conditions or illnesses which may impair their healing
- Individuals who are emotional ready for the results of breast reconstruction
There are two main types of reconstructions: implant based reconstructions and autologous reconstruction. Implant based reconstruction is typically a three staged procedure. It is either done immediately at the time of mastectomy or in a delayed fashion after mastectomy and adjuvant chemotherapy and radiation if it is needed. Sometimes a mastectomy or radiation will leave insufficient tissue on the chest wall to cover and support a breast implant. When using a breast implant in reconstruction surgery, a flap technique or tissue expansion is almost always required. Using a tissue expander is considered stage one of the reconstructive process. A tissue expander is blown up or expanded with saline in the office over time to get the patient to the breast size that they desire.
Stage two of the breast reconstruction process involves removal of the temporary tissue expander and placement of the permanent implant. Saline, silicone gel or highly cohesive shaped silicone gel implants can be used.
Stage three of the breast reconstruction process is the reconstruction of the nipple areola complex with tattooing of the pigmented portion of the areola.
Free fat transfer can be used during any stage to soften the appearance of the reconstructed breast by transferring fat to areas to improve the skin tone, texture, fix contour irregularities, or enhance the overall shape and size of the breast.
The autologous based reconstructive options are a TRAM (trans-rectus abdominal flap) or DIEP, which is where the skin and tissue is taken from the abdomen in order to recreate the breast. These can be combined with or without an implant, based on the breast desired by the patient. The latissimus dorsi is another autologous option. This flap uses muscle, fat and skin from the back tunneled to the mastectomy site and remains attached to its donor site.
Length of Surgery
One to two hours per side.
Recovery, Risks and Results
Following your breast reconstruction surgery, gauze or bandages will be applied to your incisions. A surgical sports bra will minimize swelling and support the reconstructed breast. A small tube may be placed temporarily under your skin to drain any excess blood or fluid. Your plastic surgeon will give you instructions that will include how to care for surgical sites, which medications to take and apply, specifics concerns to look out for at the surgical site and when to follow up with your plastic surgeon.
The reconstructive process is a big part of the emotional as well as the mental recovery from a breast cancer diagnosis. It is a legal right for the patients to be reconstructed and that this process is covered by health insurance, even if the mastectomy was performed recently or long ago. The most important part of the reconstructive process is the removal and treatment of the cancer. The reconstructive process may be delayed or performed later to ensure all oncologic therapies are completed. The possible risks of breast reconstruction include bleeding, infection, poor healing of incisions and anesthesia risks. Flap surgery also includes it’s own risk as the patient can partially or completely loose the donor and the reconstruction site as well as it’s sensation. Capsular contracture (breast firmness) and implant rupture are also a risk.
The final results of breast reconstruction following mastectomy can help lessen the physical and emotional impact of mastectomy. Some breast sensation may return and scar lines will improve. Quality of life should improve as well as the ability to look and feel whole again.
Dermatology and Plastic Surgery of Arizona is dedicated to educating and promoting breast cancer awareness and research. We understand that 1 in 8 women will be diagnosed with breast cancer in their lifetime and those women need to understand their reconstruction options. Surveys of breast cancer patients and their general surgeons found that only 33% of patients had a surgeon who discussed reconstruction and only 24% of surgeons referred more than 75% of their patients to a plastic surgeon. If you, a family member or a friend has questions regarding breast reconstruction, please do not hesitate to contact a plastic surgeon.