RECONSTRUCTING A LOST BREAST
Breast reconstruction is an operation that improves
quality of life and it is best deserved for every woman
that needs it. Breast reconstruction can be performed to
correct congenital abnormalities, but it is most often done after a mastectomy.
Reconstruction cannot restore full function or sensation of the breast.
However, it can offer significant improvement in appearance. It is becoming
more common over time, with an increase of almost 20 percent in the last 10
years. This may indicate that the newer techniques used for today’s
reconstructions are more appealing to patients than older methods.
Reconstructive surgery helps many patients
feel like their lives are getting back to normal after cancer treatment. This
can be a real and lasting benefit from an emotional and psychological
standpoint. Although this procedure is not necessary to restore physical
health, it is considered more than simply cosmetic.
Women who have lost one or both breasts to
cancer often feel that their body is no longer under their control. They often
feel very self-conscious about their appearance and this feeling may or may not
fade over time. They may have a sense that they are damaged, incomplete, or
even undesirable after their mastectomy. In these cases, the idea of wearing a
prosthetic to fill out an empty bra cup or simply getting used to having a
missing breast is much less than having a reconstructed breast.
Patients who have had all malignant tissue
successfully removed from their breast and who are not undergoing radiation are
typically the best candidates for this procedure. It is usually inadvisable to
pursue reconstruction until the process of radiation treatment is complete
because radiation can cause significant changes in skin texture and elasticity
and may also interfere with healing.
Patients who are in good health (other than
the presence of cancer) and who do not smoke are often candidates for a
reconstruction using their own tissue. This donor tissue may be taken from
areas such as the lower abdomen or upper back. Having a body weight that is not
too low or too high makes this option more accessible. Women without sufficient
tissue available for this type of reconstruction may still be able to have
implants inserted to rebuild their breasts.
There are several different methods
available for reconstruction after a mastectomy.
1) Autologous Tissue Flap (Grafting)
Reconstructing a breast from your own body
tissue is a much more extensive procedure called flap reconstruction. It
involves taking a section of skin, fat, and muscle from your abdomen (the
transverse rectus abdominus skin-muscle or TRAM), upper back, or, less commonly,
from your thighs or buttocks and using that to fill your breast pocket. Unless one
is very thin, there's likely to be enough extra fat and skin in your lower
belly to make a nicely shaped small to medium-sized breast.
Leaving the flap of tissue partly attached
to its blood supply, the surgeon slides it up under the skin to fill the empty
breast. The additional skin on the flap can be used to replace any that was
lost during the mastectomy, which makes an expander unnecessary. The abdomen is
closed, with the scar extending from hip to hip, much like that from an
abdominoplasty and you'll get the same result -- a flatter stomach. There's a
permanent side effect from this surgery however: you lose so much abdominal
muscle that you may no longer be able to do a sit-up or move from a lying to
sitting position without difficulty.
If the tissue is being taken from your
back, there may not be enough to fill the breast, and the surgeon may need to
use an implant as well.
Flap reconstruction usually takes six to
seven hours and requires you to stay in the hospital for three to six days.
Recovery times differ depending on the procedure and the individual patient. In
general, it takes longer to recover from flap surgery than from implant
surgery, and several months may pass before you're back to normal.
Some women choose to stop after this
operation and live with a breast mound that fills clothes and bathing suits;
others need more and opt for the additional surgery that creates a nipple and
If you choose to get additional surgery,
you'll return after the previous incisions have healed. Your doctor will shape
the nipple from the skin of the reconstructed breast or use part of the skin
from your other nipple. This reconstructed nipple will always appear to be
erect. An areola may be made with a tattoo or with a skin graft of dark skin,
usually taken from the crease where the inner thigh meets the groin. During
this operation the surgeon may do a lift, a reduction, or an enlargement of the
other breast to make it match the newly reconstructed one.
2) Breast Implants
Patients may choose to have implants used
in their reconstruction. Skin may still need to be grafted from other areas of
the body in some cases. In others, a tissue expander may be placed under the
pectoral muscle. It is inflated over time to expend the overlying tissue and
skin and create enough room for a regular implant placement. With both tissue
flap and implant procedures, the nipple and areola are usually reconstructed
using available skin that is tattooed to look pink or brown.
This type of procedure is more complex than
almost any other breast surgery. Besides the risks associated with all major
surgeries, it also carries the potential for:
Extensive scarring including puckering that
distorts the breast skin
Poor wound healing including the failure of
grafted tissue to survive
Results that look and feel unnatural
Complications from breast implants
(including capsular contracture)
Complications at the site where donor
tissue was harvested
The need for repeated surgeries to achieve
a satisfactory outcome or failure to achieve the desired outcome even with
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