Breast reconstruction

 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.

Procedure Choices

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 areola.

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.

Potential Complications

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

Significant asymmetry                       

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 multiple operations.

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