The loss of one or both breasts to cancer or other pathologic conditions is undoubtedly both physically and emotionally traumatic. Fortunately, if you choose to have breast reconstruction, there are a number of options. Breast reconstruction can be performed at the time of mastectomy or after you have recovered from mastectomy and any other cancer therapy. Some patients may not be candidates for immediate reconstruction.
Regardless of timing, the new breast or breasts can be made using either implants or a combination of skin, fat, and muscle from your own body. Each method offers advantages and disadvantages, and some patients may be more suited to one type or other. Breast reconstruction, no matter what technique is utilized, usually involves several procedures, spaced out over a period of months, to shape and tailor the new breast, create a new nipple, etc.
Breast reconstruction is a physically and emotionally rewarding procedure that may be right for you if you have breast cancer and mastectomy is planned, or if you have already lost a breast due to cancer or other conditions.
For implant reconstruction, there are usually two operations. The first, which may be performed at the same time as mastectomy, is done under general anesthesia and takes from one to three hours, depending on whether one or both breasts are being reconstructed. A silicone rubber device called a tissue expander is placed under the skin and muscle of the chest. Drain tubes are also inserted and are removed one to two weeks later. You will remain in the hospital one to two days.
For the TRAM (transverse rectus abdominis myocutaneous) flap operation, skin, muscle, and fat are transferred from the lower abdomen and onto the chest to create a breast mound. The abdominal incision is closed, leaving the patient with a “tummy tuck” scar and a flatter, more contoured belly.
For the latissimus dorsi operation, skin, fat, and muscle are transferred from the patient’s back around to the chest wall to create a new breast mound. Occasionally, a breast implant or tissue expander is used to provide added size.
After expander placement, and beginning two to four weeks after surgery, you will return to Dr. Sewell’s office in order to have saline (salt water) solution injected into the expander through the skin. This will slowly expand and stretch the skin and create a new breast mound. This process is minimally if at all uncomfortable. The expansion process is repeated every few weeks until the desired breast size is achieved. At that point, a second operation is performed, during which the tissue expander is removed and a final, usually silicone gel-filled implant is placed. Nipple areolar reconstruction can also be perfomed as an additional procedure if the patient desires.
The TRAM flap and latissimus dorsi operations usually require a longer hospital stay and significantly longer recovery at home.
Like any operation, breast reconstruction carries some associated risks, including bleeding, infection, delayed wound healing, implant or expander loss, partial or total breast flap loss, and asymmetries. During your consultation with Dr. Sewell, you will have extensive opportunity to discuss the benefits, risks, and alternatives of breast reconstruction.
If you have lost your breast or breasts to cancer or other conditions, breast reconstruction surgery is a choice to consider. Dr. Sewell will speak with you to find out what your desired results are and to decide if you are a candidate.