Breast Reconstruction is an option for virtually any woman who must lose her breast to cancer. Most patients that undergo mastectomy are candidates for reconstruction whether at the time of mastectomy or at a later date. Typical reconstruction involves a series of procedures over a period of time. There are a variety of options available in breast reconstruction and the recommendation of a qualified surgeon is paramount to achieving a good result.
What to Expect
Initially you will want both a plastic surgeon and oncologic (cancer) surgeon to develop the best plan for your reconstruction. After evaluating the patient’s age, health, skin, tissue, emotional condition and personal goals for reconstruction, your physician can discuss your best options for a favorable outcome and the risks and limitations inherent to each.
The first stage of reconstruction is usually performed under general anesthesia and in an accredited hospital or surgical facility. Additional procedures may require only local anesthesia.
One technique commonly used in reconstruction is skin expansion. This includes insertion of a balloon expander under the skin. There is a valve that allows your physician to gradually (over a period of several weeks) inject salt-water solution to fill the expander. Some are left in place as the final implant while others may be removed and replaced with a permanent implant after skin is stretched enough to accommodate it. Some women do not require tissue expansion and receive their implant as the first step.
Another technique is a procedure known as flap reconstruction. Tissue is taken from other parts of the body to create a skin flap. This flap, which may consist of skin, fat and muscle, is inserted beneath chest skin to create either a pocket or actual breast mound. One type of flap surgery leaves tissue attached to the original blood supply from the site from which it came. It is moved to the chest through a tunnel under the skin to create the pocket or mound. The other type of flap involves transfer of tissue that will be reconnected to new blood vessels in the chest area. This requires a surgeon experienced in microvascular surgery. Both flap procedures are more complex than the skin expansion and implant procedure. When tissue is removed from the abdomen for use in the breast, however, the total body contour may be improved. There may be additional surgery to lift and match the natural breast to the reconstructed breast, as well as to reconstruct the nipple and areola.
Release from the hospital generally occurs in two to five days after surgery. You will have some soreness and discomfort that can be controlled with medication. Drains will be inserted to remove excess fluids and these will be removed in one to two weeks. Stitches come out in seven to ten days. Physical activity, especially overhead lifting, will be restricted for up to six weeks following surgery.
These procedures do not restore pre-mastectomy sensation to the breast, but gradually some feeling may return. There will be scars that will fade to some extent over the next two years.
Most patients find that breast reconstruction gives them a more positive outlook and that it improves their appearance and quality of life.
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