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Overview
Breast reconstruction is a
surgical procedure to rebuild the contour of the breast, along with the nipple and
areola (the pigmented area surrounding the nipple) if desired. Recent advances in
reconstructive techniques have given patients more choices when it comes to breast
reconstruction, including the option to have breast reconstruction during the same
operation in which the breast is removed. Being diagnosed with breast cancer is not
usually a medical emergency; most women have a sufficient amount of time to research
treatment and reconstructive options before having to make any decisions.
Though some women are not interested in
breast reconstruction, many breast specialists support reconstructive surgery as an
important option for patients to consider. Women are encouraged to weigh both the
advantages and disadvantages of breast reconstruction with their plastic surgeons and
cancer treatment team and make an informed decision based on their own situation. Breast
reconstruction is most often an option for women who have had mastectomy
if their entire breast has been removed. Women who undergo lumpectomy
(surgical removal of a breast lump and a margin of surrounding tissue) rarely need breast
reconstruction.
The goal of breast reconstruction is to
create breast symmetry when a woman is wearing a bra. When a woman is nude, the
reconstructed breast will look different from the unaffected breast, regardless of the
type of reconstruction chosen. However, when a woman is wearing a bra, the size and shape
of the reconstructed breast should closely resemble the unaffected breast.
It is a common misconception that women
may have to wait a year or longer to begin the reconstructive progress after breast
surgery. Though breast cancer patients who receive chemotherapy after mastectomy may have
to delay reconstruction under chemotherapy is finished, the majority of women begin may
reconstruction soon after the surgery in which the breast is removed (if not during the
same operation).
Types of
Breast Reconstruction
There are two main types of breast
reconstruction available to most mastectomy patients:
- Saline breast implants
- Muscle flap reconstruction
The insertion of saline
(salt-water filled) implants is usually a two-part procedure. The first implant operation
involves placing a tissue expander in the intended breast area beneath the skin and chest
muscle. The tissue expander is similar to a balloon, and the surgeon will fill the
expander with salt-water solution periodically (usually once a week). The procedure to
insert the tissue expander into the breast area typically takes about forty-five minutes.
After the skin has sufficiently stretched, the surgeon will replace the tissue expander
with a permanent saline implant, usually three to four months after the first implant
surgery. Occasionally, a woman will not need a tissue expander. If this is the case, then
the surgeon will proceed directly to permanent implant surgery. Approximately 50% of
saline implants need some type of modification or replacement after five or ten years.
The second main type of breast
reconstruction, muscle flap reconstruction, involves using a patient’s own tissue to
rebuild the contour of the breast. Tissue may be taken from the back, stomach, or
buttocks. Muscle flap operations leave scars both from where the tissue was taken and on
the reconstructed breast. In a free TRAM (Transverse Rectus Abdominis Muscle) flap
procedure, the surgeon transfers some abdominal skin, fat, and a small piece of muscle
under the skin to the intended breast area. The tissue from abdomen is usually enough to
create a breast shape. If not, a saline implant may also be inserted. In a back tissue
(latissimus dorsi) reconstructive flap, a surgeon transfers muscle and skin from the
patient's back to the intended breast area. This creates a pocket where an implant is
usually inserted.
Muscle flap procedures take much longer
than implant operations, lasting about four to five hours, and patients typically stay in
the hospital three to four days, compared to one day with the implant operation. Though
the recovery is slower, the breast usually looks and feels more natural to most women.
Because muscle flap reconstruction
involves the blood vessels, women who smoke or have diabetes, vascular, or connective
tissue diseases cannot typically undergo this type of breast reconstruction.
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Latissimus dorsi muscle flap (back tissue) reconstruction. Image courtesy of NIH/NCI.
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Because many breast cancers involve the
nipple areolar complex, the surgeon usually removes the nipple during mastectomy. After
the breast volume has been rebuilt with a tissue expander or muscle flap procedure, the
nipple may be recreated. Most nipple recreation takes place two to six months after the
initial breast reconstruction to allow the new breast area ample time to heal. A new
nipple may be created from a skin graft from a woman’s inner thigh or from the areola
(the pigmented region surrounding the nipple) on her natural breast. Occasionally after a
skin graft, the skin of the newly created nipple turns white. Some surgeons prefer to
tattoo the skin graft of the new nipple to ensure that the color matches the color of the
nipple from the natural breast. See the section on peg procedures below for more
information.
CONTINUED
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