Breast reconstruction is a procedure with an important physical and emotional impact for a woman who has lost a breast due to cancer or other sickness. The reconstruction of a partial or complete breast loss is possible using a combination of plastic surgery techniques that help building a new breast but also greatly improve the general physical aspect, self-confidence and quality of life. The surgical result may look natural but the reconstructed breast will never feel like the lost one.
Usually, the breast reconstruction is done in several stages. It may be done at the same time with the mastectomy or may be postponed until the patient is cured and fully recovered after mastectomy and other additional therapies.
What is breast reconstruction?
There are several techniques meant to restore the shape, profile and size of the lost breast:
- procedures based on flaps that reposition muscular, fat or skin segments to create a breast mound or to cover a mammary implant;
- tissue expansion used to stretch the healthy skin in order to cover a breast implant;
- the insertion of a mammary prosthesis to simulate the breast shape;
- the use of skin grafts and other techniques to rebuild the nipple-areolar complex.
The results are very different. A reconstructed breast will never have the same sensibility as the original one. Scars will appear both on the donor sites and on the mammary region.
When only one breast is reconstructed, the other one may need a reduction, a lifting procedure or an augmentation in order to achieve symmetry.
The ideal candidates for breast reconstruction are the patients who are well aware of their medical problem and have completed the oncologic treatment, have no other health problems which would possibly interfere with their healing process; it is also preferable for them to be non-smokers.
Obesity, diabetes or cardiac affections may be a relative counter-indication for using flaps.
Where do I begin?
A plastic surgery consult is the first step. The surgeons’ goal is to make sure you fully understand the reconstruction options , the risks and possible complications and the recommended therapeutic algorithm including the final refinements for symmetry.
The initial evaluation
For safe and best results you are expected to sincerely describe your desired result, to fully disclose your medical history, any ongoing medical treatments, alcohol, recreational drugs or tobacco use.
The reconstruction
Always the reconstruction is a very personalised procedure. The individual anatomic features will lead to the best suited reconstruction method. When we have a small amount of mammary tissue and muscle left after mastectomy we have to use flaps. Their drawbacks are the scars both in the donor and the recipient areas, the risk of flap loss (partially or totally) and the prolonged recovery time.
A TRAM flap (based on the rectus abdominis muscle) may be used as a pedicled flap transposed to the thorax or as a free flap when the vascular pedicle is cut and reattached by microsurgical techniques in the mammary region. The latissimus dorsi flap is comprised of muscle, fat and skin from the back transposed to the anterior thorax and used to rebuilt the breast or to cover a mammary implant.
As previously stated, sometimes after mastectomy we don’t have enough tissue left in place to cover a breast implant. This is why using a breast implant needs adding a flap or tissue expansion.
Tissue expansion implies several steps made over 2-4 months after expander insertion in order to fully inflate it and stretch the skin above it. Sometimes a new surgical procedure is necessary afterwards to replace the expander with a permanent implant.
The final interventions are meant to reconstruct the nipple-areolar complex.
Before the surgery
You will be given instructions concerning any required tests, medication and specific information about the type of anaesthesia to be used.
You will be asked to sign an informed consent in order to assure your surgeon that you fully understand the procedure with all the possible risks and complications.
Among the possible risks are bleeding and developing an infection. Using flaps includes the risk of partial/total flap loss and diminished sensibility both in the donor and recipient area. The use of implants encompasses the risk of capsular contracture (firmness of the reconstructed breast) and the risk of implant rupture. Any surgical procedure comes along with anaesthetic risks.
It is important to understand that mammary reconstruction may yield impressive results but cannot match the original breast. Even after procedures on the contralateral breast the symmetry will not be perfect, but you will have a natural aspect wearing a swimsuit.
What to expect?
All mammary reconstruction procedures require hospitalization for one or two days.
After surgery
After completing the surgery, the incisions are covered with dressings. An elastic bra will help minimize the edema and will support the reconstructed breast. Sometimes drains are inserted to evacuate any fluid or blood collections underneath the skin.
At discharge, you will be instructed about any local wound care, necessary medication to help the healing process or to reduce the risk of infection and also about follow-up visits.
The healing process
In the first days following surgery you will feel some swelling and discomfort at the incisions and donor sites. These can be controlled with medication. An elastic bandage or a support bra is recommended. A return to light activities is possible a few days after surgery.
In the vast majority of cases surgeons use absorbable sutures; however, if some stitches are to be removed, this is performed 14 days postoperative; at this time you may return to your normal activity, but you are not allowed to lift heavy objects.
The healing process will continue over a few weeks along with dissipation of the edema.
Results
The final aspect of breast reconstruction can help you feel emotionally and physically complete. With time, breast sensibility will improve and the scars will look better.
Your surgeon, your choice
The decision to have cosmetic or reconstructive surgery is important, as well as choosing the right surgeon. Not all the doctors performing these procedures are plastic surgeons. Make sure your doctor is a board- certified plastic surgeon, member of the Romanian Plastic Surgeons Association.
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