The decision to have breast reconstruction is an important and personal one. With advances in breast reconstruction surgery, many women undergoing breast removal (mastectomy) or partial breast removal (partial mastectomy) choose to have their breast(s) restored. The benefits of breast reconstruction include:
- Positive effects on self-image
- Sense of femininity and sexuality
- Significant improvement in emotional well-being
Breast reconstruction surgery involves creating a breast mound that comes as close as possible to the form and appearance of the natural breast. The goal of reconstructive surgery is to create an aesthetically pleasing breast mound and to achieve symmetry with the opposite breast. If both breasts have been removed, the goal of breast reconstructive surgery is to create two symmetrical and natural appearing breast mounds.
When is breast reconstruction performed?
At the Center for Breast Care, you will be informed and counseled in breast reconstructive options prior to mastectomy, so you can make the decision for or against reconstruction before going into surgery.
Based on the personal medical history of each patient, a recommendation will be made for either:
- Immediate reconstruction. Reconstructive surgery performed at the same time as mastectomy
- Delayed reconstruction. A second operation (to reconstruct missing breast tissue) is performed after recovery from the mastectomy is complete. If radiation therapy is part of the treatment protocol, the surgeon may recommend waiting to do reconstruction after the radiation is finished.
Breast Reconstruction Options
There are different types of breast reconstruction options available to you. Although there are several approaches, the two most effective are described below. Additional options can be discussed with your surgeon during your initial consultation.
- Tissue expander/Implant reconstruction During this staged approach, a tissue expander (temporary device) is placed in the breast (under the pectoralis muscle, located between the breast and the chest wall). This is done to create a soft pocket that will eventually contain the permanent implant. The tissue expander can be placed at the time of mastectomy or years (delayed) after the initial mastectomy.
Expansion will begin a few weeks post-op, once the patient has healed, as an in-office procedure. Your will have appointments on a weekly basis to until the final volume is achieved. The expander is later exchanged, usually 1-2 months later, for a permanent saline or silicone implant.
- Autologous Reconstruction Breast reconstruction can also be accomplished by using a women's own tissues (autologous) in order to recreate the breast. Some patients prefer autologous reconstruction since the patient's own body tissue is used, and the result if a very natural (both look and feel) breast.
The most commonly used technique for this method of reconstruction is the transverse rectus abdominus myocutaneous flap or TRAM flap. This means the surgeon uses tissue, muscle, and fat from your abdomen to recreate the breast. This flap procedure is often favored by patients because of the "tummy tuck" effect--the patient's stomach will be flatter looking.
Some patients will not be a good candidates for the TRAM flap because there is not enough tissue in the abdominal area. In this case, other flap techniques can be performed; the tissue can come from the back, thigh, or buttock. In general, some patients may be less ideal candidates for autologous reconstructive surgery because of existing medical problems or inability to tolerate lengthy operations.
Hope, Balance, Empowerment, Choice
Regardless of the method chosen or the timing of the reconstruction, breast reconstruction can be overwhelming and scary. At the Center for Breast Cancer, you are ensured a thorough discussion with your plastic surgeon that can help you make an informed decision during a stressful and difficult time. Awareness and knowledge of breast restorative procedures and their potential advantages and disadvantages can be extremely comforting, provide hope, and empower a woman with a breast cancer diagnosis.