Reconstruction of a breast that has been removed due to cancer or other disease is a commonly performed plastic surgical procedure. New medical techniques and devices have made it possible to create a breast that can come close in form and appearance to matching a natural breast. Frequently, reconstruction is possible immediately following mastectomy.
Most patients undergoing mastectomy are candidates for reconstruction. In certain cases other medical conditions such as high blood pressure, obesity or smoking may cause the patient or surgeon to defer this procedure. As in any surgical procedure, there are risks and complications associated with breast reconstruction.
The most common problem, capsular contracture, occurs if the scar around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or "scoring" of the scar tissue, or perhaps removal or replacement of the implant.
Planning for breast reconstruction can be done before the mastectomy, in conjunction with your general (breast) surgeon, or after the procedure has been completed. A complete evaluation will be performed. There are a variety of surgical methods that are currently employed to accomplish breast reconstruction. These options will be discussed in detail to determine which will be most suitable for you.
Breast reconstruction usually involves more than one operation. The first stage, creation of a new breast mound, whether done at the same time as the mastectomy or later on, is usually performed in a hospital. This may be done on an inpatient or outpatient basis. This procedure usually requires general anesthesia. There are several methods that are currently employed to accomplish this first stage.
If the skin of the chest wall is tight, or in most cases of immediate reconstruction, a tissue expander will probably be required.This is basically a balloon, filled with saline (a salt solution). After the expander has been placed, the balloon is sequentially inflated using a fine needle. These inflations are performed in the doctor's office over a period of weeks following the surgery. Once the expander has reached the necessary size, a second procedure is required, to replace the expander with a permanent implant.
The type of implant that will be used will be discussed in detail during your consultation with Dr. Bromley. In some patients, if the skin and tissues of the chest wall are pliable, a permanent implant may be inserted at the initial operation. This will avoid the use of a tissue expander.
In some patients, there is not sufficient skin to permit use of an implant and/or expander. In these patient additional tissue must be transported to the chest wall to accomplish the breast reconstruction. This additional tissue can be transferred from the back or the lower abdomen, depending upon the specific needs of the patient. With this type of flap procedure, there will obviously be additional scars in the areas from which the flap was taken. These treatment options including their inherent risks and complications will be discussed in detail prior to your surgery.
Additional skin and muscle may be taken from the back and transferred to the chest wall
Skin from the lower part of the abdominal wall, attached to a strip of muscle may be used to provide additional skin and soft tissue.
Depending upon the nature of the procedure your hospitalization will vary from one to several days. In certain cases, it may be possible to perform an initial reconstruction on an outpatient basis. A drain may be used following the surgery, to prevent accumulation of blood and fluids under the skin. This will be removed in the office. Sutures will usually be removed in one to two weeks.Following this initial reconstruction it will be necessary to allow the newly created breast mound to soften over a period of time. This process takes approximately three months. Once this period has elapsed, additional surgical procedures can be planned, if desired. In some cases, reconstruction of a new nipple-areola is done.
Other patients may request reconstructive surgery on the opposite breast (augmentation or reduction) so that symmetry is achieved. In some instances, a revision of the reconstructed breast is required, including replacement or adjustment of the implant. All of these options will be discussed in detail with Dr. Bromley during this recovery period.
If you have any questions regarding breast reconstruction, or any other plastic surgical procedure, please contact our office. Photo galleries, in addition to 3D animation of this procedure can be found at the American Society of Plastic Surgeons website.
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