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In the unfortunate event where a full mastectomy is required to treat breast cancer, reconstruction is often a much welcomed option. With modern technology, techniques, and materials that are available it is possible to restore the breasts appearance to its original form with hardly any visible scarring. When this procedure is carried out it is done so by plastic surgeons specializing in restoration. It has now become a commonplace following a full mastectomy.
There are a variety of approaches and each case is unique. Consultation with a physician is required in order to select the one that is right for you.
Breast implants are one option that is typically chosen. Today implants are typically saline filled bags encased in silicone. They are placed in front of the chest wall muscles under the skin that covers the breast area.
In the past silicon filled implants were more commonly used than they are today. Then a concern arose regarding the possibility of silicon leaking into the body thus causing immune system malfunction. The FDA has recently announced that after years of careful observation and study there is little basis for worry thus making silicon breast implants legal again. Some individuals prefer them because they behave differently within the body.
In many instances reconstruction is done simultaneously with the mastectomy. In other cases physicians recommend that you wait for a period of time to allow the body to heal prior to performing any further surgery. Each case is different and can only be decided based upon its own circumstances.
Usually, two-staged delayed reconstruction is performed if the skin and chest wall tissues are flat. In this instance an implant, called a tissue expander that functions much like a balloon under the tissue, is placed underneath the muscle. A surgeon then injects saline in stages over a specific period of time. In some cases the expander itself eventually becomes the implant. In other instances the expander is removed during a later procedure and replaced with a permanent implant.
Another method of breast reconstruction is a tissue flap procedure. These procedures use skin from the stomach, the thighs, or other areas as part of the entire process.
TRAM (transverse rectus abdominis muscle flap) is one of the most common types, which uses tissue from the lower abdominal wall. A pedicle flap leaves the tissue attached to the original blood supply and stretches the tissue up the breast area. A free flap procedure removes the tissue entirely, along with muscles, fat, and blood vessels and reattaches them to blood vessels under the chest.
Another, almost equally common procedure takes tissue from the upper back. A flap is moved in front of the chest wall in effort to create a pocket. A breast implant is then inserted into the pocket. Additionally, other procedures are available such as gluteal muscle tissue.
In each case, nipple and/or areola reconstruction may or may not be part of the total surgery. It may be done later or not at all. Rarely is the nipple from the original breast used as a replacement out of concern that it may regenerate the cancer.
Reconstructive surgery does have risks.
There can be the usual surgical complications, such as infection or scarring, such as capsular contracture in which scar tissue forms around the implant. Breast implants may not last a lifetime, depending on individual circumstances, such as age. Replacing them may require an additional surgery later in life. The final result may or may not be what the patient was expecting. Only a full consultation with a physician can provide a realistic assessment of likely outcomes.
