This reconstruction process can help a woman find her self-confidence again and feel better during her cancer recovery.
What is breast reconstruction surgery?
The type of breast reconstruction surgery recommended will be based on the the individual patient.
The goal of breast reconstruction is to reform or reshape the breast after mastectomy or lumpectomy.
A mastectomy is a surgical procedure that removes the entire breast, usually including the nipple and areola, in order to treat or prevent breast cancer.
A lumpectomy is the removal of a piece of the breast where there is a smaller tumor.
While many factors determine what kind of breast reconstruction surgery would best suit an individual, there are two main types of breast reconstruction surgery.
The two main types of breast reconstruction surgery are:
- Implants or prosthetics: This involves surgery using silicone or saline implants.
- Autologous or skin flap surgery: This method uses tissue from another area of the body.
In some cases, a combination of both techniques may be used to reconstruct the breast more naturally.
Additionally, some techniques can be added on to either surgery to reconstruct the nipple area if it has been affected by the cancer treatment.
Breast reconstruction may be started at the time of the mastectomy or lumpectomy. When this is done, it is known as immediate reconstruction.
Reconstruction can also be done after the mastectomy has healed and cancer treatments are finished. In this case, the surgery is known as delayed reconstruction.
What are the options?
Here, we look at how breast reconstruction is done using implants or skin flap surgery.
After a mastectomy or lumpectomy, breast reconstruction surgery may help to restore confidence.
Breast reconstruction with implants is a procedure where silicone or saline implants are inserted underneath the skin or muscle below where the breast tissue was.
For most people, this is done in two stages. During the first surgery, a tissue expander is placed under the remaining skin of the breast or pectoralis muscles. The tissue expander acts as a temporary saline implant that gradually stretches the remaining tissue.
After the woman has healed from surgery, sterile saline or salt water is injected into the tissue expander on a weekly basis. This gradually enlarging balloon stretches the overlying skin and muscle until it has reached a size the woman is satisfied to have.
When the chest tissues are healed, and enough saline has been added to the tissue expander to prepare the chest for the implants, a second surgical procedure is done.
The tissue expander is removed and replaced with either a silicone or saline implant. The original scar is usually reopened, and therefore, typically, no new scars are left on the chest.
This complex reconstruction may be started at the time of the mastectomy or may be delayed until after the cancer treatment is complete.
Skin flap surgery
With skin flap surgery, tissue is taken from another part of the body and moved to the chest to form a breast.
The tissue to reconstruct the breast is usually taken from the abdomen but may be taken from other places on the body, including the buttock, back, or thigh.
Breast reconstruction with flap surgery is a very complex surgery, as it involves transferring tissue from one area of the body to another. This surgery is done using one of two methods:
- free flap surgery
- pedicle flap surgery
In free flap surgery, the surgeon completely removes the tissue and surrounding blood vessels to be placed in the breast.
Blood vessels are sewn to the blood vessels in the chest where the tissue is to be placed. The blood vessels are very small, so a microscope is used to sew them together in a long and technical procedure called microsurgery.
In pedicle flap surgery, the tissue that is being transplanted is not entirely cut off from all of its blood vessels prior to being transplanted. It is left attached to the body and usually rotated into the chest to create the breast. This is usually done using tissue from the abdomen or back.
Deciding to have surgery
Deciding to have breast reconstruction surgery is a very personal choice. Many women may mourn the loss of their breasts.
Because of this, many women choose to have breast reconstruction surgery. However, after choosing to have breast reconstruction surgery, a person still has some decisions to make including:
- the type of surgery to have
- when to have the surgery
- whether to have surgery on both breasts to match the reconstructed breast to the other breast
Factors that help a doctor and the woman determine what is the best kind of breast reconstruction include the following:
- the person's body type, as thin women, may not have enough tissue elsewhere to do skin flap surgery
- overall health aside from cancer
- the location and kind of cancer
- other cancer treatments involved, such as radiation or chemotherapy
- whether surgery is needed on one or both breasts
- how many surgeries a person is willing to have
- how quickly the person wants to recover from surgery
- insurance coverage
Possible side effects after breast reconstruction surgery include breast tenderness and pain, as well as limited movement. This may last around 2 months.
Breast reconstruction is major surgery. With both implant reconstruction and flap reconstruction, a person can expect to spend several days in the hospital after each operation.
An individual may need more than one surgery to fully reconstruct the breasts. Skin flap surgery can take longer to recover from than reconstruction using implants.
Both types of surgeries leave someone unable to do most of their regular activities for up to 2 months, although it may take longer before she feels normal again.
During the first 2 months, a person recovering from a breast reconstruction may experience:
- bruising, swelling, and soreness in the breasts and where the tissue was taken from in skin flap surgery
- restrictions on movements, such as lifting the arms overhead
A person will likely have stitches and drainage tubes for a period of time following the surgery.
During the initial recovery period, a doctor may prescribe painkillers to keep the individual comfortable and advise wearing an elastic support bra to reduce swelling.
Reconstructed breasts will not look exactly the same as the person's natural breasts and will not have the same sensation. However, over a few years, some sensation may return.
Risks and complications
As with any surgical procedure, there are certain risks and potential complications. Risks during or just after surgery include:
- bleeding or blood clots
- issues with the anesthesia
- fluid build-up in the breast or at the donor site
- extreme tiredness
- problems with wound healing
Complications that can occur later on include:
- Tissue death (necrosis). This may affect the skin, fat, or tissue flap.
- Loss of muscle strength at the donor site.
- Changes in breast or nipple sensation.
- The need for more surgical procedures if problems occur.
- Uneven breasts.
- Implant issues, such as movement, rupture, leakage, or the formation of scar tissue.
Breast reconstruction alternatives
Not all women who undergo mastectomies choose to have breast reconstruction done.
Some women may choose to wear a prosthetic breast form either inside their bras or attached to their bodies. These artificial body parts mimic the look and feel of the natural breast and provide the body with the weight it needs for good posture.
A doctor will advise a woman that chooses this option when she is healed enough to start wearing a prosthetic. Some insurance companies may cover breast prosthetics.
Other women may choose not to do anything after a mastectomy. They may not want to undergo the reconstructive surgeries, or they may find prosthetics uncomfortable. Others are simply accepting of with their new shape.
There are no health risks from the changed body shape that results from having breast tissue removed from one side of the chest, during treatment for breast cancer. However, a woman who has had one breast removed may be aware of posture issues and back pain from the imbalanced.