Breast reconstruction is one of the most rewarding surgical procedures available today, using new medical techniques and devices that have made it possible for plastic surgeons to create a very natural looking breast, improving the patient’s appearance and enforcing her self confidence and good psychology.
In many cases, breast reconstruction is possible immediately following breast removal (mastectomy), so the patient does not experience seeing herself with no breast at all.
Because of the fact that post-mastectomy breast reconstruction is not a simple procedure, it is good to discuss with your plastic surgeon the options that you have and decide what’s best for your case.
Most mastectomy patients are medically appropriate for reconstruction, no matter age or size or how many years ago they had the mastectomy. Women choose breast reconstruction in order to make their breasts look balanced when they are wearing a bra, to permanently regain their breast contour and to give the convenience of not needing an external prosthesis.
Statistically, the life and the psychology of women after breast reconstruction, is significantly better than those of women without reconstruction.
The surgery (Methods of breast reconstruction)
1. Skin expansion
The most common technique combines skin expansion and subsequent insertion of a silicon implant.
After your mastectomy, your surgeon will insert an expander beneath your skin and chest muscle. Through a valve mechanism buried beneath the skin, he will inject a salt-water solution to gradually fill the expander over several weeks or months. After the skin over the breast area has stretched enough, the expander will be removed in a second operation and a more permanent implant will be inserted. Some expanders are designed to be left in place as the final implant. The nipple and the areola surrounding it, are reconstructed in a subsequent procedure.
For women who do not require preliminary tissue expansion before receiving an implant, the surgeon will proceed with inserting an implant as the first step.
2. Flap reconstruction
Another technique of breast reconstruction is using tissue taken from other parts of the body, such as the back, abdomen, or buttocks, to create skin flap.
There are two types of flap surgery. In one type, the tissue remains attached to its original site, retaining its blood supply and the flap, consisting of the skin, fat, and muscle with its blood supply, are tunneled beneath the skin to the chest, creating a pocket for an implant or, in some cases, creating the breast mound itself, without need for an implant.
Another flap technique uses tissue that is surgically removed from the abdomen, thighs, or buttocks and then transplanted to the chest, by reconnecting the blood vessels to new ones in that region. This procedure requires the skills of a plastic surgeon who is experienced in microvascular surgery as well.
Flap surgery is more complex than skin expansion and needs longer recovery period. Scars will be left at both the tissue donor site and at the reconstructed breast. The benefit of this method is that when the breast is reconstructed entirely with your own tissue, the results are generally more natural and there are no concerns about a silicone implant. In some cases, you may have the added benefit of an improved abdominal contour.
Most breast reconstruction surgeries involve a series of procedures that occur over time. Usually, the initial reconstructive operation is the most complex. Follow-up surgery may be required, to replace a tissue expander with an implant or to reconstruct the nipple and the areola. Many surgeons recommend an additional operation to enlarge, reduce, or lift the natural breast to match the reconstructed breast. The only disadvantage of this procedure is that it may leave scars on an otherwise normal breast.
Nipple and areola reconstruction
Nipple and areola reconstruction can use tissue taken from the labia—the skin folds of the vulva, just outside the vagina or tissue from the inside of the thigh. The skin may darken naturally over time, or your surgeon can tattoo a custom color to match your other nipple. You can have your nipple reconstruction under local anesthesia, in less than two hours and usually you can return home the same day, after surgery. You may feel discomfort in your crotch, which lasts about a week.
Reconstructed nipples have very little sensation or sensitivity. Therefore, it may not be a good idea to use part of your existing, natural nipple to create a new nipple. In that case, both nipples may become numb.
You’ll probably be tired and sore for a week or more, after your surgery. Your doctor can give you some medication to help control your pain. You may have some drains in place for a short time after your surgery, to drain excess fluids that collect in your breast. The drainage tubes and the stitches will be removed ten days after your surgery.
You return to your normal activities after four to six weeks, depending on the type of the procedure. Give your body time to rest during this period. Your doctor will let you know of any restrictions to your activities, such as avoiding overhead lifting or strenuous physical activities.