Breast Reconstruction
Restoring the mound of your breast lost to cancer surgery is breast reconstruction. This surgery restores a more natural look, or "feel" in clothing and during activity. No surgery can restore a completely "natural" breast. In place of surgery, your breast mound can be restored using an external implant, typically worn in a special brassiere.
Reconstructive Choices
Breast reconstruction can be accomplished using either your own natural tissue or with an implant. In general, using your own natural tissue can give a more natural feel and shape, but requires a longer recovery period. Implant reconstruction is simpler, and is can usually be performed as an outpatient. In both cases, several operations are needed.
Results of Surgery
Your reconstructed breast is typically firmer than your natural breast. It will not respond to gravity, such as when you lie down. If your natural breast is "droopy," you may need (or want) surgery to "lift" your other breast.
Timing of Surgery
Breast reconstruction surgery can be started at the time of your mastectomy, or it may be performed at a later time, even years later. While it is attractive to combine your cancer and reconstructive surgeries, studies have shown that overall satisfaction with reconstructive surgery is often higher when surgery is delayed.
Needs for Reconstruction.
Any plan for breast reconstruction must accomplish two needs: 1) Establish a breast volume that matches your opposite side, and 2) Create the skin to support your reconstructed breast mound.
Reconstruction with Implants
In most cases, reconstructive surgery occurs in two major stages. In the first stage, a silicone balloon, called an expander, is placed in at the site of your cancer surgery. Over time, the balloon is inflated, stretching your skin. Expander inflation is performed in the office. After stretching your skin, the expander is removed and replaced with a permanent implant.
Either saline or gel filled implants can be used. Silicone gel filled implants are currently limited to use for patients enrolled in research coordinated with the FDA.
Saline implants use a silicone bag filled with sterile IV fluids. While there is no evidence to date that silicone gel filled implants are unsafe. If any increased risk is found, your theoretical risk from silicone will be the same with a saline filled implant as with the gel filled implant. This is due to the fact the bag is still made of silicone.
Implant Selection: Implants are available in differing sizes & shapes. Before surgery, an implant of appropriate size & shape will be selected. The size is determined by the volume of saline in your expander. When you feel your breasts are of a comparable size, that volume is the volume of the implant that will be used in your reconstruction. The specific implant that is selected is based on the dimensions of your natural breast.
Implant Surgery: Treatment is usually done as an outpatient. In all cases, the implant is centered under your planned breast mound. The implant is placed in the space created by the expander. To give the most natural breast possible, some modifications of the expander pocket are common.
Reconstruction with Your Own Tissue
For most patients, using your own tissue for breast reconstruction uses the TRAM, or Transverse Rectus Abdominus Muscle flap. You have 2 rectus abdominus muscles. In the center of your abdomen, they reach from your breast bone to your pelvis. Skin and fat from your abdomen is moved to your breast. Blood vessels in the muscle supply the skin & fat that create your new breast mound.
While this surgery results in both a breast mound and tummy tuck, it is the most invasive breast reconstruction surgery.
With rare exception, you will require the use of a mesh material in your tummy wall. This mesh helps limit the chance of a hernia.
While 10% of TRAM reconstruction patients will experience a complication after surgery, this technique offers the most natural feeling reconstructed breast.
Risks of Surgery
Risks of breast reconstruction are the same as any other surgery. They include (but are not limited to) bleeding, infection, scarring, altered sensation, asymmetry, possible need for additional surgery, and failure of the implant or expander.