Breast reconstruction following breast removal due to tumor or some other disease is one of the most successful of all plastic surgery techniques. Thanks to new medical technologies, surgeons are now able to produce a breast that bears a close similarity to a natural one. These operations can be performed simultaneously with breast removal surgery (mastectomy). In this way, when the patient has a new breast after the operation and avoids the psychological distress of a period without a breast.
However, it needs to be kept in mind that breast reconstruction after mastectomy is not a simple procedure. There are various options to be decided on by you and your doctor. Basic information about the procedure is set out below, such as operation time, how it performed and what kind of results are obtained. But it is impossible to answer all questions. Face-to-face discussion with your surgeon will make all such information available.
Who Are the Best Candidates for Breast Reconstruction?
There is no medical obstacle to breast reconstruction in just about all mastectomy patients, and most patients are suitable for simultaneous breast reconstruction and mastectomy. However, the best candidates for breast reconstruction are those in whom the cancer has entirely disappeared through mastectomy. There may be various reasons for waiting; for example, some patients are unwilling to undergo further surgery, while some find it hard to accept the diagnosis of cancer and are reluctant to consider the breast reconstruction options. Some patients may be advised to wait by their surgeons, especially in cases in which the breast is reconstructed with the patient’s own tissue (flap transfer). Patients are also advised to wait in the face of obesity, high blood pressure or cigarette consumption.
All Surgery Involves a Level of Risk and Uncertainty
Breast reconstruction is possible in just about every woman who loses a breast due to cancer. However, as with all kinds of surgery, various problems can arise after this procedure.
Problems generally associated with surgery, such as bleeding, fluid accumulation or anesthesia difficulties may also be seen after this procedure, albeit rarely. Wound healing may be delayed or impaired in smokers, or more scarring may emerge. Sometimes these problems may require a second operation. If a prosthesis is to be used, there is a, rare, risk of infection developing in the second week. In cases of this kind, it may be necessary to remove the prosthesis and replace it months later.
The most common problem is capsule contracture, the prosthesis being squeezed by the surrounding scar tissue. This may give an impression of breast hardness. There are various forms of treatment for capsule contracture; it may sometimes be necessary for the scar tissue to be removed or the prosthesis to be changed.
Reconstruction has no effect on recurrence and is no obstacle to radio/chemotherapy. Your surgeon may recommend that you have periodic mammograms in your normal and reconstructed breast.
You can start discussing reconstruction as soon as cancer is diagnosed. The ideal state of affairs is for your general surgeon and plastic surgeon to plan and perform the operation together. Once your health has been evaluated, your surgeon will give you the best options in the light of your age, anatomical structure, tissues and wishes. Your surgeon must be honest with you here. Breast reconstruction after mastectomy can improve your appearance and increase your self-confidence; however, do not forget that this operation can only provide improvement, never perfection. In addition, your surgeon must provide information about where the surgery will take place and the costs involved.
Preparation for Surgery
Your oncologist and plastic surgeon will give you various instructions before surgery, such as what and what not to eat, taking medications, etc. Do not forget someone to take you home again after the operation.
Where Your Surgery Will Take Place
Breast reconstruction generally requires a number of operations. The first step is generally performed in hospital, whether performed simultaneously with mastectomy or secondarily. The other operations can also be performed in hospital, or your surgeon may prefer to use an outpatient clinic.
The first operation, the formation of the breast tissue, is carried out under general anesthesia. In other words, you sleep through it. Secondary operations can be performed under local anesthesia (with sedation), in which case you remain awake, but calm and very relaxed. There may sometimes be a degree of distress.
There is a layer of silicone on the outer sheath of breast prostheses, while inside is either silicone gel or a combination of water and salt known as saline. The use of gel-filled prostheses was authorized by the U.S. Food and Drug Administration (FDA) in 2006. This type of prosthesis can be used by women still carrying tissue expanders and choosing to undergo reconstruction simultaneously with mastectomy. Both saline and gel-filled prostheses can be used by anyone.
Pain after your surgery can to a large extent be overcome. You will be kept in hospital for 2-5 days, depending on the scale of your operation. Drains may be inserted during surgery to prevent fluids accumulating, and these will be removed in the first or second week after the operation. Sutures are removed in 7-10 days.
Returning to Normal
It may take six weeks for you to return to normal after mastectomy and reconstruction or flap reconstruction. The process may be shorter with prosthesis surgery. Normal sensation cannot be regained with reconstruction; however, some measure of feeling may gradually return. Most scars may fade with time. However, this process may take 1-5 years and the scars never disappear entirely. However, you will be less sensitive to these scars so long as reconstruction quality is high.
Listen to your surgeon’s advice regarding when you can return to exercise and movement. As a general rule, it may be a good idea to avoid sexual relations and strenuous exercise for 3-6 weeks.
Your New Appearance
Your new breast may appear harder, softer or flatter than your normal breast. It may not have the same contour as before mastectomy, or may not be exactly symmetrical to the other breast. These differences may seem very evident to you. But for most mastectomy patients, reconstruction dramatically enhances appearance and quality of life.