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Breast Reconstruction
If you are considering a mastectomy or have previously undergone a mastectomy, it can be helpful to consult with a plastic surgeon that regularly performs breast reconstruction to determine your options. A patient does not need to make a decision right away whether or not she wants breast reconstruction. A patient can wait and have delayed reconstruction. A delay however may be imposed by the physician if she is scheduled for radiation therapy.
We will work closely with the general surgeon, the oncologist, and the radiation oncologist to help plan the type of reconstruction that is best for you. Reconstruction typically restores a sense of wholeness and helps patients go on with their lives in a more positive fashion. Breast reconstruction, however, is not for everyone. Some women are comfortable without any reconstruction after mastectomy. For those women who prefer restoration of the breasts, several good techniques are currently available.
Breast Reconstruction with Tissue Expansion and Implants
Breast reconstruction with implants is typically done in two stages. During the first stage, a tissue expander is placed underneath the muscle that remains after the mastectomy. Fluid is added to the tissue expander each week to gradually enlarge it. As it enlarges it stretches the overlying skin and muscle and creates a pocket. After the pocket is sufficiently developed the patient will come back for an outpatient procedure to remove the tissue expander and place the permanent implant. Usually the expansion process takes one to three months. The second stage will not be performed until chemotherapy is completed. At the time the permanent implant is placed, a modification of the opposite breast can be done to achieve better symmetry. Currently is it a federal law that insurance companies must offer reimbursement for the reconstruction and modification of the opposite breast for patients with breast cancer.
Breast Reconstruction with Tram Flaps
When reconstruction is done with the patient's own tissue, it is usually obtained from the skin and fat which would normally be discarded in a conventional "tummy tuck". This can be delivered to the chest wall while still attached to one of the abdominal wall muscles, to allow blood flow in to the tissue so it remains healthy and alive. In another variation of the "tummy tuck" reconstruction, the skin and fat can be totally disconnected from the lower abdominal wall and then reconnected with a small blood vessel in the armpit following the mastectomy. This is called a "free flap" because the skin and fat are free from any body connections at one point.
Nipple Reconstruction
Nipple reconstruction is generally done one or two months after the breast mound is created. A consultation for post mastectomy and breast reconstruction should be extensive and thorough, including a full explanation of the risks and benefits involved with various reconstruction procedures.
Over the last decade, one of the great advances in the management of breast cancer is refinements in post mastectomy breast reconstruction. Many patients are requesting reconstruction of the breast because of its accessibility and improved dependability. It is now possible to perform at least the first stage of the breast reconstruction at the time of mastectomy.
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