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What is Breast Reconstruction?
Breast
Reconstruction is a surgical procedure that restores the
appearance of a breast for patients who have undergone
mastectomy to treat their breast cancer. Breast
Reconstruction basically rebuilds the breast contour, and if
further desired by the patient, the nipple and the areola.
Breast Reconstruction can be performed with mastectomy,
depending on the health conditions of the patient.
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Effects of Breast Reconstruction
Breast
Reconstruction gives mastectomy patients a chance to improve
their appearance and restore their self-confidence, as well
as the opportunity to wear the same type of clothes before
the mastectomy. Due to latest medical equipments and
techniques, surgeons are now able to form breasts closely
resembling that of a natural breast.
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Candidates for Breast
Reconstruction
Good
candidates for Breast Reconstruction are mastectomy
patients, especially those whose cancer has been completely
removed by the mastectomy. Patients who wish to undergo
Breast Reconstruction have to know that reconstruction is
not a cause of the recurrence of the cancer, nor can it
interfere with chemotherapy if the cancer does come back.
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Your
Consultation
During
the consultation, BHMG’s Board Certified Surgeon will take a
complete medical history of the patient and conduct a
careful examination to evaluate overall health.
Photographs will be taken before and after surgery.
Antibiotics will be prescribed at the time of surgery to
prevent infections. Also, avoid taking drugs containing
aspirin to minimize the possibility of excess bleeding.
The
use of an antiseptic soap in the shower the night before or
the morning of the surgery may also be recommended.
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The Breast Reconstruction Surgery
Procedure
A
two-stage approach may be used in Breast Reconstruction. In
the first operation, a tissue expander is inserted. Then
this will be followed months after by the replacement of the
expander with a permanent silicone breast implant or the use
of your own tissues to reconstruct the breast mound.
Any
follow-up procedure will be done on an outpatient basis and
may only need local anesthesia. If the patient desires
nipple and areola reconstruction, this will also be done
during the follow-up procedure.
Skin Expander with Breast Implant
This
is the simplest of all Breast Reconstruction procedures.
This procedure is usually for patients who have heath
problems or contradictions to extensive surgery. This
procedure is also known to have the shortest recovery
period.
Breast
Reconstruction using tissue expanders is done in two
stages. First, a tissue expander is placed under the skin
and muscles of the chest wall at the same operation as the
mastectomy procedure. Although for other patients it may be
many months after the mastectomy before the expander is
placed. Then when the incisions are healed, saline is added
on a weekly basis to the expander. This will help the skin
stretch to accommodate the expander as it inflates due to
the addition of saline. Second, after the skin has been
sufficiently stretched, the tissue expander is then removed
and replaced by a permanent breast implant. If the patient
desires, nipple and areola reconstruction will be performed
as a separate procedure.
Advantages:
This
is the simplest surgery with the shortest recovery period.
Disadvantages:
Multiple trips to the office over
several weeks or months to undergo expansion (addition of
saline). There may also be capsule formation or poor
cosmetic result due to thin skin.
Latissimus Dorsi Myocutaneous Flap
This
Breast Reconstruction procedure involves moving the
latissimus dorsi muscle and overlying skin from the
back, tunneling it to the chest to create a new breast
mound. The surgical incision is usually made along the bra
line so that the scar will be concealed. A breast implant
is often placed under the flap, if necessary, to balance a
difference in size. If the patient desires, nipple and
areola reconstruction can be done later.
Advantages: This procedure provides good tissue
coverage for the implant used. There are reduced
probabilities of capsule formation around the implant.
Disadvantages:
An unhidden scar across the back.
This procedure may decrease strength in the back due to
muscle loss. Capsule formation may occur and result in a
need for additional surgery.
Rectus Abdominus Myocutaneous Flap
This
Breast Reconstruction procedure is the most complicated one
out of all the others. This procedure takes about 4-5 hours
of surgery. The procedure can be done either as a "pedicle"
flap or as a "free" flap. In the pedicle flap operation,
one of the rectus abdominus muscles along with its
blood supply is tunneled along with the overlying skin up to
the chest. In the free flap or microsurgical procedure, a
portion of the rectus abdominus muscle along with its
overlying skin is removed from the lower abdomen. Then the
artery and vein are surgically re-attached to an artery and
vein on the chest wall near the mastectomy location. The
breast mound is then made to match the opposite breast.
Blood
transfusion may be required during the procedure in which
you may donate your own blood before surgery to use that
instead.
Breast
implants are not usually required for this procedure. The
tissue is usually enough to match the size of the other
breast. Now, if the opposite breast is large or pendulous,
that can be decreased in size by a simultaneous Breast
Reduction. Patients who desire to have this procedure must
stop smoking six weeks before and after surgery. Failure to
comply may result in the death of the flap.
A
synthetic mesh is placed on the area of the abdominal wall
where the muscle is removed. This will strengthen the
abdominal wall and minimize the chance of hernia formation.
Again, nipple reconstruction is done as a separate
procedure, as well as some needed contouring of the new
breast mound.
Advantages:
This procedure provides the most
natural looking Breast Reconstruction with the added benefit
of a "Tummy Tuck". No implant is necessary so capsule
formation is not a risk. The scar is easily hidden with
clothing.
Disadvantages:
Moving the rectus abdominus
muscle may bring a risk of herniation of the bowel.
Abdominal strength is diminished. This is the longest
procedure and has the greatest risk for complications, and
it may even require a blood transfusion.
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Recovery
Tiredness and soreness of the chest and abdomen are likely
to be felt for a week or two after the Breast Reconstruction
procedure. Prescribed medication by the doctor can be
enough to control your discomfort.
You
may need to stay in the hospital for 2 to 5 days after the
procedure, although that may be dependent on the extent of
your surgery. Drains may be required to remove excess
fluids from the surgical sites after the operation. These
are usually removed 1 to 2 weeks after surgery. Stitches
are usually taken out in 7 to 10 days.
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Risks
As
with any other type of surgery, the usual risks are
bleeding, fluid collection, excessive scar tissue or
difficulties with anesthesia. These may occur although they
are relatively uncommon. In some instances, the
complications are severe enough to need a second operation.
There
is a possibility that an infection will develop within the
first two weeks after surgery. In some instances, the
implant may need to be removed for several months till the
infection clears, and then a new implant can be inserted.
Capsular contracture may occur if the scar or capsule around
the implant begins to tighten. This squeezing of the soft
implant causes the breast to feel hard. Capsular
contracture can be treated in several ways, and sometimes
will require either the removal of the scar tissue or even
the removal or replacement of the implant.
Other
possible complications specific for Breast Reconstruction
are:
-
Loss of breast skin requiring the removal of the
implant. This procedure is not advisable for smokers or
those who have undergone radiation due to the increased
risk of skin loss.
-
Noticeable implant outlines due to capsule formation or
thin breast skin.
-
Hardness or firm feel of the reconstructed breast due to
capsule formation.
-
Inadequate symmetry or implant position compared with
the remaining breast.
-
Decreased back strength from loss of shoulder muscle.
-
A
scar on the back.
-
A
collection of fluids (seroma) under incision requiring
needle aspiration.
-
Inadequate tissue that would require the use of a breast
implant.
-
Poor circulation to the flap resulting in tissue loss.
-
Weakness or herniation of the abdominal wall.
-
Infection, in particular of the mesh, requiring surgery
for removal.
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Frequently Asked
Questions
Q:
Who are the best candidates for Breast Reconstruction
surgery?
A:
Best candidates for Breast Reconstruction would be
mastectomy patients, especially those whose cancer has been
completely removed by the mastectomy.
Q:
How do I plan my Breast Reconstruction surgery?
A:
As soon as you are diagnosed with breast cancer, inquire
about a Breast Reconstruction. It would be best to have
your breast surgeon and plastic surgeon to work together to
develop a strategy that will get you in the best possible
condition for reconstruction.
After
evaluating your overall health, your surgeon will tell you
which Reconstruction procedure will be most appropriate for
your age, health, anatomy, tissues, and goals.
Post-mastectomy Breast Reconstruction can improve your
appearance and renew your self-confidence, although bear in
mind that the desired result is improvement and not
perfection.
Your
surgeon must also explain the anesthetic the will be used,
the facility where the surgery will be performed, and the
costs. Health insurance policies usually cover most or all
of the cost of post-mastectomy Breast Reconstruction. Do
check your policy for its coverage and limitations.
Q:
How do I prepare for my Breast Reconstruction surgery?
A:
Your oncologist and plastic surgeon will be the ones to give
you specific instructions on how to prepare for surgery.
These instructions may include guidelines on eating and
drinking, smoking and taking or avoiding certain vitamins
and medications. Be sure to have someone drive you home
after surgery and assist you for a couple of days at home.
Q:
Where will the surgery be performed?
A:
Breast Reconstruction involves more than one operation. The
first stage is usually performed in a hospital. Follow-up
procedures may also be done in the hospital or an outpatient
facility depending on the extent of the surgery you need.
Q:
What types of breast implants can be used?
A:
A breast implant is a silicone shell filled with either
silicone gel or a salt-water solution known as saline. The
Food & Drug Administration (FDA) has determined that new
gel-filled implants should be available only to women
participating in approved studies, which currently include
women who already have tissue expanders, who choose
immediate reconstruction after mastectomy, or who already
have a gel-filled implant and need it replaced for medical
reasons. In time, all patients with appropriate medical
indications may have access to silicone gel-filled implants
as well.
Q:
What happens during Breast Reconstruction surgery?
A:
Since there are many ways to undergo post-mastectomy Breast
Reconstruction, your surgeon should be able to explain to
you what to expect in each procedure. Most Breast
Reconstructions have more than one operation performed. The
first operation is usually the most complex. Follow-up
surgery is usually done to replace a tissue expander with an
implant or to reconstruct the nipple and areola. Surgeons
also recommend an additional operation to enlarge, reduce,
or lift the natural breast to match the reconstructed
breast, but do bear in mind that this procedure may leave
scars on an otherwise normal breast, and that the procedure
is most often not covered by your insurance.
Q:
How will I look or feel after the surgery?
A:
Breast Reconstruction gives women a feeling of once again
being whole. Those who have had it done at the same time as
the mastectomy have less chances of undergoing emotional
downs for having lost their breasts.
Q:
How long before everything gets back to normal?
A:
Recovery is about 6 weeks from a combined mastectomy and
reconstruction or from a flap reconstruction alone. Be
reminded that Breast Reconstruction cannot restore normal
sensation to your breasts. Some feeling may return in
time. Scars will fade over time, but they will never
disappear entirely. As a general rule, refrain from any
overhead lifting, strenuous sports and sexual activity for 3
to 6 weeks after surgery.
Q:
What happens after your Breast Reconstruction surgery?
A:
Tiredness and soreness of the chest, plus the back and
abdomen if you are to choose a flap procedure, are likely to
be felt for a week or two after the Reconstruction
procedure. Prescribed medication by the doctor can be
enough to control your discomfort.
Q:
How am I going to cope with the pain associated with having
this procedure?
A:
Patients have different levels of pain tolerance. Some
patients experience pain as an ache, while others have
greater discomfort. Medications for pain after the
procedure will be prescribed after surgery to control any
discomfort.
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