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Bid for Surgery: Breast Reconstruction
Breast
Reconstruction
(after mastectomy)
| Procedure: |
Following mastectomy, your surgeon will
insert a balloon expander beneath your skin and chest muscle. Through a tiny valve
mechanism buried beneath the skin, he or she will periodically 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 may 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 dark skin surrounding it, called the
areola, are reconstructed in a subsequent procedure. |
| Risk Factor: |
Reconstruction has no known effect on the
recurrence of disease in the breast, nor does it generally interfere with chemotherapy or
radiation treatment, should cancer recur. Your surgeon may recommend continuation of
periodic mammograms on both the reconstructed and the remaining normal breast. If your
reconstruction involves an implant, be sure to go to a radiology center where
technicians are experienced in the special techniques required to get a reliable x-ray of
a breast reconstructed with an implant. |
| Side Effects: |
Temporary bruising, swelling, discomfort,
numbness, dry
breast skin. Permanent scars. |
| Length: |
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| Anesthesia: |
The first stage of reconstruction, creation
of the breast mound, is almost always performed using general anesthesia |
| In/Out: |
Breast reconstruction usually involves more
than one operation. The first stage, whether done at the same time as the mastectomy or
later on, is usually performed in a hospital. |
| Recovery: |
It may take you up to six weeks to recover
from a combined mastectomy and reconstruction or from a flap reconstruction alone. If
implants are used without flaps and reconstruction is done apart from the mastectomy, your
recovery time may be less. |
| Duration: |
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| The Procedure |
Reconstruction of a breast that has been removed
due to cancer or other disease is one of the most rewarding surgical procedures available
today. New medical techniques and devices have made it possible for surgeons to create a
breast that can come close in form and appearance to matching a natural breast.
Frequently, reconstruction is possible immediately following breast removal (mastectomy),
so the patient wakes up with a breast mound already in place, having been spared
the experience of seeing herself with no breast at all. |
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| The best candidates. |
Most mastectomy patients are medically
appropriate for reconstruction, many at the same time that the breast is removed. The best
candidates, however, are women whose cancer, as far as can be determined, seems to have
been eliminated by mastectomy.
Still, there are legitimate reasons to wait. Many women aren't comfortable weighing all
the options while they're struggling to cope with a diagnosis of cancer. Others
simply don't want to have any more surgery than is absolutely necessary. Some patients may
be advised by their surgeons to wait, particularly if the breast is being rebuilt in a
more complicated procedure using flaps of skin and underlying tissue. Women with other
health conditions, such as obesity, high blood pressure, or smoking, may also be advised
to wait.
In any case, being informed of your reconstruction options before surgery can help you
prepare for a mastectomy with a more positive outlook for the future. |
|
| Types of anesthesia |
The first stage of reconstruction, creation of
the breast mound, is almost always performed using general anesthesia, so you'll sleep
through the entire operation.
Follow-up procedures may require only a local anesthesia, combined with a sedative to make
you drowsy. You'll be awake but relaxed, and may feel some discomfort. |
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| Types of implants |
If your surgeon recommends the
use of an implant, you'll want to discuss what type of implant should be used. A breast
implant is a silicone shell filled with either silicone gel or a salt-water solution known
as saline.
Because of concerns that there is insufficient information demonstrating the safety of
silicone gel-filled breast implants, the Food & Drug Administration (FDA) has
determined that new gel-filled implants should be available only to women participating in
approved studies. This
currently includes women who already have tissue expanders (see below under Skin
Expansion),
who choose immediate reconstruction after mastectomy, or who already have a gel-filled
implant and need it replaced for medical reasons. Eventually, all patients with
appropriate medical indications may have similar access to silicone gel-filled implants.
The alternative saline-filled implant, a silicone shell filled with salt water, continues
to be available on an unrestricted basis, pending further FDA review.
As more information becomes available, these FDA guidelines may change. Be sure to discuss
current options with your surgeon. (Above guidelines are current as of July 1992.) |
|
| The surgery |
Skin expansion. The most common
technique combines skin expansion and subsequent insertion of an implant. 
A tissue expander is inserted following
the mastectomy to prepare for
reconstruction.
Following mastectomy, your surgeon will insert a balloon expander beneath your skin and
chest muscle. Through a tiny valve mechanism buried beneath the skin, he or she will
periodically 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
may 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 dark
skin surrounding it, called the areola, are reconstructed in a subsequent procedure.
The expander is gradually filled with
saline through an integrated or separate
tube to stretch the skin enough to
accept an implant beneath the chest
muscle.
Some patients do not require preliminary tissue expansion before receiving an implant.
For these women, the surgeon will proceed with inserting an implant as the first step.
After surgery, the breast mound is
restored. Scars are permanent, but will
fade with time. The nipple and areola
are reconstructed at a later date.
Flap reconstruction. An alternative approach to implant reconstruction
involves creation of a skin flap using tissue taken from other parts of the body, such as
the back, abdomen, or buttocks.
In one type of flap surgery, the tissue remains attached to its original site, retaining
its blood supply. 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.
With flap surgery, tissue is taken from
the back and tunneled to the front of the
chest wall to support the reconstructed
breast. |
|
| Do I have to stay in a hospital after the
surgery? |
Breast reconstruction usually involves more than
one operation. The first stage, whether done at the
same time as the mastectomy or later on, is usually performed in a hospital. |
|
| Risk factors, complications, side
effects? |
If an implant is used, there is a remote
possibility that an infection will develop, usually within the
first two weeks following surgery. In some of these cases, the implant may need to be
removed for several months until the infection clears. A new implant can later be
inserted.
The most common problem, capsular contracture, occurs if the scar or capsule around the
implant
begins to tighten. This squeezing of the soft implant can cause the breast to feel hard.
Capsular
contracture can be treated in several ways, and sometimes requires either removal or
"scoring" of
the scar tissue, or perhaps removal or replacement of the implant.
Reconstruction has no known effect on the recurrence of disease in the breast, nor does it
generally interfere with chemotherapy or radiation treatment, should cancer recur. Your
surgeon may
recommend continuation of periodic mammograms on both the reconstructed and the remaining
normal breast. If your reconstruction involves an implant, be sure to go to a radiology
center where
technicians are experienced in the special techniques required to get a reliable x-ray of
a breast reconstructed with an implant.
Women who postpone reconstruction may go through a period of emotional readjustment. Just
as it took time to get used to the loss of a breast, a woman may feel anxious and confused
as she begins to think of the reconstructed breast as her own. |
|
| How long would recovery take? |
You are likely to feel tired and sore for a week
or two after reconstruction. Most of your discomfort can be controlled by medication
prescribed by your doctor.
Depending on the extent of your surgery, you'll probably be released from the hospital in
two to
five days. Many reconstruction options require a surgical drain to remove excess fluids
from
surgical sites immediately following the operation, but these are removed within the first
week or
two after surgery. Most stitches are removed in a week to 10 days.It may take you up to
six weeks to recover from a combined mastectomy and reconstruction or
from a flap reconstruction alone. If implants are used without flaps and reconstruction is
done apart from the mastectomy, your recovery time may be less.
Reconstruction cannot restore normal sensation to your breast, but in time, some feeling
may return.
Most scars will fade substantially over time, though it may take as long as one to two
years, but they'll never disappear entirely. The better the quality of your overall
reconstruction, the less
distracting you'll find those scars.
Follow your surgeon's advice on when to begin stretching exercises and normal activities.
As a
general rule, you'll want to refrain from any overhead lifting, strenuous sports, and
sexual activity for three to six weeks following reconstruction. |
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| Would I have a new look? |
Chances are your reconstructed breast may feel
firmer and look rounder or flatter than your natural
breast. It may not have the same contour as your breast before mastectomy, nor will it
exactly match your opposite breast. But these differences will be apparent only to you.
For most mastectomy patients, breast reconstruction dramatically improves their appearance
and quality of life following surgery. |
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| Cost of this procedure varies with
region from a low of $5,348 to a high of $6,275. This cost includes surgeon's fee,
anesthesia, and facility costs. |
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