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Reconstruction
Surgical advances have permitted women to have their breast rebuilt after it has been partly or completely removed for the treatment of breast cancer. Innovative techniques to reconstruct existing tissues in and around the site of the excision and to move tissue to the site – plus, special use of breast implants – have increased the surgical options available to women and have improved reconstruction results.
A significant portion of women undergoing breast removal has their breast or breasts surgically reconstructed. This surgery involves creating a breast mound that comes as close as possible to the form and appearance of the natural breast. The goal is that the breast mound matches the opposite breast as closely as possible, to achieve symmetry. If both breasts have been removed, the goal of breast reconstructive surgery is to create both breast mounds approximately the size of the woman’s natural breasts.
Criteria
In general, all women benefit from discussing breast reconstructive surgery with a plastic surgeon before undergoing the surgical treatment option of mastectomy. The surgeon’s recommendations and a woman’s preference determine which reconstructive surgery would be best.
In making a recommendation to you, your Jefferson plastic surgeon will consider the following:
- the size and location of the cancer (which determines the amount of skin and tissue to be removed in the mastectomy);
- whether tissue has been damaged by radiation therapy or aging, or is sufficiently healthy to withstand surgery;
- and other considerations, such as potential for complications and the patient's general health.
Timing and preplanning
Your clinical team at Jefferson will educate and counsel you about breast reconstructive possibilities prior to mastectomy, so that you can make the decision about reconstruction before going into surgery. Based on your medical history, your care team will recommend either:
- immediate reconstruction . This is reconstructive surgery performed at the same time as your primary breast surgery (that is, in the same operating-room session).
- delayed reconstruction . In this case, your surgeon will perform the reconstruction as a second operation after you have recovered from the primary surgery. If chemotherapy is part of your treatment protocol, your surgeon may recommend delayed reconstruction.
Types of breast reconstruction
The two most effective approaches available for both unilateral (one breast) and bilateral (both breasts) reconstruction are:
- Expander/implant reconstruction. In this procedure, the surgical team uses an expander to create a breast mound and then later replaces the expander with a permanent, filled breast implant.
An expander is an empty silicone pouch, placed under the pectoralis muscle, located between the breast and the chest wall. To enable the skin and soft tissues of the breast to grow, your surgical team will gradually fill the expander with saline solution over a period of several weeks. The saline is injected into the expander through a valve or port in the expander. Once the expander has been completely filled, your surgeon will leave it in for several more weeks to months, allowing for maximal skin and soft tissue growth.
Implants are pouches permanently filled with liquid – either saline or silicone gel. Your surgeon will select an implant matched for shape and size to the results sought for your breast reconstruction. The different types of implants have advantages and disadvantages. Your Jefferson surgeon will discuss the types of implants with you and seek your input about which to use.
- Autologous tissue reconstruction. In this approach, surgeons use the patient's own tissues to reconstruct a new breast mound, moving a flap of additional tissue. The most common types of tissue flaps are the TRAM (transverse rectus abdominous muscle) flap and latissimus dorsi flap. A TRAM flap involves removing an area of fat, skin, and muscle from the abdomen and stitching it in place to the mastectomy wound, and the latissimus dorsi flap takes muscle from the back (below the shoulder and behind the armpit) to construct a new breast mound.
Complications
All types of surgery carry some risk. A woman’s response to surgery differs due to her anatomy (body) and ability to heal. Complications from breast surgery are uncommon but can include:
- bleeding;
- fluid collection;
- infection;
- excessive scar tissue;
- and anesthesia problems.
The most common complication of breast reconstruction surgery is capsular contracture , which occurs if the scar or capsule around the implant begins to tighten. Occasionally, this or other complications are severe enough to require a second operation.
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