Breast cancer is one of the most common malignant diseases among women all over the world. Statistics show that 1 out of 7 women can get this type of cancer during their lifetime. Most women who are cured with breast cancer need to have their breast removed (mastectomy). Luckily, new reconstructive surgery methods and equipment available today made breast reconstruction possible. Even better, breast can be created immediately after it has been removed due to disease, so that the patient wakes up after plastic surgery and has a new breast. Psychologically it is very rewarding, because the patient does not have to go through the period when she does not have a breast at all.
Most patients, who had their breasts removed, are eligible for breast reconstruction immediately after mastectomy. Patients are chosen only there is certainty that cancer has been removed by mastectomy. It is important that all women know about the possibility to have reconstructive procedures. Some may want to wait before having them. Therefore, a thorough discussion with a reconstructive surgeon may help making a decision whether to have breast reconstruction or not.
There are certain limitations to this procedure, concerning overall health condition of the patient. Patients, who have high blood pressure, have other medical problems, are obese or smoking should wait before breast reconstruction.
It is the best to discuss the option of breast reconstruction straight after you are diagnosed with breast cancer. The oncologist and plastic surgeon should discuss all the possibilities together to plan the ideal strategy for you. You and your surgeons should talk about your expectations, goals and limitations of breast reconstruction in your case. Different techniques are used for different patients depending upon their health condition, spread of cancer, anatomy and others. Even though breast reconstruction may improve your looks and self-esteem enormously, perfection can rarely be reached.
Breast reconstruction is a rather complicated procedure, which involves several stages and surgeries. First operation is performed at the hospital, sometimes at the same time as mastectomy. Further surgeries may be done either at the hospital or in an outpatient department. Whether it is performed at the hospital or not, you should still ask someone to take you home after surgery and help you at home for a few days.
Usually general anesthesia is used for the first stage of the procedure, creating the breast mound. You will be asleep during general anesthesia and will not feel anything during surgery. Further operations are done using local anesthesia with sedation, and you will not feel any pain.
In order to be thoroughly prepared for the surgery, your doctor will advise you about your behavior before and after surgery and give basic instructions on drinking, eating and taking medications.
There are several possibilities for breast reconstruction: skin expansion and flap reconstruction. These options should be discussed by your doctor with you. Skin expansion is the most common method in reconstructing the breast. A balloon expander is inserted under the skin and the pectoral muscle following mastectomy. This balloon is gradually injected with saline solution by your surgeon. The process takes several weeks until a more permanent implant can be inserted instead of a balloon expander during second operation.
The aim of the balloon expander is to stretch the skin until there is enough space for the implant. In some cases, a permanent implant is inserted immediately after mastectomy, and no intermediate period is required. You should be aware that a nipple and areola are formed during the second stage of surgery.
Flap reconstruction is another modification of this reconstructive procedure. In this case a skin flap is taken from other parts of the body. Usually, skin from the back, buttocks or belly is used to reconstruct the breast.
Beware that this is a more complicated approach of breast reconstruction than tissue expansion. Since that skin is taken from the donor sites, scars will be created there and also at the breast site. Besides, it takes longer to recover after this type of surgery. The advantage of this method is that sometimes no implant is needed, since not only the skin but also the tissues underneath are transplanted from the donor sites. Therefore, no synthetic materials are needed and breasts are more natural.
Further procedures involve creation of the nipple and areola. Tissue from the genital lips of the patient may be taken and transplanted to the site of the nipple. In some cases, additional surgeries may be needed to alter the appearance of the health breast so that it matches the reconstructed breast more ideally. In that case, patients should know that scars may be formed on the healthy breast.
If you need to have a breast implant for breast reconstruction, you should discuss with your surgeon which type of breast implant you want to have. As far as FDA recommendations are concerned, saline filled implants showed to be safer compared to silicone ones.
Breast reconstruction recovery
Recovery is a gradual process and may require a lot of patience. Since breast reconstruction is a relatively complicated procedure, patients usually feel tired for a few weeks following it. Some patients feel some pain, but this can be controlled with medicines.
The surgeon will insert a drain into the reconstructed area in order to let the fluid out of the breast. You will probably have to stay in the hospital from 2 to 5 days. Drains will be left in the breast for a week or two. Your surgeon will take the stitches out in a week or 10 days.
Getting back to normal may take months, depending on the breast reconstruction technique and whether it is done in combination with mastectomy or not. Recovery time is longer for combined breast removal and reconstruction or flap reconstruction and may last for up to seven weeks. You should avoid strenuous activity for a few months after surgery.
Since breast reconstruction is improvement procedure and not perfection, your reconstructed breast may not match the healthy breast ideally. Also, sensitivity of the breast may not return, but it may improve. Scars will be visible for some time, but they will fade away with time and will not bother you. However, bear in mind that scars will not disappear completely.
Breast reconstruction side effects
Like all surgery, breast reconstruction carries some uncertainty and risks, which you should be aware of before deciding to have this procedure. Usual complications are rare, these involve scar formation, bleeding, reactions to anesthesia, fluid building. If an implant is used, there is a risk of infection. In that case, the implant may have to be removed until the patient is healed.
More complicated problems, risks, are capsular contracture. This means that a scar around the implant contracts and the breast feels hard while touching. New implant insertion may be needed and the surgeon usually performs the plastic surgery to free the scar.
Some psychological symptoms may develop after surgery, since some women may need time to gain the feeling that it is her breast. Also, all patients should be aware that mammograms are necessary for both breasts after breast reconstructions in order to make sure that cancer does not reoccur. Patients with implants should go to see qualified radiologists, who know how to examine breasts with implants.
In most countries the cost of breast reconstruction procedures is covered by health insurance. However, if a patient decides to have additional plastic surgeries on the healthy breast for it to match the reconstructed breast better, the cost of such procedure is not covered by health insurance.
Even though perfection is not reached, most women are happy with breast reconstruction results. Breast reconstruction procedure improves women’s appearance and enhances their self-confidence. Other people do not even notice that a woman has undergone this procedure. All women are able to have this procedure and they should be informed about it as soon as they are diagnosed.