How It's Done:
A new breast mound can be created using a flap technique or tissue expansion method. These two methods may be used in conjunction with each other, or they may be performed as a predecessor to the placement of breast implants.
Risks & Complications:
Risks can include excessive or prolonged bleeding, infection, loss of sensation, tissue death, delayed or incomplete healing of incisions, and adverse reactions to anesthesia. In cases where breast implants are used as part of the reconstruction, capsular contracture is also a risk. It is important to note here that, despite the controversy surrounding silicone breast implants in recent years, there has been no link proven between breast implants and autoimmune or other systemic diseases, although implants can make breast changes harder to detect.
Normal breast sensation will not return to your reconstructed breast, and there will be some visible scarring from your reconstruction procedure. Depending on the type of reconstruction techniques used, it is possible that the scarring may be extensive, although most scars fade considerably over time. Most patients still find that the benefits of breast reconstruction far outweigh the considerations of scarring and loss of sensation.
Recovery & Downtime:
For breast reconstruction surgery where a flap technique is used, recovery time is generally about six weeks, though it may be less for other types of procedures. It is important to avoid strenuous activity during your recovery period, according to your doctor’s specific instructions.
In addition, patients should keep in mind that secondary procedures like nipple reconstruction (usually at about 8 weeks) can lengthen recovery time. This is also the time to think about scheduling any surgery you may need on the remaining natural breast for the sake of symmetry.
Thanks to the Women’s Health and Cancer Rights Act of 1998, health insurance plans are now required to cover post-mastectomy breast reconstruction as long as the patient was eligible for and received benefits from her plan for the mastectomy. Insurance companies now must cover not only reconstruction of the breast on which the mastectomy was performed, but also surgery performed on the remaining natural breast, as needed to provide a symmetrical appearance. Of course, coverage is subject to any deductibles which may be in effect, so check with your insurance company to determine what out-of-pocket costs may be.
Anesthesia & Other Details:
Primary breast reconstruction surgery is almost always performed with the patient under general anesthesia, and almost invariably takes place in a hospital. In addition, most cases require a short hospital stay of one to five days. However, when follow-up procedures are required, they may be in-office or outpatient procedures, performed under only local anesthetic with mild sedation.
Flap techniques utilize a flap of skin from a donor site on the patient’s own body. Sometimes, the flap is comprised of skin and fatty tissue only, but a flap may also include muscle from the donor site. In some methods, the flap remains attached to the blood supply at the donor site and is tunneled under the skin and put in place to form the new breast mound. In others, the flap is completely detached from the donor site. In most cases, the flap is only used to provide the muscle and tissue needed to support and cover an implant. However, it can occasionally be used to completely reconstruct the breast mound.
Common Types of Flap Techniques:
- TRAM flap: uses muscle, fat, and skin from the patient's abdomen; stays attached to the donor site blood supply and is tunneled up beneath the skin before being placed in position on the breast; TRAM is a popular flap option because the patient winds up with a "tummy tuck" as a bonus.
- latissimus dorsi flap: uses muscle, fat, and skin from the patients back, stays attached to the donor site blood supply.
- DIEP flap: uses only skin and fat from the patient’s abdomen; detached from donor blood supply
- SGAP flap: uses only skin and fat from the patient’s buttocks; detached from donor blood supply
Autologous Augmentation :
This procedure is akin to a breast implant made from the patient's own living tissue. In this technique, the patient’s skin and fat is taken from under the arm, next to the breast. Then it is turned over and placed under the breast to augment it. This technique places the flap under the skin, so it is used in cases where the skin overlying the breast has been spared, or when there has been tissue expansion performed prior to the procedure.
Breast Reconstruction Surgery Explained:
Breast reconstruction employs a variety of plastic surgery techniques in an effort to restore a patient’s breast(s) as closely as possible to pre-mastectomy size, shape and appearance. Breast reconstruction surgery can only be performed once the patient is healed and fully recovered following a mastectomy, although there are newer techniques, like the skin-sparing mastectomy, which also may be considered a “first step” in the reconstruction process.
It is important to remember that results can vary greatly from patient to patient, and that your breast(s) will not look or feel exactly the same as before your mastectomy. Another thing to keep in mind is that there is no way to avoid visible incision lines on the breast, either from the mastectomy itself or from the reconstruction, although your surgeon will take care to minimize scarring for the most pleasing aesthetic result possible. Some reconstruction techniques will also leave scars on the donor area.
In addition, it is important to be aware that if you had only a unilateral mastectomy, the reconstructed breast will not be perfectly symmetrical with your remaining natural breast. If a patient wishes to improve symmetry, some form of surgery may be recommended to alter the intact breast to appear more similar to the reconstructed breast. This surgery may entail a breast lift, augmentation, reduction, or some combination of two or more of these options.