Reconstruction of a breast that has been removed due to cancer or other disease is one of the most rewarding surgical procedures. New medical techniques and devices have made it possible for surgeons to create a breast that can come close in form and appearance to that of the matching 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.
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.
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You can begin talking about reconstruction as soon as you’re diagnosed with cancer. Ideally, you’ll want your Breast Surgeon and your Plastic Surgeon to work together to develop a strategy that will put you in the best possible condition for reconstruction. After evaluating your health, Mr Klein will explain which reconstructive options are most appropriate for your age, health, anatomy, tissues, and goals. Post-mastectomy reconstruction can improve your appearance and renew your self-confidence. Don’t hesitate to ask Mr Klein any questions you may have, especially those regarding your expectations and concerns about the results. Mr Klein will explain the procedure in detail, including the risks and limitations, the type of anesthesia that will be used, the type of facility where the surgery will be preformed and the costs involved. Be sure to tell Mr Klein if you smoke, and if you’re taking any medications, vitamins, or other drugs.
Virtually any woman who must lose her breast to cancer can have it rebuilt through reconstructive surgery. But there are risks associated with any surgery and specific complications associated with this procedure. During your consultation the procedure will be explained in detail, including the risks and limitations.
While there are many options available in Post-Mastectomy reconstruction, Mr Klein will discuss the one that’s best for you.
Skin expansion is the most common technique and combines skin expansion and subsequent insertion of an implant. Following Mastectomy, Mr Klein will insert a balloon expander beneath your skin and chest muscle. Through a tiny valve mechanism buried beneath the skin, Mr Klein 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. The nipple and the dark skin surrounding it, called the areola, are reconstructed in a subsequent procedure. Some patients do not require preliminary tissue expansion before receiving an implant. For these women, Mr Klein will proceed with inserting an implant as the first step.
Flap Reconstruction is an alternative approach to implant reconstruction and involves the 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. Another flap technique uses tissue that is surgically removed from the abdomen, thighs, or buttocks and then transplanted to the chest by reconnecting the blood vessels to new ones in that region. This procedure requires the skills of a plastic surgeon who is experienced in Microvascular surgery as well. Regardless of whether the tissue is tunneled beneath the skin on a pedicle or transplanted to the chest as a Microvascular flap, this type of surgery is more complex than skin expansion. Scars will be left at both the tissue donor site and at the reconstructed breast, and recovery will take longer than with an implant.
|A. A tissue expander is inserted following the Mastectomy to prepare for reconstruction.|
|B. 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.|
|C. 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.|
|D. Most of the scars will be hidden under your clothes and in the normal creases of your skin.|
|E. The transported tissue forms a flap for a breast implant, or it may provide enough bulk to form the breast mound without an implant.|
|F. Tissue may be taken from the abdomen and tunneled to the breast or surgically transplanted to form a new breast mound.|
|G. After surgery, the breast mound, nipple, and areola are restored.|
|H. Scars at the breast, nipple, and abdomen will fade substantially with time, but may never disappear entirely.|
Most Breast Reconstruction involves a series of procedures that occur over time. Usually, the initial reconstructive operation is the most complex. Follow-up surgery may be required to replace a tissue expander with an implant or to reconstruct the nipple and the areola. Many surgeons recommend an additional operation to enlarge, reduce, or lift the natural breast to match the reconstructed breast.
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 Mr Klein.
It may take you up to six weeks to recover from a combined Mastectomy and Breast 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.
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.