Know more about Breast Reconstruction Surgery

What is Breast Reconstruction Surgery?

The purpose of breast reconstruction is to reform or reshape one or both breasts after a mastectomy or lumpectomy.

• A mastectomy is a surgical procedure during which a surgeon removes the entire breast, usually including the nipple and areola, to treat or prevent breast cancer.

• A lumpectomy is the removal of a breast section that contains a smaller tumour.

Breast reconstruction which takes place at the time of mastectomy or lumpectomy is called immediate reconstruction. But at times a person might choose to undergo reconstruction after the mastectomy has healed and after the radiation treatment is completed. This is called delayed reconstruction.

How is Breast Reconstruction Surgery Performed?

• Step 1 – You will be under general anaesthesia during your mastectomy and immediate breast reconstruction.
• Step 2 – Your breast surgeon will usually make an oval-shaped incision over the nipple area. In some people with certain early breast cancers, the nipple could be preserved in the breast. This is performed by using incisions at the bottom of the breast or near the nipple. However, the nipple-sparing mastectomy or areola-sparing mastectomy depends on the stage and location of your breast cancer.
• Step 3 – From the incision, your surgeon will remove all of the breast tissue of that breast. They may also remove a few or all lymph nodes under your arm, depending on the stage of cancer.
• Step 4 – The plastic surgeon will then reconstruct the breast or breasts. Generally, a breast may be reconstructed with an implant or with your own tissue from another part of your body.

After reconstruction, your breast surgeon will attach temporary drainage tubes to your breast. This is to make sure that any excess fluid has to be removed during healing. Your chest will be wrapped with a bandage.

What are the options for Breast Reconstruction Surgery?

There are many factors that can help to determine the suitable type of breast reconstruction; the two main options are given below:

1) Breast reconstruction with implants:

There are two types of implants used in breast reconstruction. When reconstructing a breast with implants, the surgeon will insert silicone or saline implants underneath the skin or muscle, to replace the previous breast tissue. Saline-filled implants use sterile saltwater inside the implant. Whereas, Silicone-gel filled implants are made of a type of rubber. Saline-filled implants are the most common implant type, but many people think that silicone implants feel more like a natural breast. Your plastic surgeon may recommend a two-stage procedure. The first stage is to place an implant expander and the second stage is used to complete the tissue reconstruction.

• Stage 1 – A surgeon places a tissue expander or an expandable balloon underneath the remaining breast after the surgery. The expander is a temporary saline implant that gradually stretches the remaining tissue.
• Stage 2 – After the person has fully healed following surgery, a surgeon will inject salt water gradually into the expandable balloon on a weekly basis. This balloon gradually grows, stretching the overlying skin and muscle until the breast reaches a size that is comfortable for the patient.

When the chest tissues heal and the surgeon has added enough saline to the tissue expander to prepare for the implants, they will perform the second procedure to insert the implants. The surgeon will remove the tissue expanders and replaces them with either a silicone or saline implant. They will usually reopen the original scar. This means that the procedure will not leave any scars on the chest. In some cases, a surgeon could place a permanent saline or silicone implant during the mastectomy, without the use of a tissue expander.

Things to keep in mind for Breast Reconstruction with Implants:

• Recovery time with implants is shorter than with tissue flap reconstruction.
• No implant will last forever. Your implant will likely need to be replaced.
• Silicone implants will need monitoring with MRIs every few years to detect rupture.
• Your body may have problems with the implants, such as infection, scarring, and implant rupture.
• Future mammograms may be harder to perform with implants.
• An implant may affect your ability to breastfeed.

2) Tissue flap surgery:

Breast reconstruction with flap surgery is a complex procedure that is performed by a plastic surgeon. The surgeon will take tissue from another part of the body and move it to the chest to rebuild the breast. The surgeon removes this tissue from the abdomen, buttock or inner thigh. There are two methods available for this surgery:

• Free flap surgery: A surgeon removes the tissue and the blood vessels completely. They stitch the blood vessels to other blood vessels in the chest at the needed site of placement. These blood vessels are very small, so the surgeon has to use a microscope to sew them together in a procedure called microsurgery.

• Pedicle flap surgery: A surgeon will not remove the transplanted tissue from its blood vessels entirely. Instead, the tissue remains attached to the body, and the surgeon rotates this into the chest to form the breast. A surgeon will use tissue from the abdomen or back for pedicle flap surgery.

Things to keep in mind for Breast Reconstruction with Tissue flap surgery:

• Tissue flaps generally look and feel more natural than implants.
• The size of the tissue flaps can adjust with the rest of your body as you gain or lose weight.
• You will not need to replace tissues as you would likely need to replace implants.
• Surgery generally takes longer than implant surgery, with a longer recovery time.
• It will leave multiple surgical site scars because multiple areas of your body will be operated on.
• Some people may experience muscle weakness or damage in the tissue donor area.

Alternatives

Some people choose to use a prosthetic breast from either inside their bras or attached to their bodies. These artificial body parts look and feel like natural breast(s) and provide the body with a balancing weight to support its posture. They can start wearing prosthetics after the body has fully healed.