In the unfortunate event where a full mastectomy is required to treat breast cancer, reconstruction is often a much welcomed option. With modern technology, techniques, and materials that are available it is possible to restore the breasts appearance to its original form with hardly any visible scarring. When this procedure is carried out it is done so by plastic surgeons specializing in restoration. It has now become a commonplace following a full mastectomy.
There are many different techniques an each case is unique and approached on an individual and personalized basis. A consultation with a physician is necessary in order to select the right method and approach for you.
Breast implants are one option that is typically chosen. Today implants are typically saline filled bags encased in silicone. They are placed in front of the chest wall muscles under the skin that covers the breast area.
In years past, silicon filled implants were more typical. There was a concern for the possibility of silicon leaking into the body and causing immune system problems. But the FDA recently announced, after years of careful study, that there was little basis for worry and silicon breast implants are now legal again. Some prefer them for their different behavior.
In many instances reconstruction is done simultaneously with the mastectomy. In other cases physicians recommend that you wait for a period of time to allow the body to heal prior to performing any further surgery. Each case is different and can only be decided based upon its own circumstances.
Usually, two-staged delayed reconstruction is performed if the skin and chest wall tissues are flat. In this instance an implant, called a tissue expander that functions much like a balloon under the tissue, is placed underneath the muscle. A surgeon then injects saline in stages over a specific period of time. In some cases the expander itself eventually becomes the implant. In other instances the expander is removed during a later procedure and replaced with a permanent implant.
Tissue flap procedures are another category of breast surgery. These use skin from the stomach, the thighs or other area as part of the total process.
TRAM (transverse rectus abdominis muscle flap) is one of the most common types, which uses tissue from the lower abdominal wall. A pedicle flap leaves the tissue attached to the original blood supply and stretches the tissue up the breast area. A free flap procedure removes the tissue entirely, along with muscles, fat, and blood vessels and reattaches them to blood vessels under the chest.
Another, almost equally common procedure takes tissue from the upper back. A flap is moved in front of the chest wall in effort to create a pocket. A breast implant is then inserted into the pocket. Additionally, other procedures are available such as gluteal muscle tissue.
In each case, nipple and/or areola reconstruction may or may not be part of the total surgery. It may be done later or not at all. Rarely is the nipple from the original breast used as a replacement out of concern that it may regenerate the cancer.
Reconstructive surgery is not entirely without risks, of course.
You can have the typical surgical complications including infection, and scarring. Breast implants also are not guaranteed to last a lifetime and depending upon your age may need to be replaced via another surgery at a later time. The final result might not be what the patient was expecting. Only a complete in depth consultation with a physician can provide a realistic assessment of what to expect.