Breast Reconstruction - How and why it is performed

Breast reconstruction is performed to reshape or reform one or both of the breasts of a patient after the patient has a mastectomy due to breast cancer. In order to restore symmetry between the two breasts, patients can have breast reconstruction to replace any missing breast tissue, skin or a removed nipple. The amount of breast reconstruction that is performed depends on the amount of work done during the mastectomy due to the size, location and width of the tumor that was removed.

The Decision to have Breast Reconstruction

The decision to have breast reconstruction performed is an individual decision for each patient. Patients can choose to undergo breast reconstruction or they can wear external breast pads or forms. They can also make the decision to not make any changes to their appearance at all after they have a mastectomy.

Ideal candidates also include patients that do not feel “whole” after having one or both breasts removed. The reconstruction of the breasts can provide them better self-esteem and an improved self-image.

Breast Reconstruction Options

When it comes to breast reconstruction, patients have a number of options to achieve their desired results:

• Breast implants can be placed in the area where the breasts were removed to provide a greater amount of volume and shape. The two types of breast implants are made of saline and silicone gel. Saline breast implants are silicone shells that are filled with saline which is sterile salt water. These implants can be filled during the breast reconstruction surgery or they can come pre-filled as well. Silicone breast implants are silicone gels filled with silicone which is a plastic gel. Both types of implants are available in either smooth or textured shells. The FDA requires women to be at least 18 years of age to get saline implants and at least 22 years old to get silicone implants.
• Tissue flap procedures use the actual tissue from a patient that is normally taken from the back or abdomen of the person to create a mound that resembles a breast. If the tissue is removed from the abdomen, it is known as a TRAM flap. If the tissue is taken from the back of the patient, it is known as a latissimus dorsi flap. There are times when it is necessary for the tissue that is being moved to remain attached to its blood supply. If it does not have to remain connected to its own blood supply, it can be disconnected and later reconnected to the blood supply in its new location.
• Nipple reconstruction is often a popular choice during breast reconstruction because the nipple and areola (dark area around the nipple) are usually removed during mastectomy surgery. Nipple reconstruction is performed after breast reconstruction and the nipple can be created from tissue that is removed from the abdominal flap or the back. The tissue is tattooed to resemble the normal nipple color. There are times when the nipple from the original breast can be reattached if the tissue is free of cancer. In addition, a prosthetic nipple can be created by the surgeon making a copy of the natural nipple and then coloring the areola. The prosthetic nipple will need to be glued to the breast.

Depending on the procedure used to reconstruct the breast, a breast reconstruction surgery generally takes anywhere from one to six hours to perform.

Breast Reconstruction Recovery

Patients will experience some discomfort for a few days after breast reconstruction surgery. Patients will be encouraged to start walking after a few days. After the surgery, patients will likely have drains placed at the incision sites to get rid of excess fluids.

The time spent in the hospital varies per patient and can often depend on the type of surgery and the extent of the work that needs to be performed. The average hospital stay can be anywhere from a day or two to 5 or 6 days.

There will be some soreness, swelling and bruising for 2 to 3 weeks after the surgery. Most patients resume normal activities around 6 to 8 weeks after breast reconstruction surgery.

Breast Reconstruction and Health Insurance

As mentioned above, a mastectomy is performed due to the treatment of breast cancer. Because breast reconstruction is considered to be part of a treatment for a disease, the cost of some, or all, of the breast reconstruction is normally covered by health insurance.

Best Time to have Breast Reconstruction

The best time for a patient to have breast reconstruction surgery depends on the desires of the patient. Breast reconstruction surgery can be performed at the same time as the breast is removed or it can be performed months, or years, after the mastectomy. If the patient is undergoing any type of chemotherapy treatment for the breast cancer, breast reconstruction is normally postponed until the chemotherapy treatment is completed. Patients should be aware of the fact that breast reconstruction does not lessen the chances of the cancer returning. If the cancer does return, patients will need to consult with a board-certified doctor about their treatment options.

MA