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Breast Reconstruction

Breast Reconstruction is most commonly performed for women that have had a mastectomy for treatment of breast cancer. Patients that have had a lumpectomy or partial mastectomy may also have the need for breast reconstruction procedures. Breast reconstruction may also benefit other women that have operations or injuries, such as burns, involving their breasts. Birth defects resulting in abnormalities of development may also be reconstructed. Poland's Syndrome is a developmental birth deformity which results in one breast failing to develop into a normal size compared to the opposite breast.

The function of the breast, aside from the brief periods when it serves for lactation, is an organ of female sexual identity. The female breast is a major component of a woman's self image and is important to her psychological sense of femininity and sexuality. The ultimate goal of breast reconstruction is to achieve bilateral symmetry. Because near-equal symmetry is a prerequisite for "normalcy," reconstruction on the contralateral or unaffected breast is often required to achieve the best possible match of size and configuration.

A number of surgical techniques are used to recreate the breast mound and nipple-areolar complex. The goal is to create a breast that matches the shape, size, and feel of the normal breast as much as possible. The skills that are used to reconstruct a breast after a mastectomy are also used for other types of breast reconstruction.

Most patients report that breast reconstruction has enhanced their lives and contributed to an improved quality of life.

WHO IS A CANDIDATE

  • Most of the women that undergo a mastectomy for cancer or pre-cancerous breast disease.
  • Women that have noticeable lack of symmetry between the operated (lumpectomy or partial mastectomy) and normal breast.
  • Women who are in good physical health, psychologically stable, well informed about the procedure, and realistic about the outcome.
  • Women with localized disease.
  • Women, including teenagers, who have a failure of one breast to develop.
  • Patients who should be able to stop smoking for several weeks before and after this major surgery.

Breast reconstruction

Breast Reconstruction Before and After Gallery

INTENDED RESULTS

  • A breast mound and nipple with the surrounding pigmented areola.
  • A shape and size that matches, as much as possible, the opposite breast.
  • Adjustment of size or shape of the opposite breast, if necessary, to achieve the best symmetry.
  • An attractive alternative to the use and to the discomfort of an external prosthesis.

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TIMING OF BREAST RECONSTRUCTION PROCEDURES

  • Immediate reconstruction is done after the general surgeon does the mastectomy and removal of lymph nodes.

  • Delayed reconstruction is done several months or more afterward, usually after recovery from additional (adjuvant) therapy, such as chemotherapy or radiation therapy. Some women also seek delayed reconstruction after becoming dissatisfied using an external prosthesis.

  • Teenage women, who realize that one of their breasts is under-developed compared to the opposite breast, can have placement of a tissue expander or adjustable breast implant (prosthesis) for reconstruction during adolescence. This is inflated with saline (salt water of the same type as IV fluid) to match the size of the normally developing breast. As the uninvolved breast continues to grow during adolescence, additional saline is added in Dr. Weeter's office to match the size of the normally developing breast. Some women wait until completion of breast development to determine the optimal size for their breasts. (It may be preferable to reduce an overly large, heavy breast and augment the under-developed breast.)

PROCEDURES

  • Reconstruction of the breast mound can use some of the patient's own tissues to replace the tissues removed with the mastectomy, or can use a soft saline filled implant, made of a silicone envelope, or a combination of both techniques.

  • Breast Implants: The most common breast reconstruction uses an implant placed beneath a covering of muscle and skin, with its underlying, cushioning fat layer and blood vessels. Typically a tissue expander is inserted beneath the covering tissue layers and partially filled. The overlying tissues adjust to the changes of surgery. After several weeks of recovery from the surgery, a series of additions of the saline gradually inflates the implant to the desired size. When the desired breast mound size has been achieved, the tissue expander is removed and replaced by the permanent breast implant. This is usually done as an outpatient. Use of an implant usually has the easiest recovery and the risks are least with this type of reconstruction.

  • Flap reconstruction: Use of the patient's own tissues moved from other body areas can also be chosen to reconstruct the breast mound. The skin and underlying fat and muscle, which supplies the blood supply, is called a flap. The surgery does require a longer hospital stay, and recovery is not quite as easy as with the use of a breast implant alone. Because the reconstruction is made with the patient's tissues, it may feel more like a natural breast.

    • The Transverse Rectus Abdominus Musculocutaneous Flap (TRAM flap) uses the skin and fat layer of the lower abdomen with its underlying muscle layer to recreate the breast mound. Because the site that donates these tissues is then sutured together as it is when Dr. Weeter does an abdominoplasty, commonly called a "tummy tuck", this method is sometimes called a "tummy tuck reconstruction." A number of factors affect the suitability of this method, such as previous abdominal surgery and smoking. It may not be appropriate for all candidates for breast reconstruction.

    • The Latissimus Dorsi Musculocutaneous Flap brings the skin and fat layer with the muscular blood supply from the back around to the front side of the chest wall to build up a breast mound. Because this has a thinner fat layer, a small breast implant may be required.

  • Reconstruction of the nipple and areola: Reconstruction of the nipple is generally performed after recovery from the breast mound reconstruction. The nipple is created using local skin and underlying tissue from the breast mound area that is lifted and brought together for its reconstruction. The pigmented area around the nipple, called the areola, will have medical tattooing to complete the reconstruction. Reconstruction of the nipple and areola are usually done as outpatient or treatment room procedures.

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RECUPERATION AND HEALING

  • Recovery time and resumption of the activities of daily living varies depending on the type of procedure.
  • Hospitalization is usually one to three days. If reconstruction is done at the time of the mastectomy it may add a day or two to the hospitalization, depending on the type of reconstruction that is done.
  • Usually drainage tubes are used for a short time post-operatively.
  • Initial discomfort subsides daily and can be controlled with oral medication.
  • Driving can usually begin within about a week.
  • Walking exercises may begin within about 2 weeks and slowly increased over the next 6 weeks.
  • Usually, Dr. Weeter's patients return to progressively more normal activity within several weeks.
  • The scars at the incision lines typically will be pinkish and firm a few weeks after surgery, but after many months they usually become pale and soft. After 8-12 months, the scars are relatively inconspicuous.
  • The post-operative swelling and tightness gradually decrease in the weeks following all of these procedures.
  • When a tissue expander is used for reconstruction, saline will be added to the tissue expander to stretch the skin and build up the breast mound. This begins 3 weeks following surgery and continues weekly until reaching the final size. At a second outpatient operation the tissue expander is exchanged for a permanent breast implant.
  • With the flap reconstruction operations, the new tissue of the breast area will gradually lose the swelling and tightness, and gradually develop a softer feel and look. As the tissues mature, the breast mound will settle and have a natural contour.

OTHER OPTIONS

  • An external prosthesis can be worn within the brassiere or bathing suit.
  • Modification of the opposite breast may be chosen to achieve improved symmetry of the breasts.

INSURANCE GUIDELINES

  • Pre-authorization by the insurance company is required prior to surgery. Dr. Weeter and his staff will assist you in obtaining pre-authorization from your insurance carrier.

  • Legislation: Women's Health and Cancer Rights Act of 1998

  • In October 1998, federal legislation was signed into law requiring group health plans and health issuers that provide medical and surgical benefits with respect to mastectomy, to cover the cost of reconstructive breast surgery for women who have undergone a mastectomy.

  • The law states:
    • The attending physician and patient are to be consulted in determining the appropriate type of surgery.
    • Coverage must include all stages of reconstruction of the diseased breast, procedures to restore and achieve symmetry on the opposite breast and the cost of prostheses and complications of mastectomy, including lymphedema.

NOTE: The specific risks and the suitability of this procedure for you may be determined only at the time of consultation. All surgical procedures have some degree of risk. All of this web site content, and any email responses to your inquiries are strictly for general informational and educational purposes. It is not medical advice and should not be taken as medical advice. It should not be used to diagnose or treat a health problem or disease. It is not meant to be a substitute for professional medical care.

Information on breast reconstruction in Louisville, Kentucky. Read about breast cancer, mastectomy, treatment, implants, candidates for surgery, timing and procedures and Poland's Syndrome.

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