Breast Cancer - Reconstruction
In those tragic cases where a full mastectomy is required to treat breast cancer, reconstruction is a welcome option. With modern techniques and materials it is possible to restore appearance to a near invisible state. Carried out by specialized plastic surgeons, restoration is now commonplace.
There are a variety of approaches and each case is unique. Consultation with a physician is required in order to select the one that is right for you.
Breast implants are one commonly chosen option. Today, these are usually saline filled bags with a silicon outer shell. They are placed in front of the chest wall muscles under the skin covering 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 some cases, reconstruction is done during the mastectomy. In others, physicians recommend a waiting period to allow the body to heal before any further surgery. Each case is individual and can only be decided on its own merits.
Typically, though, two-stage delayed reconstruction is performed if the skin and chest wall tissues are flat. An implant, called a tissue expander that functions like a balloon under the tissue, is placed beneath the muscle. The surgeon then injects saline in stages over a period of time to gradually fill the sac. In some instances, the expander itself becomes the implant. In other cases, in a later procedure, the expander is removed 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, about equally common, uses tissue from the upper back. A flap is moved in front of the chest wall to create a pocket. A breast implant is then inserted into the pocket. There are other procedures as well, such as one that uses 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.
There can be the usual surgical complications, such as infection or scarring, such as capsular contracture in which scar tissue forms around the implant. Breast implants may not last a lifetime, depending on individual circumstances, such as age. Replacing them may require an additional surgery later in life. The final result may or may not be what the patient was expecting. Only a full consultation with a physician can provide a realistic assessment of likely outcomes.
