After a mastectomy, some women choose to undergo breast reconstruction. Whether practical or emotional, each patient has her own reason for undergoing reconstruction. Some women have difficulty finding clothes that fit properly while others are embarrassed when they lose their prosthesis while swimming or running. However, many simply want to feel whole again.
The creation of a new breast can dramatically improve your self-image, self-confidence and quality of life. Although surgery can give you a relatively natural looking breast, a reconstructed breast will never look or feel exactly the same as the breast that was removed.
Breast reconstruction ideally occurs once breast cancer treatment is complete. Some women may delay breast reconstruction until they are well recovered from their cancer treatment and feel confident in their reconstructive choices.In some cases, reconstruction can be performed immediately following the mastectomy under the same anaesthetic. Immediate reconstruction requires coordination between the general surgeon performing the mastectomy and the plastic surgeon and in some cases, can lead to a delay in the operation due to restricted operating room time. Immediate reconstruction is a reasonable option for women requiring a prophylactic mastectomy or patients with small cancers who will not require post-operative radiation.
Breast reconstruction can be performed in two types of procedures:
One option is to place a silicone implant under the chest skin and pectoralis muscle. This often involves an initial procedure several months in advance to insert a tissue expander. The expander is a balloon-like shell that can be gradually filled by injecting saline though the skin into a port within the expander. [IMAGES FOR THIS] The skin is slowly stretched so that a permanent implant will fit comfortably under the skin and pectoralis major muscle. There are several types of permanent implants ranging from saline filled or silicon filled. The surgery to place either the tissue expander or implant takes about one hour and is performed as day surgery.
The second option is autologous reconstruction which uses the patient’s own tissue to reconstruct the breast. The tissue can be taken from different parts of the body, including the abdomen, back, thigh and buttocks. Skin and tissue taken from the lower abdomen is the most common form of autologous reconstruction. These tissues are taken with their own blood supply or the blood supply is returned to the tissue once it is placed on the chest. Tissue with its own blood supply is termed a flap. With a flap reconstruction the skin over the lower abdomen is supplied by blood vessel that runs through the rectus abdominis (RA) muscle. Because the flap is oriented across the lower abdomen this flap is called a Transverse Rectus Abdominis Musculocutaneous (TRAM) flap. If the same skin and fat is taken without any muscle it is called a Deep Inferior Epigastric Perforator (DIEP) flap. When the tissue is completely removed from the body and then reconnected separately is termed a free flap. Which type of procedure depends on the patient and the size of flap required.
TRAM or DIEP flap harvest leaves patients with a scar running across the lower abdomen and a scar around the belly button (umbilicus). In some cases it can cause abdominal weakness, however this is not a common complaint. Slow healing or a collection of fluid under the skin (a seroma) can also occur post-operatively. If the reconnected blood vessels to the flap clot, this can cause complete loss of the flap, though this is a rare occurrence. Patients generally stay in hospital for three-five days after a TRAM reconstruction and it can take two-three months after the operation for a full recovery.
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