After a mastectomy, some women choose to undergo breast reconstruction. Each patient has her own reason for undergoing reconstruction.
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 anesthetic.
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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 anesthetic.
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.
About the procedure
Breast reconstruction can be performed with implants or your own tissue.
Procedure options
Implant Based Reconstruction
Implant reconstruction using a breast implant to reconstruct the breast. The implant sits under the chest skin and often the pectoralis muscle. Implant reconstruction often requires two surgeries. The first operation a tissue expander which is a balloon-like shell that can be gradually filled by injecting saline though the skin into a port. The skin is slowly stretched so that a permanent implant will fit comfortably under the skin and pectoralis major muscle. The second surgery removes the tissue expander and replaces it with a permanent implant. These surgeries are approximately 6 months apart.
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Some people are candidates for a “direct to implant” reconstruction. This is when a patient has a mastectomy, and the final implant is placed on the same day. The goal is to remove the breast and complete the breast reconstruction in one surgery. Many patients who have this surgery still have a second surgery at some point to improve size, shape or symmetry of the reconstruction.
Implant surgery typically takes 1-1.5 hours per breast and is performed as day surgery. The scar pattern and location will depend on the type of mastectomy that is done.
Infection and poor healing can occur after implant surgery, which may lead to additional surgeries or for the implant to be removed.
Tissue-based Breast Reconstruction
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. The tissue is taken with the blood vessels that supply the tissues. The blood supply is reconnected once it is placed on the chest. Tissue with its own blood supply is termed a flap.
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Skin and tissue taken from the lower abdomen is the most common form of autologous reconstruction. With a flap reconstruction, the skin over the lower abdomen is supplied by a 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. Which type of procedure depends on the patient and the size of flap.
Abdominal 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 tissue reconstruction and it can take 2-3- months after the operation for a full recovery.
Implants VS Tissue
Implants |
Tissue |
|
| Advantages |
Surgery is all kept to the chest (no other surgical sites) Shorter recovery Tissue can look and feel more like a breast
|
Tissue reconstructions rarely need future surgery
Tissue can look and feel more like a breast
|
| Disadvantages |
Implants are a medical device, future surgeries are very likely
May look/feel less like a breast
|
Additional surgical site to harvest tissue (i.e. lower abdomen)
Longer recovery
|
| Operating Time | 1-1.5 hours per breast | 5hrs per breast |
| Average Hospital Stay | 0 days (day surgery) | 3-5 days |
| Average Recovery Time | 6-8 weeks | 8-12 weeks |
| Major complication rate | 5-15% | 1-5% |
| Complication rate in the setting of radiation | High | No increased risk |
Patient Resources
Breast Reconstruction Awareness (BRA) Day
BRA Day 2022 Playlist on Youtube
Contact one of our Breast CAncer Reconstruction experts today.
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