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Breast Reconstruction

Breast reconstruction is one of the most complex but gratifying areas of plastic and reconstructive surgery. It demands a unique blend of sound medical judgment, technical expertise, a sense of body aesthetics, and a strong patient-surgeon rapport. The entire breast or part of the breast can be reconstructed with an implant, or with the patient's own tissues. Moreover, numerous procedures to balance or revise the healthy or reconstructed breast, create a nipple, or further refine the scars or contours are also offered.

When is breast reconstruction surgery needed

According to the American Cancer Society, every year more than 200,000 American women must face the challenges of breast cancer, and some will also need to consider breast reconstruction options.  Major advances in cancer treatment, in addition to advances in reconstructive surgery, have allowed women to have more choices than ever in the way they approach breast surgery.

Reconstructive breast surgery is a great availability for women that have undergone a mastectomy. Doctors are able to rebuild breasts by removing skin and fat from the stomach or other areas to rebuild the contour of the breast, as well as the nipple and areola if the woman wishes.

In most circumstances the woman that considers reconstructive breast surgery have had a mastectomy. Rarely does a lumpectomy necessitate the procedure. The purpose of reconstructive breast surgery is to regain breast symmetry after the mastectomy. Not every woman will choose a reconstructive breast surgery but most doctors will encourage patients to consider all options before deciding.

While breasts reconstructed through surgery will have a different appearance then before the mastectomy, with a bra and clothing it should not be a noticeable difference. Most women will be able to choose between a saline breast implant or muscle flap reconstruction. Since muscle flap reconstructive breast surgery involves blood vessels, some women will not be able to have this type of technique as an option, including:

  • smokers
  • diabetics
  • women with vascular or connective tissue diseases

How is breast reconstruction surgery performed?

Over time, researchers have been trying to develop more efficient ways of performing reconstructive breast surgery by minimizing the mastectomy scar, as well as the reconstruction scars, and achieving the most aesthetically pleasing look. According to current figures, 12 percent of women alive today will develop breast cancer. Many decisions will need to be made during a stressful situation.

Immediately undergoing a reconstructive breast surgery can help a woman getting a mastectomy to avoid waking up from surgery without her breast, a circumstance that can help to ease some of her fears. If a patient is thinking about having breast reconstruction surgery, she is advised to discuss the options prior to the mastectomy.  Even if the patient does not choose to undergo breast reconstruction surgery at the time of the mastectomy, discussing its possibility can help better determine the best course of treatment knowing the patient has possible future interest in the procedure.

Different breast reconstruction options include:

  • one-stage immediate breast reconstruction, that is performed at the same time as the mastectomy
  • two-stage immediate reconstruction, that is performed if your skin and chest wall tissues are tight and flat 

Tissue flap procedures use tissue from the tummy, back, hip or buttocks to reconstruct the breast, and the two most common types of tissue flap surgeries are the TRAM flap and the latissimus dorsi flap.

TRAM flap uses tissue from the abdominal area, while the latissimus dorsi flap uses tissue from the upper back.  An added effect of the TRAM flap procedure is that because the tissue from the lower abdominal wall is often not enough to create a breast shape, the skin, fat, blood vessels and at least one of the abdominal muscles are moved from the abdomen to the chest area, which results in a tummy tuck.

Most commonly, patients will have the saline filled implant used for their reconstruction surgery, but silicone gel implants are also used.  Silicone gel implants were taken off the market in 1992 because of safety concerns but remained in use in clinical trials and for women who have had a mastectomy.   Plastic surgeons and patients have contended that silicone-gel implants restore the natural look and feel of a breast much better than saline.

Women are often concerned with how different breast reconstruction options affect the recurrence of breast cancer, but it does not cause problems with treatments in case the cancer should recur.  Breast reconstruction also does not obscure a return of breast cancer, though it is still important to go for regularly scheduled mammograms on the opposite breast.

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Doctors performing Breast Reconstruction

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