Breast reconstruction is a physically and emotionally rewarding procedure for a woman who has lost one or both breasts due to cancer or another condition. 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.
Best candidates for the procedure:
Breast reconstruction is a highly individualized procedure. You should do it for yourself, not to fulfill someone else’s desires or to try to fit any sort of ideal image. Each surgical plan is different, and designed to fit you and your reconstructive goals.
Breast reconstruction is a good option for you if:
- You are able to cope well with your diagnosis and treatment.
- You do not have additional medical conditions or other illnesses that may impair healing.
- You have a positive outlook and realistic goals for restoring your breast and body image
It’s important that you feel ready for the emotional adjustment involved in breast reconstruction. It may take some time to accept the results of breast reconstruction.
The success and safety of your breast reconstruction procedure depends very much on your complete candidness during your consultation. You’ll be asked a number of questions about your health, desires and lifestyle.
Techniques or options:
Breast reconstruction typically involves several procedures performed in multiple stages. It can:
- Begin at the same time as mastectomy, or
- Be delayed until you heal from mastectomy and recover from any additional cancer treatments
In general, breasts are reconstructed either using implants, or one’s own body tissues (autologous methods), or sometimes a combination of both techniques. The options are numerous, and each has its own set of benefits and drawbacks.
- Breast implants can be an addition or alternative to flap techniques. Saline and silicone implants are available for reconstruction. Reconstruction with an implant alone usually, but not always, requires tissue expansion.
- Tissue expansion stretches healthy skin to provide coverage for a breast implant. Reconstruction with tissue expansion allows an easier recovery than flap procedures, but it is a more lengthy reconstruction process. It requires many office visits over 2-3 months after placement of the expander to slowly fill the device through an internal valve to expand the skin. A second surgical procedure will be needed to replace the expander because it is not designed to serve as a permanent implant.
- A TRAM flap uses donor muscle, fat and skin from a woman’s abdomen to reconstruct the breast. The flap may either remain attached to the original blood supply and be tunneled up through the upper abdominal area, or separated from the original blood supply and reattached using microsurgery.
- DIEP or SGAP flaps are advanced techniques do not use muscle, and transport tissue to the chest from the abdomen or buttock, thus potentially minimizing donor site weakness.
- A latissimus dorsi flap uses muscle, fat and skin from the back tunneled to the mastectomy site and remains attached to its donor site, leaving blood supply intact.Occasionally, the flap can reconstruct a complete breast mound, but often provides the muscle and tissue necessary to cover and support a breast implant.
- Grafting, tattooing, local flaps and other specialized techniques create a nipple and areola. Breast reconstruction is completed through a variety of techniques that reconstruct the nipple and areola. These are minor procedures that are completed at the end of the reconstructive process.
Surgery for your breast reconstruction is most often performed in a hospital setting, possibly including a short hospital stay, and will likely be under general anesthesia. Some follow-up procedures may be performed on an outpatient basis, and local anesthesia with sedation may be used. These decisions will be based on the requirements of your specific procedure and in consideration of your preferences and your doctor’s best judgment.
Following your surgery for flap techniques and/or the insertion of an implant, gauze or bandages will be applied to your incisions. An elastic bandage or support bra will minimize swelling and support the reconstructed breast. A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid. A pain pump, or long acting local anesthetics, may also be used to reduce the need for narcotics. To get an idea of the results you can achieve with breast reconstruction, view Dr. Samson’s breast reconstruction before and after photos.
Recovery from surgery is highly variable, and depends both on your health status, and the nature of the procedure performed. Generally, for most procedures you can expect a two to four-week recovery period before normal physical activities can be resumed. Most reconstructive surgery of the breast requires two or three stages for completion. Healing will continue for several weeks as swelling decreases and breast shape and position improve. It can take between nine months and year after the final surgery for the scars to mature fully, and the final reconstructive results to be obtained.
The decision to have breast reconstruction surgery is extremely personal. You’ll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable. Your plastic surgeon will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedures you will undergo and any risks or potential complications.
The possible risks of breast reconstruction include, but are not limited to, bleeding, infection, poor healing of incisions, and anesthesia risks. You should also know that:
- Flap surgery includes the risk of partial or complete loss of the flap and a loss of sensation at both the donor and reconstruction site.
- The use of implants carries the risk of breast firmness (capsular contracture) and implant rupture.
Breast implants do not impair breast health. Careful review of scientific research conducted by independent groups such as the Institute of Medicine has found no proven link between breast implants and autoimmune or other systemic diseases.
Breast reconstruction surgery after breast cancer is considered a reconstructive procedure and should be covered by health insurance. The Women’s Health and Cancer Rights Act (WHCRA) of 1998 is a federal law which requires most group insurance plans that cover mastectomies to also cover breast reconstruction. Under the WHCRA, mastectomy benefits must cover:
- Reconstruction of the breast that was removed by mastectomy
- Surgery and reconstruction of the other breast to make the breasts look symmetrical or balanced after mastectomy
- Any external breast prostheses breast forms that fit into your bra) that are needed before or during the reconstruction
- Any physical complications at all stages of mastectomy, including lymphedema fluid build-up in the arm and chest on the side of the surgery
However, your coverage may only provide a small part of the total fee, depending on your plan details.
When choosing a plastic surgeon for breast reconstruction, remember that the surgeon’s experience and your comfort with him are just as important as the final cost of the surgery.
Commonly combined procedures:
It is common to combine mastectomy with the first stage of reconstruction in appropriate cases, determined in consultation before surgery. Implant surgery is sometimes combined with flap surgery when additional breast volume is desired. Also, fat grafting is becoming more frequently used as an adjunctive treatment to enhance the final shape and form of the breast. Fat grafting can be combined with most of the reconstructive procedures when desired. Whenever possible we try to combine procedures to reduce the number of stages required to complete the reconstruction.
if you are interested in these or other breast or cosmetic surgeries in the Daytona Beach, FL area, schedule a consultation by calling 386-756-9400 or fill out our contact form.