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Reconstruction of a breast that has
been removed due to cancer or other
disease is one of the most rewarding surgical procedures available today.
By utilizing a variety of medical techniques and devices, it is possible for
surgeons to create a breast that can come close in form and appearance to
matching a natural breast.
Breast reconstruction is often performed immediately following breast removal
(mastectomy). This approach is called immediate breast reconstruction and
allows the patient to wake up with a breast mound already in place, having been
spared the experience of seeing herself with no breast at all.
Immediate breast reconstruction is usually reserved for women who are unlikely
to require further treatment after their mastectomy, such as chemotherapy or
radiation therapy. For patients who are either not candidates for immediate
breast reconstruction or choose not to undergo reconstruction at the time of
their mastectomy, breast reconstruction can be performed at any time in the
future (delayed breast reconstruction). The issue of timing of breast
reconstruction, will be discussed with you at the time of your initial consultation.
Most breast reconstruction involves a series of procedures that occur over time.
The initial operation is usually the most complex, and involves the
reconstruction of a new breast mound. Typically, a second operation is
performed 3-6 months later, at which time final shaping of the breast mound is
achieved and reconstruction of the nipple and the areola is performed. At the
same time, patients often undergo surgery to enlarge, reduce or lift the natural
breast to match the reconstructed breast.
Options for Breast Reconstruction
Skin Expansion
At the time of mastectomy, a balloon expander is inserted beneath the skin and
chest muscle. This balloon expander, is very much like a deflated breast
implant. Following the surgery, the patient makes periodic visits to the office
where a salt water solution is injected through a tiny valve mechanism in the
balloon expander to gradually fill the expander over several weeks or months.
After the skin over the breast area has stretched enough, the balloon expander
is removed and a more permanent implant is inserted.
Flap Reconstruction
As an alternative to using an implant, the breast can be reconstructed using the
patient's own skin and fat taken from other parts of the body, such as the back
or abdomen. The tissue usually remains attached to its original site, retaining
its blood supply. The flap, consisting of the skin, fat and muscle with its blood
supply are tunneled beneath the skin to the chest, creating the breast mound
itself. In general, flap reconstruction is more complex than balloon expansion,
but has the advantage of reconstructing the breast entirely with the patient's
own tissue. In some cases, there may also be the added benefit of an improved
abdominal contour.
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