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Breast Reconstruction is a plastic surgery technique to reconfigure the shape of one or both breasts after a mastectomy. A mastectomy is a surgical procedure to remove cancer from the breast(s). Many women who choose breast reconstruction after a mastectomy find that it improves their self confidence and quality of life. The reconstruction may be done at the same time (immediate reconstruction or direct-to-implant) as the mastectomy surgery or later (delayed reconstruction).
Ask your doctor how many procedures would be involved. If you are having reconstruction at the time of your mastectomy, your surgeon may do a skin-sparing mastectomy. This means only the area around your nipple and areola is removed and skin is left to make reconstruction easier.
Delayed breast reconstruction means that the rebuilding is started after your mastectomy. If radiation therapy is part of your treatment, your doctor may recommend that you wait until the radiation therapy is completed. Radiation therapy given after breast reconstruction may cause scarring and delay healing.
If you are having breast reconstruction later, your surgeon will remove enough skin over your breast during the mastectomy to be able to close the skin flaps at the procedure later.
Your breast can be reconstructed in a number of different ways, such as with breast implants, by harvesting tissue from another part of your body to transplant at the site of reconstruction, or a combination of both. If you're thinking about having breast reconstruction, let your doctor know ahead of time. That way your surgical team can discuss the best treatment option for you.
Today, there are many types of mastectomies to choose from, including some that lend themselves to better cosmetic outcomes afterwards. For example, in a skin-sparing mastectomy, your surgeon will only remove the area around your nipple and areola and leave excess skin to provide the material needed for effective, immediate reconstruction. How your surgeon reconstructs your breast(s) will depend on what type of mastectomy you received, when you received the mastectomy, and other factors such as your age and body type.
Immediate breast reconstruction, or direct to implant, is performed at the same time as the mastectomy. The advantage to having the surgery done immediately is that the chest tissues are not damaged by radiation therapy or scarring so the cosmetic outcome is often better. Immediate
reconstruction also minimizes surgery, although you still may need additional follow-up procedures to complete the reconstruction.
Fat grafting, also known as autologous fat transfer, uses liposuction to remove fat cells - typically from the abdomen or thighs - and injects them into the breasts in a series of outpatient procedures. While fat grafting can be done immediately after a mastectomy under general anesthesia, it is generally performed on an outpatient basis under IV sedation. Fat grafting typically takes two to three hours to perform, and recovery time is generally minimal, with patients back to normal activities within three weeks.
Many women choose implants for their breast reconstruction; implants are sacs filled with saline or silicone. Initially, there was concern about silicone implants leaking and causing immune system disorders, but many studies refuted this belief. So the FDA approved silicone implants again in 2006. More recently, in 2013, a newer type of implant was also approved in the United States called a form-stable implant (also referred to as a "gummy bear" implant). These implants keep their shape even if they are cut or broken. Breast reconstruction with implants generally involves two surgeries. Your doctor can explain all of your implant options so you can decide what's best for you.
Flap procedures transplant harvested tissue from your lower abdomen, back, buttocks, or thigh to your breast(s). Two of the most common types of tissue flap procedures are the TRAM flap and the latissimus dorsi flap. The Tram flap uses tissue taken from the lower abdomen and the latissimus dorsi flap uses tissue taken from the upper back. Both of these operations create two scars that will fade over time, but never completely disappear. One scar will show where the tissue was harvested and the other will show at the site of the reconstructed breast where the tissue was transplanted.
As an NAPBC comprehensive breast cancer center, the mission of The Breast Center at Littleton Adventist Hospital is to improve care and quality of life for our breast cancer patients. The multidisciplinary program includes breast surgeons, radiation oncologists, medical oncologists, medical physicists, surgical staff, and nurse navigators. If you have questions about breast reconstruction, your doctor and nurse navigator can explain all of your treatment options in detail. Our experts are here to support you every step of the way.
For more information, contact our
breast cancer nurse navigator at 303-738-7787.
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