Treatment of breast cancer through mastectomy is the most common reason women undergo breast reconstruction. Other reasons include women who underwent “lumpectomy and radiation therapy” for breast cancer and those with congenital breast deformities that result in an underdeveloped breast.
Since the 1990′s, more women are being treated with radiation therapy and partial removal of the breast, commonly referred to as “lumpectomy.” While this treatment can preserve much of the breast, it can create distortion of the breast and sometimes even pain. To restore missing breast volume, correct breast shape or relieve pain caused by scar tissue, tissue from the back or the abdomen can be placed in the breast to rectify these problems.
Many factors need to be weighed when considering options for breast reconstruction-the treatment plan for the cancer, your general medical condition and your personal expectations and goals. Planning and coordinating breast reconstruction with the other treating physicians-the general surgeon, the medical oncologist, the radiation oncologist and your primary care physician-allows everyone to be on “the same page” with your care and treatment plan.
The goal of breast reconstruction is not only to restore and reconstruct the involved breast, but to create breast symmetry. Although there are different options, the process generally involves more than one procedure, with each procedure being involved to the degree necessary. In certain patients, some of these procedures may not be necessary at all.
Breast cancer is one of the most common cancers in women. One out of nine women will develop breast cancer during their lifetime. Emotionally, the diagnosis of breast cancer is very distressing. Besides being confronted by a potentially life-threatening disease, the removal or deformity of a sexual organ is devastating to a woman’s self-esteem and body image. In restoring a normal appearance, breast reconstruction can help a woman feel more comfortable and feminine, enabling her to live a normal life and restoring a sense of wholeness.
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The first stage is to create a mound in the shape of a breast. The mound can be produced by using tissue from other areas of your body, commonly referred to as a “flap,” or with a breast implant.
Once the new mound is created, the second stage is designed to create breast symmetry. This may involve sculpting and shaping the tissue mound created in the first procedure and/or performing a breast lift or breast reduction on the other breast if necessary. This second stage is usually performed six weeks later at the earliest.
After the shape and symmetry of the breasts have been addressed, the nipple and areola reconstruction is started.
The nipple is usually made by folding and rearranging the skin on the most projecting part of the mound to create a nipple. Nipple reconstruction can be performed as an outpatient, and depending on the technique used, is sometimes combined with the areola reconstruction.
Areola reconstruction is the final step in the breast reconstructive process. Tattooing is one method used for this part of the reconstruction.
In certain situations, plastic surgeons in Missouri can team up with the general surgeon and perform the first stage of breast reconstruction at the same time as the mastectomy. The benefits of immediate reconstruction are numerous. Fewer operations are needed. Waking up with a breast mound helps alleviate the sorrow caused by losing a breast, and the extra skin created by the mastectomy can be used to better conceal scars and achieve a more natural reconstruction.
Immediate breast reconstruction may not be the best choice for everyone. The cancer treatment plan may dictate that breast reconstruction be delayed until the other treatments are completed, such as chemotherapy or radiation therapy. Some patients simply feel overwhelmed with coping with the cancer treatment aspects and prefer to address breast reconstruction at a later date.
Breast reconstruction does not have to be performed at the time of mastectomy, but can be performed successfully even months or years later. Delayed reconstruction is preferred in certain situations where other cancer treatments may be necessary after mastectomy, such as radiation therapy. Delaying reconstruction may also permit the patient to examine reconstruction options more thoroughly.
Breast implants are frequently used for immediate or delayed breast reconstruction. Dr. Jones will talk with you in more detail if you are a candidate for breast augmentation in St. Louis. The FDA allows either saline-filled or silicone gel-filled implants to be used in breast reconstruction.
Most of the time, a tissue expander is used prior to placement of a breast implant. As a result of mastectomy, the breast skin is removed. To allow room for a breast implant, a deflated balloon-like sac, called a tissue expander, is placed under the chest skin. In the office, the patient undergoes progressive filling of the sac with saltwater through a valve which is part of the tissue expander and located under the skin. Once the skin is sufficiently expanded to accommodate the breast implant, the tissue expander is removed in a second operation, usually six months later, and replaced with a breast implant.
Breast reconstruction with tissue involves moving muscle, fat and skin from either the abdomen, back or buttock to make a breast mound. Using tissue to reconstruct the breast requires a longer hospital stay and a longer recovery period. Compared to breast implants, tissue reconstruction usually looks, feels and ages more like a normal breast. When radiation therapy has been used in the breast cancer treatment, tissue reconstruction is preferred to breast implants. Examples of tissue reconstruction include: TRAM Flap (Abdomen)-The most commonly used tissue for breast reconstruction is tissue from the lower abdomen. The tissue removed from the abdomen is the same tissue removed for a “tummy tuck.” Fat and skin attached to one of the abdomen muscles, the rectus abdominus muscle, is used to make the reconstructed breast.
Latissimus Flap (Back)-The latissimus dorsi muscle, one of the largest muscles on the back, and the overlying fat and skin are used to make the breast mound. A breast implant is often necessary in combination with the tissue to make a mound of sufficient size.
Gluteal Flap (Buttock)-Part of the gluteal muscle and the overlying fat and skin is used to reconstruct the breast mound. This technique involves microsurgery and takes eight to 10 hours.
Pedicle TRAM flap for breast reconstruction.
Latissimus Dorsi Flap for breast reconstruction.
Gluteal Free Flap for breast reconstruction.
Tensor Fascia Lata Free Flap for breast reconstruction.
Free TRAM flap for breast reconstruction.
Ideally, breast reconstruction should be discussed as part of your breast cancer treatment plan. We want to make sure you understand all of the options and all of your questions and concerns are addressed. The consultation will begin with a complete medical history and exam. You will be asked about the planned or previous treatment of your breast cancer, including radiation therapy or chemotherapy. You should tell Dr. Jones if you have any history of abdominal surgery; any previous history of breast surgery; any history of lupus, rheumatoid arthritis or connective tissue diseases and the results of your mammograms. If you are planning to become pregnant in the future, you should mention this to us.
The examination will evaluate the size and shape of your breasts and the other sites that can serve as a donor site for tissue, especially your abdomen and back. Options available to you will be discussed, including implants. You can see photos of recent patients before and after surgery, and patient references are available upon request. Photographs will be taken for your medical record.
The goal of Dr. Jones and the Genesis staff is to make your surgical experience as easy and comfortable for you as possible. You will be asked to stop smoking and avoid certain vitamins and drugs that can cause increased bleeding, such as aspirin, ibuprofen and vitamin E. Additional preoperative instructions and prescription to be used postoperatively will be provided. For convenience, we recommend that you have your prescriptions filled several days prior to the procedure. Breast reconstruction surgery involves more than one procedure. The first two procedures are performed under general anesthesia. Reconstruction of the nipple and areola are performed using IV sedation and local anesthesia.
Your procedure will be performed in an outpatient surgery center or hospital. Dr. Jones will see you before the procedure and place ink marks on the skin. Antibiotics will be administered at the time of surgery. The procedure varies considerably, depending on the technique used. Breast implants take two to three hours Tissue reconstruction can take from three to nine hours. Drains are placed at the time of surgery and are removed a few days later.
Following surgery, you will be taken to the recovery area where you will continue to be closely monitored. Pain medications are administered to keep you comfortable. You will be kept in the hospital at least overnight, longer if tissue reconstruction is performed.
The postoperative course varies, depending on the technique used. In general, recovery time is four to six weeks. Recovery from tissue reconstruction is longer than when using breast implants. You can expect to be sore for several days. After one week you should be able to participate in light activity, such as brief walks. Heavy lifting and sexual activity are limited for a number of weeks, depending on which procedure is used. The scars may be red for several months, but should gradually improve.
Reconstructing a missing breast can restore a sense of wholeness. As a result you may find your body proportions are more balanced, and you have a greater self-confidence in your appearance. Your clothes may fit better, and you can wear a swimsuit with confidence. If you become dissatisfied with the appearance of your breasts, you may want to consider revision of the implants and/or a breast lift. We recommend an annual follow-up to make sure you remain satisfied with your result. Mammograms of the reconstructed breast are not necessary, but you should have annual mammograms for the other normal breast.
Every year, thousands of women undergo successful breast reconstruction and are very pleased with the outcome. However, as with any surgical procedure, there are potential risks from anesthesia, bleeding or infection. The following are issues to consider when undergoing breast reconstruction.
However, all reconstructions involve: