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Breast Reconstruction

Restore your body image

Stages of Breast Reconstruction | About Radiation | General Considerations

The purpose of breast reconstruction is to restore your body image and enable you to wear most types of clothes without restriction. Most women can wear the revealing styles of clothing with confidence after their breast reconstruction and it is usually difficult, if not impossible, to tell which side is reconstructed while dressed. The need for an awkward and sometimes embarrassing external prosthesis is eliminated by surgical reconstruction of your breast.

Historically, breast reconstruction was only performed after the loss of a breast due to cancer treatment. However, with the availability of genetic testing, many women who are at very high risk of developing breast cancer are now considering risk-reducing (prophylactic) mastectomy as a course of treatment and prevention. In these cases, both breasts are removed before cancer has a chance to develop.

There are several options in breast reconstruction, all methods ultimately involve:

The following applies to both women undergoing reconstruction following cancer treatment or risk-reducing (prophylactic) mastectomy.

  • No method of breast reconstruction will precisely duplicate a normal breast.
  • It is not possible, for example, to restore normal sensation or eliminate the scar that results from the mastectomy, although it can be frequently integrated into the reconstruction so that it is less obvious.
  • Despite these shortcomings, the vast majority of women are very pleased with the results achieved by breast reconstruction.

Your breast reconstruction may be performed immediately after mastectomy during the same surgery (Immediate Reconstruction) or at a time weeks to years later (Delayed Reconstruction).

  • The optimal timing is variable and depends on a number of factors, including the stage of the cancer, your medical history, your social and psychological situation and the potential need for postoperative radiotherapy.
  • While both Immediate Reconstruction and Delayed Reconstruction may ultimately result in an aesthetic outcome, it is our preference to perform Immediate Reconstruction whenever possible as the results tend to be better.

Stages of Breast Reconstruction

Breast reconstruction, by whatever method, should be viewed as a staged effort (typically two or three stages) directed towards achieving an attractive, symmetrical outcome.

  • Stage 1: The first stage is a “rough draft” reconstruction where the breast mound is recreated.
  • Stage 2: The second stage(s) is aimed at improving breast symmetry and fine-tuning the reconstructed breast in terms of size, shape, and position. During the second stage, minor revisions of the reconstructed breast and nipple reconstruction may be performed. It is during this second stage that some women consider surgery of the opposite breast, such as a breast reduction, lift, or enlargement, to further achieve breast symmetry.
  • Stage 3: After your breast is reconstructed, most women choose to have nipple reconstruction with areolar tattooing to obtain reasonable color match around the nipple and help camouflage scars. This is often an office procedure that is done using a local anesthetic and lasts less than 20 minutes.

About Radiation

Currently, many women receive radiation therapy as part of their treatment. Radiation therapy has significant effects on tissues, the most important of which is fibrosis (scarring) of the skin.

  • Following breast reconstruction with implants, this scarring can prevent adequate tissue expansion and is associated with an increased incidence of capsular contracture (scarring around implants).
  • When using your own tissues for reconstruction (such as TRAM, latissimus, or gluteal flaps), radiation may cause shrinkage and distortion of the reconstructed breast.

Thus, if you will require radiation therapy, the decision to perform immediate reconstruction must be made carefully with the knowledge that this treatment may adversely affect the ultimate cosmetic outcome.

General Considerations

Breast reconstruction is considered to be a highly successful procedure. With that being said, there are no guarantees of success regardless of the method you select. Unfortunately, there is always the possibility of one or more complications, or even total failure. Although the results of breast reconstruction are rarely perfect, they generally are quite effective at recreating the lost breast while helping to restore your dignity and self-esteem. In most cases women are quite satisfied with their results and, in retrospect, would chose to undergo the procedure again.

 

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