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The
goal of breast reconstruction is to create the most
natural looking and feeling breast possible with minimal
discomfort. Following mastectomy, women have two options
for breast reconstruction, which may be performed at
the time of the mastectomy or at a later date. The type
of breast reconstruction that is most appropriate for
you will depend on your medical situation, overall health,
size and shape of your breasts, lifestyle, and goals.
Prophylactic mastectomy and reconstructive surgery may
or may not be covered by your health insurance
Saline
implants. In this option, a plastic surgeon
places tissue expanders — hollow, empty balloons
— behind the breast muscles and then gradually
fills them with saline (salt water). Placement of the
tissue expander usually occurs under general anesthesia
in an operating room. The surgery takes about one to
two hours and may require a brief hospital stay or may
be done on an outpatient basis. Sometimes, the procedure
may be done at the same time as the mastectomy. Typically,
women resume normal activity after three to six weeks.
Over the course of two to four months, the expanders
are slowly filled with saline to stretch the skin until
fully inflated. This process is generally painless,
similar to the gradual expansion of the abdomen during
pregnancy. In a second operation the actual saline implants
are put in place, replacing the tissue expander. The
surgery is usually performed under general anesthesia
and may require a brief stay or may be done on an outpatient
basis.
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Getting saline
implants after a prophylactic mastectomy requires
multiple steps:
-
Implanting tissue expanders that are used to stretch
the skin
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Removing the tissue expanders and putting saline
implants in their place
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Reconstructing the nipple
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After
complete healing from prior reconstructive surgery,
a third procedure is performed months later to create
a nipple. For this procedure, either tissue is transplanted
from other areas of the body (for example, the vulva,
earlobe, toe, or upper thigh), or an area can be tattooed
to make a more natural looking skin tone on the a nipple.
Because saline implants can leak over time, they may
need to be replaced every 5 to 15 years.
The
advantage of this method is that it is the simplest
reconstructive method available, and all of the surgeries
are relatively minor.
The
disadvantages of this type of breast reconstruction
include a long, visible scar, and the requirement for
multiple procedures — placing the tissue expanders,
switching the tissue expanders with the implants, and
nipple reconstruction or tattooing. Also, routine visits
every two to three weeks to have the tissue expander(s)
inflated are required. In addition, initially the breast
will be relatively small until after the expander has
been inflated a few times. The reconstructed breast
with the implant will always feel somewhat hard and
often tight, and will never droop naturally. There is
also a high chance that additional surgeries will be
needed over time to replace or remove implant(s) due
to leakage, deflation, or other problems related to
the implant.
The Food and Drug Administration has put together a breast implant consumer handbook, which may be obtained by visiting the FDA Website's Breast Implant Section.
Tissue
transfer.
Some
women may prefer reconstruction using their own tissue
to create a breast. The most common type of tissue transfer
procedure used for breast reconstruction is called a
transrectus abdominis myocutaneous flap (also called
a TRAM flap) and involves transplanting a flap of abdominal
skin, fat, and blood vessels from the abdominal wall
to the chest wall. The tissue flap may be left attached
to the blood supply and moved to the breast area through
a tunnel under the skin, or it may be removed and reattached
to the breast area. Alternatively, skin, fat, and muscle
from the back (latissimus), hip, or buttocks may be
used in addition to or in place of abdominal tissue.
Women who are overweight, smoke cigarettes, have had
previous operations at the flap site, or have circulatory
problems may not be good candidates for a tissue flap
procedure. In addition, women who are very thin may
not have enough tissue to create a breast mound.
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Breast
reconstruction using your own tissue after a prophylactic
mastectomy requires surgery that takes three to
six hours, followed by a hospital stay of approximately
five days, and later, nipple reconstruction
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This
surgery takes about three to six hours and is usually
performed in an operating room under general anesthesia.
Typically, the hospital stay is three to eight days
with an average of five days. Recovery takes approximately
6 to 12 weeks, although some report that it may take
up to a year to resume a completely normal lifestyle.
A nipple-areolar complex is created through one of the
methods described above.
The
advantages of this method include the fact that the
reconstructed breast is soft and lifelike because your
own tissue is used to construct the breast. Also, the
procedure requires one surgery with an additional visit
for women who choose to have a nipple reconstruction.
Some women consider it an additional benefit that skin,
muscle, and fat are removed from the abdomen (similar
to a "tummy tuck").
The
disadvantages of these surgeries include the fact that
flap surgery, especially the TRAM flap, is a major operation.
The surgery is more extensive than breast reconstruction
with implants and the recovery time is longer. With
flap surgery, a long, visible scar will remain after
surgery. In the TRAM procedure, there will be a long
abdominal scar below the navel and there may be temporary
or permanent muscle weakness in the abdominal area.
If latissimus tissue is used, there will be a long scar
on the back, which can usually be hidden in the bra
line. There may also be additional scars on the reconstructed
breast. Both surgeries are more painful than the surgeries
for tissue expansion and implant surgery. However, most
patients do very well and report that they are pleased
with the outcome.
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