Breast reconstruction is a surgical procedure usually designed to reconstruct the breast of patients who have had a mastectomy due to breast cancer.
The best candidates for breast reconstruction
Depending upon the patient, there may be several different options for breast reconstruction involving breast implants as well as using the patient’s own tissues. Not every patient will be a candidate for every reconstructive technique.
The best candidates, however, are women whose cancer, as far as can be determined, seem to have been eliminated by mastectomy. Still, there are legitimate reasons to wait. Many women aren’t comfortable weighing all the options while they’re struggling to cope with a diagnosis of cancer. Others simply don’t want to have any more surgery than is absolutely necessary. Some patients may be advised by their surgeons to wait, particularly if the breast is being rebuilt in a more complicated procedure using flaps of skin and underlying tissue. Women with other health conditions, such as obesity, high blood pressure, or smoke, may also be advised to wait.
In any case, being informed of your reconstruction options before surgery can help you prepare for a mastectomy with a more positive outlook for the future. You can begin talking about reconstruction as soon as you’re diagnosed with cancer, ideally, you’ll want your breast surgeon and your plastic surgeon to work together to develop a strategy that will put you in the best possible condition for reconstruction.
Your evaluation and options
After evaluating your health, your surgeon will explain which reconstructive options are most appropriate for you age, health, anatomy, tissues, and goals. Be sure to discuss your expectations frankly with your surgeon. He or she should be equally frank with you, describing your options and the risks and limitations of each. Post-mastectomy reconstruction can improve your appearance and renew your self-confidence – but keep in mind that the desired result is improvement, not perfection. Your surgeon should also explain the anesthesia he or she will use, the facility where surgery will be performed, and the costs. In most cases, health insurance polices will cover most or all of the cost of post-mastectomy reconstruction. Cheek your policy to make sure you’re covered and to see if there are any limitations on what types of reconstruction are covered.
Preparing for surgery
Your oncologist and your plastic surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking and taking or avoiding certain vitamins and medications. While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.
While there are many options available in post-mastectomy reconstruction, you and your surgeon should discuss the one that’s best for you. Skin expansion. The most common technique combines skin expansion and the subsequent insertion of an implant. Following mastectomy, your surgeon will insert a balloon expander beneath your skin and chest muscle. Through a tiny valve mechanism buried beneath the skin, he or she will periodically inject a salt-water solution to gradually fill the expander over several weeks or moths. After the skin over the breast area has stretched enough, the expander may be removed in a second operation and a more permanent implant will be as the final implant.
The nipple and the dark skin surrounding it, called the areola, are reconstructed in a subsequent procedure. (For more information on tissue expansion, ask your surgeon for the ASPRS brochure on this procedure.) Some patients do not require preliminary tissue expansion before receiving an implant. For these women, the surgeon will proceed with inserting an implant as the first step.
Don’t be shy ask any questions you need to know. It’s important you know all about your breast reconstruction before you have a surgery.