Breast Reconstruction

BREAST RECONSTRUCTION IS A PHYSICALLY AND EMOTIONALLY REWARDING PROCEDURE for a woman who has lost a breast due to cancer or other disease. Reconstruction of a breast that has been partially or completely removed is possible through a combination of plastic surgery techniques that not only creates a new breast but also can dramatically improve a womans self-image, self-confidence and quality of life.

The results of breast reconstruction can be relatively natural in appearance and feel; however a reconstructed breast will never look or feel exactly the same as the breast that was removed.
Breast reconstruction typically involves several procedures performed in multiple stages.

It can begin at the same time as mastectomy or may be delayed until a patient has healed from mastectomy and recovered from any additional cancer treatments that may be necessary. It is important that a woman feel ready for the emotional adjustment involved; much like losing a breast, it takes some time for a woman to accept the results of breast reconstruction.
This brochure presents an overview of breast reconstruction following mastectomy. The best way to learn how breast reconstruction can help fulfill your personal goals is a consultation with a plastic surgeon.

Before the operation make sure that

• Your surgeon is a licensed physician to practice medicine in the country you are having the procedure
• Your surgeon has completed extensive training and examinations in plastic surgery
• Your surgeon is a member of a national plastic surgery society that is recognized by the International Confederation of Plastic, Reconstructive and Aesthetic Surgery (IPRAS)

What is breast reconstruction?

Breast reconstruction is achieved through several reconstructive plastic surgery techniques that attempt to restore a breast to near normal shape, appearance and size following mastectomy and may include:

• Flap techniques that reposition a womans own muscle, fat and skin to create or cover the breast mound
• Tissue expansion that stretches healthy skin to provide coverage for a breast implant
• Surgical placement of a breast implant to create a breast mound
• Grafting and other specialized techniques to create a nipple and areola

While breast reconstruction can effectively rebuild a womans breast, the results are highly variable. A reconstructed breast will not have the same sensation and feel as the breast it replaces. Visible incision lines will always be present on the breast, whether from reconstruction or mastectomy. In addition, flap techniques will leave incision lines at the donor site, commonly located in less exposed areas of the body such as the back, abdomen or buttocks.
Where only one breast is affected, it alone may be reconstructed. In addition, a breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry in the size and position of both breasts.

Through the advocacy efforts of the American Society of Plastic Surgeons9 (ASPS*) and breast cancer support groups, insurance companies are now required by law to provide coverage for breast reconstruction and related procedures to adjust the opposite breast. Pre-certification may be required.

Good candidates for breast reconstruction are women who are:

• Able to cope well with their diagnosis and treatment
• Do not have additional medical conditions or other illnesses that may impair healing
• Non-smokers
• Individuals with a positive outlook and realistic goals for restoring their breast and body image
• Flap procedures may not be appropriate for some women with conditions such as obesity, heart disease and diabetes.

Where do I begin?

A consultation with your plastic surgeon is the first step to learn how breast reconstruction can restore your breasts appearance. A consultation is designed to fully educate you about your options for breast reconstruction in a supportive,non-pressured environment, and will include:

• A discussion of your goals and an evaluation of your individual case
• The options available in breast reconstruction surgery
• The likely outcomes of breast reconstruction and any risks or potential complications
• The course of treatment recommended by your plastic surgeon, including procedures to achieve breast symmetry

Your plastic surgeon will also answer your questions.

Evaluation

Overall health and personal outlook can greatly impact the outcome of breast reconstruction surgery. These will be carefully evaluated in consultation with your plastic surgeon.
The success of your procedure, safety and overall satisfaction requires that you:

• Honestly share your expectations
• Fully disclose health history, current medications, the use of vitamins, herbal supplements, alcohol, tobacco and drugs
• Commit to precisely following all of your plastic surgeons instructions

Safety

By making the decision to consult a plastic surgeon and following all the instructions given, you are taking an important step in helping to assure your safety.
Your plastic surgeon should have completed surgical training and examinations in plastic surgery which uniquely I qualifies them to perform cosmetic and reconstructive procedures of the face and entire body..

My breast reconstruction

Breast reconstruction is a highly individualized procedure. Techniques offer varying advantages and choosing the appropriate course of treatment requires careful consideration of patient anatomy, patient and surgeon preference and desired, realistic outcomes.
Flap techniques may result in a more natural feeling breast and are necessary when little tissue or muscle remains following mastectomy. Incision lines appear at both the donor and reconstruction sites and a lengthy recovery follows. There is also a remote chance of partial or full loss of the flap due to poor healing.
Sometimes a mastectomy initially leaves insufficient tissue on the chest wall to cover and support a breast implant. The use of a breast implant for reconstruction almost always requires either a flap technique or tissue expansion. Reconstruction with tissue expansion allows an easier recovery than flap procedures, but it is a more lengthy reconstruction process. Many office visits over 4-6 months after placement of the expander are necessary to slowly fill the device through an internal valve to expand the skin and create adequate healthy tissue. A second surgical procedure will be needed to replace the expander if it is not designed to serve as a permanent implant.
Breast reconstruction is completed through techniques that reconstruct the nipple and areola (the darker skin surrounding the nipple). Breast reconstruction may be performed at one time or over an extended period, depending on the techniques used, your breast cancer treatment, and the pace at which you wish to achieve your results. Complete reconstruction generally occurs in multiple procedures occurring over several months time.

Preparing for surgery

Your plastic surgeon will carefully explain your breast reconstruction procedure. Prior to surgery, you will be given specific instructions that may include:

• Pre-surgical considerations, diagnostic testing and medications
• Day of surgery instructions and medications
• Specific information related to the use of anesthesia

In addition, you will be asked to sign consent forms to assure your plastic surgeon that you fully understand the course of treatment you will undergo and any risks or potential complications.
Possible risks of breast reconstruction include bleeding, infection or poor healing. Flap surgery includes the risk of extreme tissue loss and a loss of sensation at both the donor and reconstruction site. The use of implants carries the risk of breast firmness (capsular contracture) and implant rupture. All surgery carries risks associated with anesthesia. These risks and others will be fully discussed prior to your consent.
It is important to understand that breast reconstruction can produce remarkable results, however it cannot exactly match a breast lost to mastectomy. Even with revision procedures on the opposite breast, symmetry between the breasts will not be perfect. However, your appearance under most clothing and swimsuits can be quite natural and balanced.
It is important that you address all your questions directly with your plastic surgeon. It is natural to feel some anxiety, whether anticipation for the outcome of breast reconstruction, or preoperative stress. Discuss these feelings with your plastic surgeon.

What to expect

The surgical techniques involved in breast reconstruction are most often performed in a hospital setting, possibly including a short hospital stay. Initial reconstruction procedures are most commonly performed under general anesthesia. Some procedures may be performed on an outpatient basis and local anesthesia with sedation may be used for certain follow-up procedures. These decisions will be based on the requirements of your specific procedure and considerations of patient and surgeon preference. Your plastic surgeon and the assisting staff will fully attend to your comfort and safety.

Following surgery

Following flap techniques and/or the insertion of an implant, gauze or bandages will be applied to your incisions. An elastic bandage or support bra will minimize swelling and support the reconstructed breast. A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid. Before being released from the hospital, you and an accompanying family member, friend or caregiver will be given specific instructions that may include:

• How to care for the surgical site
• Medications to apply or take orally to aid healing and reduce the potential for infection
• Specific concerns to look for at the surgical site or in overall health
• When to follow up with your plastic surgeon.

Progress and healing

Initial healing from breast reconstruction will include swelling and discomfort at the donor site for flap techniques. Medication may be prescribed to control the discomfort. A support bra will be recommended around the clock during initial healing of the reconstructed breast. It is important to cleanse any incision sites and apply ointment as directed.
Follow all instructions carefully; this is essential to the success of your outcome. A return to light activity is possible as soon as you feel ready, usually within a few days of surgery.
In many cases non-removable, absorbable sutures are used for closure in flap techniques or with implant insertion. If removable sutures are used, these will be removed within two weeks following surgery. You may be ready to return to more normal activity at this time, so long as you do not engage in any heavy lifting or vigorous exercise.
Healing will continue for several weeks as swelling dissipates and breast shape and position refine. Continue to follow your plastic surgeons instructions and attend follow-up visits as scheduled to monitor your results.

Results and outlook

The final results of breast reconstruction following mastectomy can help you feel physically and emotionally fulfilled.
Over time, some breast sensation may return, and scar lines will improve, although never disappear completely. There are trade-offs, but most women feel these are small compared to the large improvement in their quality of life and the ability to look and feel whole again. Careful monitoring of breast health through self-exam, mammography and other diagnostic techniques is essential to your long-term health.