BREAST RECONSTRUCTION SURGERY

Overcoming cancer is an enormous triumph, and living without a breast, or only a portion of a breast, following a mastectomy is a situation that affects every woman differently. Some choose to embrace it. Some pad their bra with silicone breast inserts. Others opt to undergo breast reconstruction surgery, which promises many physical and psychological benefits. Assuredly, there are no greater surgical results than feeling like you are back to your complete self.

Through reconstructive plastic surgery techniques, your breasts, nipples and areola can be ‘rebuilt’—and the original symmetry can be restored—using implants or donor tissues from other parts of your body. The procedure can replace the skin and breast tissue, which varies from patient to patient according to the width, size and location of the original tumor and its proximity to the nipple, which may be removed along with the cancer.

Commonly a breast lift, breast reduction or breast augmentation is needed on the other side to attain the best results. If only one breast needs an aesthetic boost, it alone can be reconstructed to match the other one. Immediate reconstruction can be done during mastectomy surgery to lessen the trauma of having a breast removed, as well as the expense and discomfort of having two major operations.

You are a candidate for breast reconstruction if:

• You’ve been diagnosed with breast cancer and had or will have a mastectomy (surgical removal of a breast).

• You’ve been diagnosed with breast cancer and had or will have breast conservation surgery, such as partial mastectomy or lumpectomy (surgical removal of the tumor and surrounding breast tissue).

• You have a genetic mutation and will have a prophylactic mastectomy (removal of non-cancerous breast to prevent cancer).

What To Expect

You’ll have decisions to make: Do you want to use your own tissue? Or do you want to opt for implants? (In some cases, you may opt for a combination of both). Following a mastectomy, the skin of the breast is very delicate and has limited circulation, though this eventually improves with time.  Sometimes the decision is already made for you if your skin is so thin there’s not enough of your own tissue to do an implant reconstruction.

That being said, there are a couple of different breast-friendly donor sites that exist on your body for transfer to your breasts. Your lower abdominal skin and fat can be used to recreate a new breast and the results are said to be akin to a tummy tuck (the donor area in the stomach is often flatter and tighter).

A traditional method for this procedure is the TRAM flap (Transverse Rectus Abdominus Muscle) which sacrifices your abdominal muscles that make up your 'six-pack'. Dr. Kirman however uses advanced techniques of the DIEP or SIEA flaps (Deep Inferior Epigastric Perforator or Superficial Inferior Epigastric Arteries) that will spare your abdominal muscles completely. Your belly skin and fat can be moved to the breast position and, through microsurgical technique, the circulation is restored to the tissue (the arteries and veins are then re-connected to those in the chest area).

The Latissimus Dorsi is the large muscle on your back, which can be brought to your chest to bring healthy skin and tissue to be paired with an implant to create a new breast as well.

A tissue expander—which is a temporary breast implant slowly filled from underneath the skin to get larger over time—can be used to stretch the breast skin to the ideal size and shape for an implant. The expander has a port, which is essentially a metal or plastic valve, that allows for the gradual addition of a salt water solution over time until the skin gradually is stretched enough to accommodate an implant. This process can take several weeks.

A biologic tissue matrix, donated from a once-living being such as a human or pig, can be processed and sterilized to remove all cells and make it safe for your use. It can be used to provide a solid framework and support your breast for your blood vessels to grow and eventually become your own live tissue. These biologic tissue matrices are almost always used along with breast implants in reconstruction. 

Before

Prior to surgery, you will not be able to eat or drink anything after midnight. Depending on your chosen surgical method, you should expect to stay overnight or a few nights at the hospital. You’ll want to prepare your home to make it as comfortable and easy to navigate as possible.

During

There are several different types of breast reconstruction operations to recreate the breast mound. How this is done varies greatly and Dr. Kirman will walk you through it in great detail.

After

No matter what specific type of breast reconstruction surgery you undergo, you’ll have at least one drain placed beneath your incisions, for about a week, that will need emptying. One of the most common patient complaints is that the breasts look and feel swollen or bruised after surgery. This is only temporary.

Things To Consider

• Reconstructed breasts will not have the same sensation nor feel of the original breasts they’re replacing.

• There will be visible scars, both from reconstruction and mastectomy and at the donor site (usually the back, abdomen or buttocks). If 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 of the size and position of both breasts.

• Even though breast reconstruction is optional, it does not fall under ‘cosmetic surgery,’ since it is part of the treatment of a disease, and therefore will be covered by your insurance per The Women’s Health and Cancer Rights Act.

• It’s possible to do a successful breast reconstruction months or even years after your mastectomy, giving you plenty of time to mull over this very important decision. If chemotherapy or radiation has been planned or already started, reconstruction surgery is planned around those treatments will not affect your care.

FAQS

Q. Will it hurt?

A. Breast reconstruction surgery can be complex and can involve other areas of your body, and can be painful. Typically, the most pain is experienced within the first few days after breast reconstruction surgery. Your level of pain will typically decrease each day and may be effectively treated with various pain medications. Your breasts and chest may feel tight. You may also experience difficulty raising your arms.

Q. Does reconstruction increase the risk of my cancer returning?

A. Reconstructive breast surgery is not linked to an increase in the risk of cancer returning, nor does it make detecting returning cancer any more difficult. The risks of recurrence depend on a number of factors, including the stage of disease, characteristics of the cancer and any additional breast cancer treatments.

Q. How long does the breast reconstruction process take?

A. It varies. The reconstruction process can usually take about six months to one year if no further cancer treatment is necessary. Sometimes it takes multiple surgeries to make the reconstructed breast look like the remaining natural breast. Mastectomy surgery can take two to three hours to complete. If you're having an implant or tissue expander inserted at the same time or for a future reconstruction surgery, this will take another hour or two. If you are using your own body tissue for breast reconstruction, this will add three to six hours to your surgery. 

Q. How long is the recovery process?

A. It can take six weeks to fully recover from reconstructive surgery that’s been done at the same time as a mastectomy.

Q. How soon before I can work out again?

A. You’ll gradually be able to increase how much you walk, but it will be close to six weeks before you will be able to resume an aggressive cardio routine and three months before you’ll be able to lift any weights.

Q. When can I resume having sex?

A. Sooner than you think. It depends on a couple of factors: the specific type of surgery you had, how much discomfort or pain you are in, and when you feel ready to reveal your new breasts.