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Cosmed Aesthetic Plastic Surgery Center |
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BREAST RECONSTRUCTION Post-mastectomy reconstruction is reconstructive plastic surgery to restore the form and appearance of a breast following total or partial removal. A consultation with a plastic surgeon is the first step a woman should take if considering breast reconstruction. You may choose to have a consultation before your mastectomy to learn about the various reconstruction possibilities available to you. The plastic surgeon and your general surgeon often work closely together on those aspects of your mastectomy that influence reconstruction. During the visit, you should candidly discuss your expectations about looking and feeling better after reconstructive surgery. Post-mastectomy reconstruction can improve your appearance and renew your self-confidence, but keep in mind that the desired result is improvement, not perfection. After examining you, the surgeon will discuss variables that influence the decisions involved in reconstruction. Breast reconstruction may be performed at the time of the mastectomy or after a convalescence of several months. The plastic surgeon also will explain which reconstructive technique is most appropriate for you, after taking into account your age, the amount and thickness of chest skin following the mastectomy, any tissue changes resulting from radiation therapy and your preferences about the placement of the scars. After explaining the surgical technique to be used, the surgeon will discuss other specific details of your case, including the anesthesia, where the operation will be performed and what the surgery realistically can accomplish. At the same time as reconstruction it may be desirable to augment or reduce the size of the opposite breast to make the overall result of the surgery as symmetrical as possible. If restoration of the nipple and surrounding dark pink skin or areola is desired, additional surgery can be performed at a later date. Further factors to consider before electing post-mastectomy reconstruction, such as risk and cost, should be discussed with your surgeon at this time. Thousands of women undergo successful breast reconstruction each year. Nevertheless, you should be aware of the potential risks of surgery and specific complications associated with reconstruction. Post-mastectomy reconstruction has no effect on whether or not there is a recurrence of disease in the breast, nor does it interfere with treatment if it develops. Postoperative complications, such as delayed healing, infection or localized collections of blood, may occur and can be treated. Occasionally a second operation may be indicated to revise scars or soften breasts that become too firm due to excessive scar formation called capsular contracture. Your surgeon will discuss these and other possible complications, as well as their treatments, during your consultation. Risk of complications can be minimized by closely adhering to your surgeon's advice on follow-up care during the healing process. Since post-mastectomy reconstruction is performed to restore a breast that has been lost due to illness, the surgeon's fees and other costs may be partially or fully paid by your insurance carrier. Reconstructive mammaplasty is performed to recreate a breast that has been removed during mastectomy. (Fig. 1) The extent of the breast reconstruction procedure depends on what changes are desired and what you and your surgeon deem appropriate. The operation usually is performed in a hospital under general anesthesia which will make you sleep through the entire procedure. There are various surgical approaches to breast reconstruction. The technique employed will differ according to the type of mastectomy performed and the condition of the breast skin.
Another reconstructive technique uses a flap from the abdomen consisting of part of the rectus abdominus muscle and its overlying skin. Incisions are made in the abdomen to form the flap which is then tunneled to the, breast area. (Fig. 4) When the flap is folded in on itself, it may create a large enough mound to preclude a breast implant. If additional fullness is desired, a prosthesis may also be used. The donor site is closed by sutures, leaving a flatter stomach and a low scar. (Fig. 5) In some patients, the surgeon may employ yet another reconstructive technique. A balloon-like device called a skin or tissue expander is placed beneath the chest muscle and gradually filled with a saline solution over several weeks. The stretched skin may allow implantation of a prosthesis to create a more generous breast mound. Depending on the reconstructive technique and whether surgery is performed on the opposite breast at the same time, the operation can last from two to seven hours. Following surgery, restrictive bandages are placed over the breast. When a later operation to reconstruct the nipple and areola is desired, the surgeon generally uses skin grafts and combinations of local tissue from other parts of the body, most commonly the upper inner thigh and lips of the vagina. (Fig. 6) After surgery, soreness and discomfort will be felt, both in the new breast and in the donor site if a flap has been brought into the area from the back or abdomen. They can be easily controlled by medication. Depending on the extent of your surgery, you will be released from the hospital in two to five days. Sutures generally will be removed within two weeks of surgery. Although the surgeon has made every effor to keep scars as inconspicuous as possible, they are the inevitable result of mastectomy and breast reconstruction. Scars will not fade completely but in most cases, will be very acceptable. The reconstructed breast may feel firmer and look rounder or flatter than your naurel breast. Most likely, it will not have the same contour as your breast before mastectomy, nor will it exactly match your opposite breast. Reconstruction cannot restrore normal sensation, but in time some feeeling will return to the breast area.
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