In those tragic cases where a full mastectomy is required to treat breast cancer, reconstruction is a welcome option. With modern techniques and materials it is possible to restore appearance to a near invisible state. Carried out by specialized plastic surgeons, restoration is now commonplace.
There are many different approaches and each case is unique and different. Consultation with a physician is necessary in order to choose the technique that is right for you.
Breast implants are one option that is typically chosen. Today implants are typically saline filled bags encased in silicone. They are placed in front of the chest wall muscles under the skin that covers the breast area.
In the past silicon filled implants were more typical. There was a huge concern that the silicon could possibly leak out into the body thus causing problems for the immune system. The FDA recently announced after years of study that there isn’t much basis for worry and silicon breast implants are now legal again. Some individuals prefer silicon implants because they behave differently.
In many instances reconstruction can be performed during the mastectomy. In other instance physicians recommend a waiting period to allow the body to completely recover and heal prior to undergoing any additional surgery. Each case is individual and can only be decided by the physician and the patient in question.
Typically, though, two-stage delayed reconstruction is performed if the skin and chest wall tissues are flat. An implant, called a tissue expander that functions like a balloon under the tissue, is placed beneath the muscle. The surgeon then injects saline in stages over a period of time to gradually fill the sac. In some instances, the expander itself becomes the implant. In other cases, in a later procedure, the expander is removed and replaced with a permanent implant.
Another method of breast reconstruction is a tissue flap procedure. These procedures use skin from the stomach, the thighs, or other areas as part of the entire process.
TRAM (transverse rectus abdominis muscle flap) is one of the most common types of tissue flap procedures. This procedure uses tissue from the lower abdominal wall. A pedicle flap leaves the tissue attached to the original blood supply and stretches the tissue all the way up into the breast area.
Another, almost equally common procedure takes tissue from the upper back. A flap is moved in front of the chest wall in effort to create a pocket. A breast implant is then inserted into the pocket. Additionally, other procedures are available such as gluteal muscle tissue.
In each instance nipple and/or areola reconstruction may or may not be in order. In some instances it will be done simultaneously with breast reconstruction, in others it might be done later, sometimes it is not even done at all. The original nipple is rarely used as a replacement as it has yet to be determined whether or not it can regenerate cancer.
Reconstructive surgery is not entirely without risks, of course.
You can have the typical surgical complications including infection, and scarring. Breast implants also are not guaranteed to last a lifetime and depending upon your age may need to be replaced via another surgery at a later time. The final result might not be what the patient was expecting. Only a complete in depth consultation with a physician can provide a realistic assessment of what to expect.
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