Removal of a breast because of disease is both a physical and an emotional trauma. Reconstructive surgery can be a tremendous help in restoring self-confidence and morale for women who have undergone a mastectomy.
Breast reconstruction creates a new breast that approximates the original in shape and size. It won’t exactly duplicate the one it replaces, and it won’t feel the same, but for most women it is a great emotional boon on the road to recovery. The new breast may be formed by inserting an implant, by using a tissue flap taken from elsewhere on the body, or by using a combination of these two methods. A nipple and areola (the pigmented area around the nipple) are then created from natural tissue or synthetic material.
Breast Reconstruction after Mastectomy
Breast reconstruction may begin at the time of the mastectomy surgery, or it may be done after mastectomy. Breast reconstruction after mastectomy is a common method for reshaping the natural contours of the body. In either case, you’ll want to discuss the options with Dr. Jensen before your mastectomy in order to determine what is going to be best for you. Depending on the specific procedures being used, as well as your post-mastectomy therapy, reconstruction may be performed in stages. If just one breast is being reconstructed, it’s possible that additional surgery will be recommended for the other breast—a lift, augmentation, or reduction—to create the best possible match.
Breast Implants after Mastectomy
See Breast Augmentation to learn more about breast implants and the process of inserting them. In reconstruction, flap surgery may be used to form a pocket for the implant. A breast implant used for reconstruction after mastectomy without flap surgery typically requires the insertion of a tissue expander. During return sessions over several months, the expander will be used to stretch the skin over the implant.
Breast reconstruction surgery usually is performed in the hospital under general anesthesia. It may involve a hospital stay of one to several nights.
Flap surgery involves taking a section of skin, fat, and often muscle from the abdomen, back, or another body area and using it to form a new breast, or to cover a breast implant. There are several variations of this procedure, which the surgeon will explain in detail during your consultation. The choice will depend on your particular situation, body, and expectations. The following are the most common flap surgery techniques:
TRAM flap surgery. Short for “transverse rectus abdominis muscle,” TRAM flap surgery takes a flap of skin, fat, and muscle from the lower abdomen. The TRAM flap breast reconstruction may be “tunneled” up under the skin to its new location, still attached to its original blood supply, or it may be removed to be shaped and re-attached to blood vessels in the breast area. TRAM flap surgery results in a tummy tuck as well.
DIEP flap surgery. The DIEP flap surgery technique (“deep inferior epigastric artery perforator”) also utilizes abdominal skin and fat, but in this case no muscle is removed. As a result, muscle weakness is less of a factor. The flap is detached and reformed as a breast mound and, as with TRAM flap surgery, a tummy tuck is a secondary benefit.
Latissimus dorsi flap surgery. Skin, fat, and muscle from the upper back are tunneled under the skin to the chest area, remaining attached to their original blood vessels. This flap creates a pocket to support a breast implant.
Flap Surgery Results and Recovery
Recovery time from breast reconstruction surgery depends on what type of surgery has been performed. For implant surgery, you can expect soreness for a couple of weeks or so, while recovery from flap surgery takes somewhat longer. Pain medication will be prescribed to see you through the initial discomfort. You’ll need to avoid strenuous exercise and heavy lifting for several weeks; a support bra will help reduce swelling and hold the breast in position while you are healing. The breast’s final shape will be evident as the swelling goes down over a period of weeks.
Scars from reconstructive surgery will be permanent, though eventually their redness will fade. With flap surgery, you’ll have a scar where the incision was made to remove tissue and also another scar on the newly formed breast. Scars from implant surgery are quite small.
You won’t regain the same feeling you had in your original breast, though some sensation may come back over time. While breast reconstruction is a life-affirming choice for most women, there is likely to be a period of emotional adjustment to your new body.
With implants, the main risk is for capsular contracture, the formation of hardened tissue around the implant—the body’s way of defending itself against foreign matter. If this occurs, it can affect the shape of the implant, and breast capsulectomy surgery may be needed to remove the hardened tissue capsules. Though it rarely occurs today, rupture is also a risk with a silicone implant, so regular screenings are needed to monitor the implant.