Removal of a breast because of disease can be 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 can then be created from natural tissue around and tatoos can then be placed to restore the look of natural breasts.
Tissue expander breast reconstruction
Breast reconstruction typically begins at the time of the mastectomy surgery (immediate reconstruction), but it may also be done after mastectomy (delayed reconstruction). With immediate reconstruction the breast tissue is removed but skin is retained. Tissue expanders are then implanted in the location of the breast tissue that was removed. The tissue expander may be placed either above or below the pectoralis muscle. A biological resorbable mesh is placed like an internal bra to support the tissue expander. Over several years the mesh becomes part of the body and is replaced with strong collagen by the body to provide permanent support. The tissue expander is a saline implant which is more rigid than a typical implant in order to provide structural support for the new breast shape. It has an integrated fill port that can be accessed in the office to add saline. At the time of surgery, the implant is filled up just enough to fill out the skin envelope. At follow-up appointments fluid can be added to stretch the skin to the desired size. This process can take several weeks to several months depending on patient factors. A drain is placed at the time of surgery to remove any fluid that may build up in the operative field. The drains will be removed in the office when the output is low enough. It is important to take good care of the drains to avoid infection. Drain instructions will be given at the hospital.
Tissue expanders remain in place until they are ready to be exchanged for permanent implants. Since every patient is different and their treatment plans differ, the timing of this will be discussed with Dr Jensen. In general, tissue expanders will remain in place until all adjuvant cancer treatments are finished including radiation and chemotherapy. The tissue expander removal will typically be scheduled as an outpatient procedure. In incision is created on the breast either in the mastectomy scar or elsewhere to remove the tissue expander. The breast is further shaped and a permanent breast implant is placed. This is typically a smooth round silicone gel implant. Implant sizers are used to determine the correct size of implant. Although perfect symmetry is rarely achievable, considerable time and attention is given to match the breasts and find just the right implant size for each patient. Following placement of the implant, fat is transferred to improve the shape and cosmesis. Unwanted fat is harvested from elsewhere on the body via liposuction. It is then transferred into the breast with a needle technique to shape the breast.
Nipple reconstruction is typically the final step in the reconstructive process. It is performed to restore a physical projection at the location of the nipple. It adds dimension to the breast reconstruction and improve a natural look and feel. The procedure involves elevating skin flaps and sewing them down in such a way to create a small mound of tissue. Following the nipple reconstruction, tattoos can be added to give the color of the nipple and areola. This is typically done a year after the nipple is created to allow the scars to fully mature. Many women choose to forgo the surgical nipple reconstruction portion and proceed directly to tattoo placement. Tattoo artists can place a 3-Dimentional tattoo to give the appearance of a nipple without the physical bump in the skin. This is more favorable to many women. This final step can be discussed with Dr Jensen and his staff. The tattoos are not placed at Dr Jensen’s office, rather a tattoo artist well trained in the art of creating realistic appearing body art should be consulted. Dr Jensen has a list of qualified tattoo artists that can assist you in this final step.
Flap surgery involves taking a section of skin, fat, and sometimes 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.
- Latissimus dorsalis 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
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 with implant or tissue expander surgery can vary in location and size depending on many factors including location and size of tumor, breast size and other patient factors.
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.
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.
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. Breast implant rupture is also a risk with silicone implants, so regular screenings are needed to monitor the implant.