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Breast reconstruction plastic surgery
To get answers to the most frequent questions about breast reconstruction
plastic surgery, please select one of the links below:
I've recently learned that I have breast
cancer and that I will require some type of surgery. What options
are available to me for breast reconstruction?
As the surgical techniques for the treatment of breast cancer
have evolved, so have the techniques of breast reconstruction.
Reconstructive options depend upon the surgical procedure that
will be (or has been) performed.
In most cases the deformity created by lumpectomy followed by
radiation therapy will be minor because the nipple and areola
and the bulk of the breast tissue is undisturbed. Although most
women are satisfied with the aesthetic result following lumpectomy,
plastic surgical procedures are available to improve the appearance
of the breast and to recreate symmetry.
With mastectomy, either radical or modified radical, the entire
breast is removed along with the nipple and areola. The complete
removal of the breast results in a scar across that half of the
chest which creates the need to wear forms or prostheses. Such
a requirement is often a cumbersome and unnatural burden for many
women because it requires them to wear special bras, makes participation
in any form of athletic activity very difficult and can cause
skin irritation.
The numerous procedures that have evolved over the past three
decades were developed primarily to help this group of women who
have undergone a mastectomy. Today, in addition to earlier cancer
detection and more conservative, gentler surgical techniques for
treatment, innovations in reconstructive surgery have also evolved,
and it is now possible to achieve a more natural looking reconstructed
breast with better symmetry and skin quality.
What are the goals of breast reconstruction?
The goals are quite simply to recreate what has been lost. The
most important goal is to recreate a breast mound (known in reconstructive
terms as "volume") that looks as similar as possible
to the opposite breast. Remember that the breast is made of milk
glands and their ducts as well as fat and connective tissue. The
ducts empty into the nipple and the areola is simply the pigmented
skin surrounding the nipple.
The goals of breast reconstruction are to recreate a natural,
pleasing breast shape or "mound" with a credible nipple
and areola. The reconstructed breast along with its nipple and
areola should have good symmetry or balance with the other side
and should match the opposite breast in shape as well as in skin
texture and color. The inframammary fold (the crease below the
breast) should be distinct and match the opposite side in length,
shape and height.
While the losses of the breast mound and the nipple and areola
are easy to understand, many women aren't aware that in most mastectomies
a significant amount of skin, which had allowed the breast to
maintain its natural form, is also lost. Most mastectomy incisions
are shaped like an ellipse (or leaf) surrounding the nipple/areolar
complex, and because the surgeon brings the two edges of the ellipse
together to form a linear scar, the skin loss is not obvious.
If one considers the tightness of the tissue adjacent to the mastectomy
scar, it's easier to understand how much skin has actually been
lost. In order to reconstruct the breast the lost skin must be
recreated. This is the key to understanding breast reconstruction,
as an important goal of almost every technique available is to
make up for this skin loss in some way.
Appearance of a
mastectomy scar
Why should I consider breast reconstruction?
Breast reconstruction yields many benefits:
-
It allows a woman to feel more comfortable and attractive
in her external appearance, especially in intimate situations
and when changing clothes in public areas.
-
The need for a cumbersome external form or prosthesis is
eliminated.
-
The reconstructed breast looks and feels more natural than
a prosthesis and is rapidly incorporated into a woman's "body
image" or psyche. This yields many psychological benefits
to the patient as she is no longer reminded on a daily basis
that she is a cancer survivor and she may feel "whole"
once again.
-
A greater ease in the fit of clothing as well as the ability
to participate in sports and other social activities without
worrying about appearance or a shifting prosthesis makes the
difficult road to recovery somewhat easier.
In addition, women who undergo reconstruction may better adjust
psychologically to their mastectomy and may seek treatment for
breast cancer sooner knowing that restoration is possible. Unfortunately,
while there are no techniques that can erase the mastectomy scar,
its appearance can often be revised and improved. Even though
the exact recreation of the opposite breast is difficult if not
impossible, the majority of women are very satisfied with their
breast reconstruction and highly recommend it to others.
How will the reconstructed breast feel?
Because it is impossible to bring back the nerve supply to the
breast; the new reconstructed breast will never feel like a natural
breast. Initially, it will be completely numb, but over time,
the reconstructed breast will regain some sensation.
How intrusive will breast reconstruction be?
Breast reconstruction following mastectomy does not preclude
the subsequent use of chemotherapy and/or radiation therapy.
A recent study found that only 24% of women found reconstruction
to be the most difficult aspect of treatment. In the same study
92% found chemotherapy to be the most difficult with 32% for mastectomy
and 31% for radiation therapy. (Reference: Pusic, A., et. al.,
Surgical Options for Early-Stage Breast Cancer: Factors Associated
with Patient Choice and Postoperative Quality of Life. Plast.
Reconstr. Surg. 104: 1325, 1999.)
What techniques are available for reconstruction?
The reconstructive technique chosen is dependent upon the surgical
technique used to treat the breast cancer. We find it convenient
to categorize the current reconstructive methods into two groups.
Autologous techniques use only the body's own
tissues and non-autologous techniques utilize
an implant of some type. This difference applies only to the mound
reconstruction as the techniques for nipple and areolar reconstruction
are virtually identical for these two groups.
What are the non-autologous techniques?
The non-autologous techniques were the first
to evolve and they account for about 80% or more of breast reconstructions
today. These techniques rely on an implant to recreate either
a portion of the breast mound or the entire mound that has been
lost.
In most cases there is not enough skin remaining after the mastectomy
to permit placement of the implant as a single stage procedure
(although this is not always true for the newer techniques utilizing
"skin-sparing" mastectomies -- see below). To accommodate
for the loss of skin, a "tissue expander" is usually
placed first. Then during a second operation, the tissue expander
is removed, and the final implant is placed.
This type of reconstruction is known as the "implant and
expander" method and has been the most commonly performed
type of reconstruction for many years.
Why can't the final implant be placed right
away in a single operation?
Remember when a mastectomy is performed, several things are eradicated.
The entire breast mound along with the nipple and areola are removed,
and in addition, skin is also removed.
In most modified radical mastectomies an ellipse (or leaf like
shape) of skin is removed with the nipple/areolar complex at its
center.
In a radical mastectomy, in addition to muscle tissue a larger
amount of skin is removed and a skin graft is often required to
close the wound. This shortage of skin prevents plastic surgeons
from placing the final implant as a single, one-stage procedure.
If this were attempted there is a significant risk that the incision
would not heal properly because of the tension that would result.
It is sometimes possible to place a small implant as a single
stage procedure; however for most patients, this would not ordinarily
provide adequate symmetry. "Skin-sparing" mastectomies
are designed to address this problem and to permit single stage
reconstruction.
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454-0044.
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