Breast Reconstruction
Facing the loss of one or both breasts can be very traumatic. Every women diagnosed with breast cancer should be given information about reconstructive options as part of her breast cancer treatment. Almost any woman who loses her breast can have it rebuilt through reconstructive surgery. And discussion about reconstruction can start immediately after diagnosis. The decision to undergo breast reconstruction is an intensely personal one. The decision should be made by the patient, not by treating physicians. It really is a quality of life issue. And it doesn't matter how old the patient is or if they're married or single. There are several surgical approaches to reconstructing a totally or partially missing breast. The choice of technique depends on age, health, the state of the remaining tissue, surgical scars, skin thickness, radiotherapy treatments, the shape and volume of the breast to be reconstructed and the remaining breast, etc. Reconstruction may be simple, involving nothing more than the insertion of an implant, or more complex. In some cases, for instance, it may be necessary to replace local tissue with tissue from elsewhere in the body (a flap of skin or of skin and muscle). Step-by-step reconstruction is another option, for instance to adjust the size of the other breast, rebuild the nipple and so on. Flap reconstruction is a more complex procedure than skin expansion. Scars will be left at both the tissue donor site and at the reconstructed site, and recovery time is longer than with an implant. However, when the breast is reconstructed with one's own tissue, the results are generally more natural and concerns related to implants are non-existent. Skin expansion This common technique combines skin expansion and subsequent insertion of an implant. Following mastectomy, a balloon expander will be inseted beneath the skin and chest muscle. Through a tiny valve mechanism buried beneath the skin, he or she will periodically inject a salt-water solution to gradually fill the expander over several weeks or months. After the skin over the breast area has been sufficiently stretched, the expander is removed in a second operation and a more permanent implant -- either saline or silicone -- will be inserted. Some expanders are designed to be left in place as the final implant. The nipple and dark skin surrounding it -- called the areola -- are reconstructed in a subsequent procedure. Flap reconstruction An alternative approach to implant reconstruction involves creation of a skin flap using tissue taken from other parts of the body, such as the abdomen, back or buttocks. In one type of flap surgery, the tissue remains attached to its original site, retaining its blood supply. The flap, consisting of skin, fat and muscle with its blood supply, are tunneled beneath the skin to the chest, creating a pocket for an implant or, in some cases, creating the breast mound itself without need for an implant. Another flap technique uses tissue that is surgically removed from the abdomen, thighs or buttocks and then transplanted to the chest by reconnecting the blood vessels to new ones in that region. Recovery times for both procedures range from six months to one year, or longer, depending on individual circumstances. Not all women are good candidates for breast reconstruction. Women who have had a mastectomy or Lumpectomy with radiation are typically not strong candidates for skin expansion reconstruction. Radiation changes the characteristics of skin tissue, causing a variety of complications ranging from excessive scar tissue development, to blood supply and overall healing problems. While radiation does present some difficult challenges, it doesn't automatically rule out the possibility of reconstruction. While each circumstance is different, if there is enough good tissue to work with, reconstruction remains a viable option for most women. Patients that are emotionally unstable should probably postpone reconstruction. Coping with the reality of breast cancer is an extremely overwhelming process. If a woman cannot understand the risks and limitations of reconstruction prior to her mastectomy surgery, I would recommend she wait. Managing Misconceptions Most misconceptions regarding breast cancer reconstructionare caused by a lack of information. Common misconceptions include having to wait up to one year to safely undergo reconstruction, reconstruction makes it difficult to identify cancer if it recurs, and reconstruction interferes with cancer treatments, such as chemotherapy. All are wrong on all counts. Reconstruction can take place immediately following mastectomy with little complication. In the case of implants, reconstruction may take longer if the patient has to undergo chemotherapy, but otherwise doesn't interfere with the process. Managing Expectations It is important to remember that the goal of reconstruction is improvement, not perfection. Be sure to discuss your expectations candidly with your plastic surgeon, and expect nothing less than total honesty from him or her in return. To ensure reconstructive surgery has the desired outcome, breast symmetry procedures – surgery to the other breast -- is usually also part of the reconstructive process. Symmetry procedures either reduce, lift or reshape the remaining breast to ensure a better match to the reconstructed breast. Symmetry procedures can be an ongoing process, with periodic adjustments necessary to correct the affects of the aging process. The information on this web site is only intended as an introduction to this procedure and should not be used to determine whether you will have the procedure performed nor as a guarantee of the result. The best method of determining your personal options is to schedule a personal consultation with Dr. Makki. He will be able to answer specific questions related to your situation. Please don't hesitate to call for any questions that you might have