Women who have had a breast removed (mastectomy) due to cancer or other disease process may seek reconstructive surgery to replace the missing breast. These patients desire restoration in order to “feel whole again.” Sometimes patients do not want to wear an external prosthesis because it is uncomfortable or does not work with certain clothing options.
Breast reconstruction usually involves several procedures performed in stages. The first stage may begin at the same time as the mastectomy procedure or be delayed until the patient heals from the mastectomy and has completed cancer treatments.
There are several surgical options for breast reconstruction. The patient’s own muscle, fat, and skin can be taken from either the abdominal area (TRAM flap) or from the back (latissimus dorsi flap) to form a new breast mound.
Another option is to place a breast implant (silicone or saline) under the skin to create the mound. Placement of an implant is followed by tissue expansion. The expansion process uses a tissue expander device that is placed under the skin and slowly filled with saline over the course of 4-6 months to expand the skin creating an implant pocket. The tissue expander must be replaced as it is not designed to be a permanent implant.
Breast reconstruction is completed by the creation of the nipple/areola complex. After the areola complex has been defined, patients may have medical tattooing to darken the skin to match the opposing breast. Fine tuning procedures using fat grafting to add volume or liposuction to reduce volume are sometimes needed to complete the desired result.
Some patients also require surgery on their non-affected breast to achieve symmetry. This can be accomplished with breast reduction, mastopexy, or even augmentation. Your body size and shape and your desired result will dictate the best option for achieving symmetry.
Breast reconstruction surgery is often performed in the hospital under general anesthesia. Some of the stages of reconstruction may be performed in an outpatient surgical center or office setting. Your surgeon will choose the best facility option for your procedure based on the procedure itself and insurance company requirements.