In the unfortunate event where a full mastectomy is required to treat breast cancer, reconstruction is often a much welcomed option. With modern technology, techniques, and materials that are available it is possible to restore the breasts appearance to its original form with hardly any visible scarring. When this procedure is carried out it is done so by plastic surgeons specializing in restoration. It has now become a commonplace following a full mastectomy.
There are many different approaches and each case is unique and different. Consultation with a physician is necessary in order to choose the technique that is right for you.
Breast implants are one option that is typically chosen. Today implants are typically saline filled bags encased in silicone. They are placed in front of the chest wall muscles under the skin that covers the breast area.
In the past silicon filled implants were more typical. There was a huge concern that the silicon could possibly leak out into the body thus causing problems for the immune system. The FDA recently announced after years of study that there isn’t much basis for worry and silicon breast implants are now legal again. Some individuals prefer silicon implants because they behave differently.
In many instances reconstruction is done simultaneously with the mastectomy. In other cases physicians recommend that you wait for a period of time to allow the body to heal prior to performing any further surgery. Each case is different and can only be decided based upon its own circumstances.
Usually, two-staged delayed reconstruction is performed if the skin and chest wall tissues are flat. In this instance an implant, called a tissue expander that functions much like a balloon under the tissue, is placed underneath the muscle. A surgeon then injects saline in stages over a specific period of time. In some cases the expander itself eventually becomes the implant. In other instances the expander is removed during a later procedure and replaced with a permanent implant.
Tissue flap procedures are another category of breast surgery. These use skin from the stomach, the thighs or other area as part of the total process.
TRAM (transverse rectus abdominis muscle flap) is one of the most common types, which uses tissue from the lower abdominal wall. A pedicle flap leaves the tissue attached to the original blood supply and stretches the tissue up the breast area. A free flap procedure removes the tissue entirely, along with muscles, fat, and blood vessels and reattaches them to blood vessels under the chest.
Another common tissue flap procedure that is equally as common as a TRAM uses tissue from the upper back. A flap is moved in front of an individual’s chest wall to create a pocket. Following that a breast implant is inserted into the pocket. There are other procedures in addition to this one; there is even one that uses gluteal muscle tissue.
In each instance nipple and/or areola reconstruction may or may not be in order. In some instances it will be done simultaneously with breast reconstruction, in others it might be done later, sometimes it is not even done at all. The original nipple is rarely used as a replacement as it has yet to be determined whether or not it can regenerate cancer.
Reconstructive surgery is not entirely without risks, of course.
You can have the typical surgical complications including infection, and scarring. Breast implants also are not guaranteed to last a lifetime and depending upon your age may need to be replaced via another surgery at a later time. The final result might not be what the patient was expecting. Only a complete in depth consultation with a physician can provide a realistic assessment of what to expect.
