Breast Reconstruction

Breast cancer is expected to affect one in eight women in America in 2007. There are basically two options for women who are diagnosed with breast cancer:

  • Lumpectomy (removal of the cancer) with postoperative radiation
  • Mastectomy (removal of the breast tissue and lymph nodes)

Each woman is treated as an individual. A careful discussion between her and her primary physician, general surgeon, plastic surgeon, and oncologist will determine the treatment. In those women who select a mastectomy, reconstruction is an option. Studies have revealed a psychological benefit is derived by many women who choose reconstruction. Thanks to a bill signed into law in May, 1997, by Texas governor George W. Bush, insurance coverage is available to women for breast reconstruction, as well as necessary surgery of the unaffected breast.

RECONSTRUCTION

Two primary decisions must be made. These are:

  • Immediate vs. delayed reconstruction
  • Autologous (her own) tissue vs. synthetic (tissue expander/implant)

Many women choose immediate reconstruction because of the psychological benefit and the desire to "feel normal again". Delayed reconstruction, however, remains an option.

MATERIALS

What are the differences between reconstruction with tissue expander/implants and autologous tissue?

  1. Tissue expander/implant
    • An inflatable device inserted at the time of mastectomy or as a delayed procedure.
    • Requires multiple office visits to fill with normal saline to expand the chest skin.
    • Most expanders are temporary and will eventually be replaced with permanent implants at a later operation.
    • The implants are either saline or silicone gel
  2. Autologous Tissue (3 basic types)
    • TRAM - This reconstruction consists of transferring abdominal skin, fat, and muscle.The patient receives a tummy tuck at the time of surgery.
    • Latissimus dorsi - Reconstruction with skin, fat, and muscle from the back.
    • Free flap - Skin, fat, and muscle are usually taken from the abdomen (rarely, the buttocks) with associated arteries and veins which are connected to arteries and veins in the chest

PERTINENT INFORMATION:

  • Anesthesia - general
  • Setting - hospital for several days
  • Recovery - return to normal activities in 1 month
  • Scars - depends on the surgery (abdomen, back, or buttocks, as well as the breast). Usually heal very well with time.

ADDITIONAL PROCEDURES

  • Nipple-areola reconstruction - Many women elect to undergo nipple reconstruction from existing chest skin, plus areola reconstruction which is often done by the surgeon or a trained tattoo artist. These procedures are usually performed several months after the initial reconstruction and are much simpler and easier than the original surgery with rapid recovery.
  • Mastopexy (lift) - Many women elect to undergo surgery on the unaffected breast to obtain symmetry, and thus, match the reconstructed breast.