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The Breast Reconstruction Process

Timing of Your Reconstructive Breast Surgery

Reconstructive breast surgery, or at least a portion of it, can sometimes be performed at the same time as the surgeon performs the cancer surgery, called immediate reconstruction. Some women opt for this in order to reduce the number of times they have to go to surgery. For others, they do not want to see themselves without breasts, so it is important in their recovery to avoid seeing themselves that way.

Immediate reconstruction is not an option for everyone, however. Sometimes, it is necessary to complete all stages of cancer treatment prior to reconstruction in order to avoid ruining the reconstruction. Also, it is recommended for women that are obese, have diabetes or smoke to wait until a later time for reconstruction. All of those conditions cause delayed or altered wound healing as a result of vascular damage, and it is best if their wounds have time to heal completely prior to another surgery.

Choosing a Reconstructive Procedure

There are two main categories of breast reconstruction procedures: breast implants and various flap procedures. There are several different aspects of your particular cancer and body type to discuss when choosing the type of surgery that is right for you. For example:

  • How much tissue will need to be removed from your breast?
  • Do you have any other medical problems that need to be considered?
  • Will you have radiation as part of your treatment plan?
  • What type of reconstruction procedures have you considered?

If you choose to have breast implants, it will be required that enough skin is left after the mastectomy to cover the implants and close the skin. If a lot of skin must be taken during the mastectomy, a tissue expander may be surgically inserted under the skin in the location that the implants will eventually hold. Over several weeks, the tissue expanders will be filled with saline and the skin will gradually grow and stretch to cover them. When the skin is stretched to the point that it will cover the desired implant size, the tissue expanders will be removed and the implants will replace them. Breast implants are a balloon-like in shape and are typically filled with saline or rarely, silicon. If a skin-sparing mastectomy was performed originally and the patient does not desire to have larger breasts than what she had prior, implants can sometimes be placed immediately following mastectomy.

The other category of breast reconstruction procedures, flap procedures, involves a complex transfer of tissue from one part of the body, typically the back or abdomen, to the chest in order create the new breasts. When the tissue is transferred from the abdomen, either by a “free-flap” or a “trans-rectus” flap, the skin on the abdomen is closed and this tightens the abdomen creating a “tummy-tuck”. Every type of flap procedure requires that blood vessels are kept intact and not damaged during the surgery, so that the tissue that has been transferred will have the blood supply and nutrients to heal. For this reason, women with diabetes, connective tissue disorders and women who smoke are not good candidates for flap procedures.

It’s important to understand up front, that it may take more than one surgery to achieve the reconstructive result that you and your surgeon desire. Furthermore, if you choose to have implants, they may need to be replaced at some point during your lifetime.1  Since the nipple will have been removed during the initial mastectomy, some women desire to have it replaced. This will have to be done after you have healed from the reconstructive surgery. Typically, the shape of a nipple is tattooed on the newly created breast. However, it is possible to transfer a small piece of tissue that looks like a more realistic nipple, and then tattoo it to have the appearance of a nipple.

Coordinating Surgeons

If you and your cancer surgeon decide that you will have a mastectomy as part of your treatment and you think that you may want to have some kind of breast reconstruction, it is wise you meet with a plastic surgeon early. The plastic surgeon can work with the cancer surgeon to determine the best cancer surgery and subsequent reconstructive surgery that you desire. You may even choose to have reconstructive surgery at a later date in order to recover from the mastectomy first, but it is never too soon to get a plastic surgeon involved as part of the treatment team.2

References

1 Bonner, D. (2008). The 10 Best Questions for Surviving Breast Cancer. New York: Fireside.

2 Kaelin, C. (2005). Living Through Breast Cancer. New York: McGraw-Hill

This article was originally published on July 27,2012 and last revision and update of it was 9/2/2015.