If you, or someone you know or love, has been diagnosed with breast cancer, you know how difficult and frightening it can be. Fortunately, the options that a woman has for treating breast cancer have become greater, and the prospects for successful treatment and recovery have never been better. One area of great progress in recent years is in the field of breast reconstruction after mastectomy.
Sometimes a mastectomy on one or both breasts may be needed or advisable for certain breast cancers. If that is the case, we can now offer a growing number of options for reconstruction. The goal of reconstruction is to allow people to live their daily lives and activities while trying to minimize the physical change visible on their body. Women who have chosen breast reconstruction have been shown on average to have a better self image and less depressive symptoms after mastectomy. Of course, individual results vary.
Breast reconstruction is a field of plastic surgery which allows you to have your breast form rebuilt to the extent possible after mastectomy. Breast reconstruction can be begun immediately at the time of mastectomy, a so-called immediate reconstruction, or at a later date in what is termed a delayed reconstruction.
There are several major types of breast reconstruction with a growing array of choices within each type as discussed below.
1. Implants and Tissue Expanders
The most commonly used techniques for breast reconstruction use breast implants to recreate the fullness of the breast. These devices may be filled with saline (salt-water solution) or silicon gel. Many times, in order to create enough room to place the implant, a device called a tissue-expander is placed at the time of mastectomy. A tissue expander is an inflatable balloon like device that is placed in the area of the breast after mastectomy, usually under the pectoral muscle. The tissue expander device is then gradually inflated, gradually stretching the skin, to make enough room for a breast implant to be placed later. The inflation is done for you in our office. At a subsequent stage, the expander is removed and the breast implant is placed. In some cases, the implant can be placed without going through the tissue expansion phase, but not everyone has enough tissue to allow for that. That is sometimes referred to as a “direct to implant technique.” When implants and tissue expanders are used, we now have a wide range of different types, styles, shapes and materials to offer people.
Several newer techniques are allowing us to improve the look and feel of the reconstructed breast. One is use of a product called Alloderm (or similar products now available). Alloderm is derived from donor skin collagen which has had all the cells removed from it. It has been called a “regenerative matrix”. Think of it like an apartment building for cells, but the “apartments” are empty. When placed in the body, your cells see the “apartments” and some of them “move in”. That is, the spaces become populated by your own cells and the matrix becomes incorporated into your own tissue. This allows us to restore tissue in areas where tissue was removed and helps add a layer of coverage over the implant. It can also help relieve tightness without having to move your own tissues quite as much as might otherwise be necessary. It also resists the tendency for the implant space to contract as much. Another area of development in breast reconstruction is the use of ones own fat in what are called fat grafts which can be placed in areas that need that. Of course, each of these techniques has its own pros and cons.
At Plastic Surgery Professionals, we take time to explain to you the various options as well as the risks and possible advantages to help you make the best decision for your situation and considering your personal goals and preferences.
2. The second major approach to reconstructing the breast is the use of tissue from the abdomen. The “Tummy-tuck flap” or TRAM flap has been the widely used approach to that. More recently, microsurgery has been used to help transfer tissue from the abdomen. These techniques move excess bulging tissue from the abdomen similar to that removed in a tummy tuck operation. In this case, however, the tissue is transferred with blood supply from an underlying muscle or with blood supply that is reconnected with microsurgery. Although there is a donor scar across the abdomen, it is similar to that after a tummy tuck procedure.
3. A third approach is to transfer tissue from the back with a technique called a latissimus flap. This approach brings muscle and skin from the back where there is extra, to the front where it is needed to reconstruct the breast. This technique is commonly combined with an implant and can allow one to skip the stage of tissue expansion. It does, however, leave a scar on the back.
4. Nipple Reconstruction
The appearance of the nipple areolae on the breast is an important part of the the reconstruction. Patient’s have told us over the years that after the nipple reconstruction was placed “it looks complete”, “it looks whole again”. We can offer our patient’s one of several techniques that generally do not require a skin graft and can be done with just local anesthesia. The sequence often utilizes micropigmentation which is a sterile medical grade of tattoo that helps us get closer to the appearance of the opposite side. Of course, perfect symmetry is never achievable.
The truth is that there is also no one best technique for reconstructing the breast after mastectomy. Be sure you select a plastic surgeon with experience and who will take the time to explain your options to you as we think that is important. At Plastic Surgery Professionals, our doctors have been caring for people and performing breast reconstruction for over 25 years. Please call us at 410-715-9205 if you would like to arrange a consultation and learn more.