After a breast cancer diagnosis, the number of options for treatment can be stressful. If it is right for you, breast reconstruction can improve quality of life and help get to a sense of normal. Some patients do not desire breast reconstruction, but everyone should be educated regarding their options.
The type of breast cancer surgery that is offered depends on the location, and size of the cancer, as well as the size and shape of your breasts. Your breast surgeon can sometimes save your nipple if it is appropriate. You may or may not need lymph nodes removed, depending on the type of size of your cancer. The location of your surgical incision depends on the size and location of your cancer.
Types of Reconstruction
Aesthetic Flat Closure
Aesthetic flat closure is a type of reconstruction in which patients choose to improve the appearance of their chest wall without reconstruction of a formal breast mound.
Aesthetic flat closure rearranges the skin, fat, and soft tissue of the chest wall to produce a smooth, flat contour. Fat grafting can be used in conjunction with this type of reconstruction to further improve contour irregularities.
Tissue expanders are a common reconstructive option. Many women will have tissue expanders placed at the time of mastectomy.
A tissue expander is a temporary type of implant that has a port underneath the skin. This port allows injection of fluid in your surgeon's office to increase the size of the tissue expander and stretch out the skin/ muscle to make room for an implant.
The tissue expander is placed either on top of or underneath the muscle after a mastectomy, depending on your expected treatment course and preferences.
When the tissue expander is first placed in surgery, it will be flat. After about 2 weeks, the tissue expander will be filled during clinic visits.
Once the tissue expander is completely filled, healing is complete, and swelling has gone away, then the tissue expander is exchanged for a permanent implant or flap reconstruction (see below).
After the tissue expander is completely filled, it can be exchanged for an implant in a surgery after which you go home the same day.
Implants allow a patient to have the same size or slightly larger breasts than her current breast size. Implants are generally the option that gives the fastest recovery.
Direct-to-Implant: For patients that would like their breast reconstruction similar to or smaller than their current breast size, a permanent breast implant may be placed at the time of mastectomy (instead of a tissue expander). The implant will be covered with a mesh that will support it.
Not everyone is a candidate for Direct-to-Implant because the safety of this reconstruction cannot be determined until the mastectomy is complete. The implant can sometimes cause too much stress on the skin when placed at the time of mastectomy.
Types of Implants: Implants are filled with silicone or saline. They come in different sizes and shapes. The best implant shape and type can be discussed with the plastic surgeon.
Autologous (Flap) Reconstruction
After cancer treatment, some people decide to have breast reconstruction that does not involve implants. Flap reconstruction involves borrowing fat and/or muscle, as well as its blood supply, from somewhere on your body and transferring it to the breast area. The locations where fat and/or muscle can be borrowed include the belly, leg, back, or buttocks. After the surgery, the hospital stay is typically 2-3 days, and the flap is monitored to make sure that it is taking well to its new location on the breast.
Flap reconstruction can help give the breast a softer feel and can help a patient avoid implants.
In patients with large breasts who are candidates for a lumpectomy (small area of breast + cancer removed), the plastic surgeon can perform a breast reduction on the opposite side to make the sizes of the breasts even on both sides. This is called an oncoplastic reduction.
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