Breast reconstruction

Overview

Breast reconstruction, the surgical procedure aimed at recreating breasts after a mastectomy or lumpectomy, can involve multiple stages and techniques. There are various approaches to breast reconstruction, including the use of saline or silicone breast implants, as well as utilizing tissue from other parts of your body, such as lower abdominal tissue.

Breast reconstruction can be done immediately following breast cancer surgery (referred to as immediate reconstruction) or be postponed to a later date, which may be months or even years after the initial procedure (known as delayed reconstruction). Depending on your specific circumstances, you may require reconstruction for both breasts or just one, and in some cases, the reconstruction process may involve multiple surgeries performed over time.

It’s important to note that not everyone who undergoes a mastectomy chooses to undergo breast reconstruction. The decision to pursue breast reconstruction is deeply personal and varies from person to person.

Types of breast reconstruction surgery

Following mastectomies, there are two primary kinds of breast reconstruction surgery.

Flap reconstruction

During flap reconstruction, your surgeon forms a breast using autologous tissue, which is taken from your own body. Usually, the lower abdomen (belly) is where the tissue is taken from. However, it may also originate from your back, bottom, or thigh.

To create a new breast, your surgeon may extract muscle, fat, skin, and blood vessels from these parts of your body. Doctors refer to this tissue as a flap. Occasionally, a flap (pedicled flap) is moved through your body by a surgeon. In this manner, the flap keeps its own blood supply. Alternatively, they might attach the free flap—which is separated from its own blood supply—to the blood vessels in your chest.

Among the varieties of flap reconstruction are:

• Latissimus Dorsi (LD) flap. The back’s muscle and tissue are removed by providers. The LD flap is transplanted through the back into the breast region while it is still attached to its own blood supply.
• DIEP flap. Your doctor removes the lower abdomen’s skin, fat, and blood vessels. There is no removal of the underlying abdominal (belly) muscle with a DIEP flap.
• TRAM flap. Your doctor extracts muscle, fat, blood vessels, and skin from the lower abdomen.
• PAP flap. Your surgeon creates a breast by excising tissue from the back and inner of your thigh. Your thigh’s muscle is not transplanted during this process.
• TUG flap. This method takes tissue from your thigh, much like a PAP flap. TUG flaps are used to transplant both muscle and tissue.
• SIEA flap (or SIEP flap). Similar to a DIEP flap, but using different blood vessels, is this technique. This method isn’t as frequently used by providers. Few persons possess the blood vessels required for a successful surgery.
• IGAP flap. Your butt provides the tissue needed for this surgery. During this process, muscle is not employed.
• SGAP flap. Moreover, this method just removes tissue from your butt—not muscle. It makes use of a distinct set of blood arteries compared to the IGAP flap technique.

Implant reconstruction

Surgeons often utilize saline or silicone implants to mimic breast tissue in implant–based breast reconstruction. In some cases, surgeons may opt to combine these implants with your body’s own tissue. This can involve procedures such as mastectomy and implant reconstruction, which can be performed together, or you may choose to undergo implant reconstruction following a mastectomy.

The following implant reconstruction types exist:

• Under the chest muscle. The implant is positioned behind the chest muscle.
• Above the chest muscle. The implant is positioned above the muscle in your chest by your surgeon. Due to the fact that your chest muscle stays in position, you might not require as much healing time.
• Implant with tissue expander. An expander is inserted beneath your skin by your surgeon. You or your surgeon fills the expander with saline approximately once a week. Your skin stretches and becomes larger with time. When your skin has grown to cover the implant, your surgeon will install place it.

Oncoplastic reconstruction after lumpectomy

In the event that you meet the criteria for a lumpectomy, oncoplastic reconstruction can be advantageous. You can find out if you qualify for breast conservation by speaking with your oncologic breast surgeon. On the other hand, radiation therapy will be necessary after a lumpectomy.

Surgeons performing oncoplastic reconstruction perform breast reduction or breast lift procedures concurrently with the lumpectomy. The breast form is improved and the defect left by the lumpectomy is filled up with a breast reduction or lift. For symmetry, the other breast will require a breast lift or reduction.

Some types of mastectomies, specifically “nipple–sparing mastectomies,” retain the areola and nipple. The areola refers to the darker skin surrounding the nipple. In cases where a new nipple is necessary, healthcare providers can create one using either nearby breast skin or by transplanting skin from another part of your body through a skin graft.

Following nipple reconstruction, some individuals opt to enhance the appearance further by getting a 3D tattoo of an areola. Skilled tattoo artists are capable of crafting lifelike areola designs through this process.

Reasons for undergoing the procedure

Breast reconstruction typically follows a surgical procedure intended to treat or prevent breast cancer. It is used by providers to reconstruct lost or damaged breast tissue and reshape breasts. This surgery could also be done to restore symmetry. This indicates that they create identically sized and shaped breasts. Reconstructing breast tissue resulting from congenital anomalies (birth deformities) is a less usual procedure.

It’s typical to have breast loss after a mastectomy. Many women find that having breast restoration surgery helps them deal with these intense feelings and move on.

Risks

Breast reconstruction carries the same dangers as any surgical procedure: bleeding and infection. The type of operation and the amount of tissue left over after radiation and surgery for breast cancer affect the outcome.

You most likely won’t feel anything at all in your surgically restored breasts after surgery. You might gradually regain some skin sensation. But the feeling won’t be the same as it was.

Following breast reconstruction surgery, complications could include:

• Blood clots. These might occur more frequently following specific kinds of flap reconstruction procedures.
• Differently sized or shaped breasts. Maybe one feels firmer than the other. There might not be symmetry in the areolas and nipples.
• Bruising or scarring surrounding the breast reconstruction. Scars remain after every breast reconstruction procedure. They might disappear with time.
• Fat necrosis. After flap surgery, the transplanted tissue dies.
• Problems with the implants (for implant reconstruction). These issues may manifest as implant rippling, wrinkling, and ruptures (tears).
• Sensitivity, discomfort, or weakness at the donor location following flap reconstruction surgery. Donor locations can be the back, bottom, thigh, or lower abdomen.

Before the procedure

Reconstruction of the breast occurs following a mastectomy or lumpectomy. Before having breast reconstruction surgery, you might also require chemotherapy or radiation if you have breast cancer. Your surgeon will talk with you about your surgery alternatives and inquire about your goals.

Your surgeon will first perform a thorough examination. Your breasts will be measured and photographed by them. Inform your healthcare practitioner about your medical history, current medications, and surgical procedures. Before the surgery, your doctor could ask you to cease using a certain medicine.

During the procedure

In a hospital setting, a surgeon will conduct a procedure to restore your breasts. Your healthcare provider will administer anesthesia, rendering you unconscious and pain–free during the process. The initial step typically involves the surgeon performing either a mastectomy or lumpectomy.

While you remain unconscious, the breast reconstruction procedure is carried out by your surgeon. If you are undergoing implant reconstruction, the surgeon places the implant within your chest. In the case of a flap operation, tissue is harvested from another area of your body to construct and implant the new breast.

During the procedure, your surgeon may also insert a small tube, known as a drain, beneath your skin. This tube extends outward from your chest, allowing for the drainage of blood and fluids as you heal. Once you no longer require these tubes, your healthcare provider will remove them.

After the procedure

You might have to spend up to a week in the hospital following surgery. Your doctor will keep an eye on you to make sure you’re recovering. You could put on a surgical bra. The bra minimizes swelling and supports your breasts while they recuperate. Your doctor will provide you with information on how to take care of yourself when it’s time to return home.

Following surgery, your doctor will assist you in managing your pain. They might suggest over–the–counter or prescription painkillers. When taking medication, carefully adhere to your doctor’s directions.

To make your breasts match, you could require additional surgery if you have reconstruction on one of your breasts. This could involve breast augmentation or reduction surgery.

Outcome

The duration and nature of your post–operative recovery can vary widely and depend on several factors, including the specific procedure you underwent and your overall health.

During your recovery period, it’s important to avoid activities like heavy lifting, strenuous exercise, and certain other actions to give your body the necessary time to heal. When you’re ready to resume your usual activities, it’s advisable to have a discussion with your doctor to ensure a safe and gradual return to your routine.

After breast reconstruction surgery, it’s crucial to remain vigilant for any signs of cancer recurrence. Regular check–ups with your healthcare provider are essential. Additionally, routine mammograms should be performed on the non–reconstructed breast to screen for any potential malignancies.