BREAST RECONSTRUCTION Procedure Pictures
A diagnosis of breast cancer and the thought of losing one or both breasts can cause significant stress and anxiety. Patients are often overwhelmed with the sheer volume of information regarding cancer treatment (surgery, chemo, radiation, etc.), so it can be difficult to digest information regarding breast reconstruction as well. Dr. Steele will take the time to educate and help guide you through the difficult decisions you:
- Whether or not to pursue breast reconstruction
- Whether to have reconstruction at the time of mastectomy (immediate) or at a later time (delayed)
- Which reconstruction technique to use- your own tissue, implants, or both
The following FAQs will be helpful for understanding breast reconstruction in more detail:
What is breast reconstruction?
Breast reconstruction includes surgical procedures that are performed to restore a breast’s natural appearance, shape and size following a mastectomy (surgical removal the breast). Breast reconstruction also can be performed for correction of changes due to partial removal of the breast (lumpectomy) and for congenital or developmental absence or abnormalities.
Why should I choose to undergo breast reconstruction?
The decision to undergo breast reconstruction is a personal one. Many women choose to have breast reconstruction after a mastectomy to restore their sense of femininity and intimacy with their partner, to attain symmetry in bras and clothing, and to enhance self-esteem and self-image following breast cancer. Women, who have had breast reconstruction, will often later say that the reconstruction brings a sense of closure to their cancer treatment and helps minimize the reminder of having had breast cancer.
When can breast reconstruction be performed?
Breast reconstruction may take place immediately following a mastectomy or may be delayed. Advantages of immediate breast reconstruction include fewer operations, improved cosmetic results, and less psychological distress. Delayed breast reconstruction may be completed anytime following a mastectomy and is appropriate for those women requiring radiation therapy as part of their cancer treatment. Additionally, those patients who are unsure about breast reconstruction can always undergo reconstruction at a later time. There are many medical and personal factors that also contribute to the timing of breast reconstruction. This will be discussed with your plastic surgeon at the time of your consultation.
How many operations will be necessary to obtain desired results?
The number of operations needed for breast reconstruction varies for each individual and can range from one to four or five procedures depending on the reconstructive technique and a patient’s particular goals. Typically these operations are spread out over several months and are tailored to the patient’s schedule. Generally, the first operation forms the breast mound and is the longest operation, usually requiring at least an overnight stay. A second operation is generally needed for refinement of the breast shape, placement of permanent breast implants, and reconstruction of the nipple. Fat grafting, using a patient’s own fat, may also be performed to improve the size, shape, and symmetry of the reconstructed breast(s). These secondary procedures are usually less invasive and can be performed as outpatient surgery. A final operation may be necessary to tattoo the nipple and areola.
Will I have to have surgery on the unaffected breast?
There are a variety of surgical procedures available to obtain symmetry of the breasts. These procedures may be completed during the reconstruction process and include: breast augmentation, breast lift, and breast reduction. Your surgeon will discuss this with you during your consultation.
Will my insurance cover my breast reconstruction surgery?
All medical insurance policies, including Medicare, must cover breast reconstruction after mastectomy and procedures performed on the other breast for symmetry. The Women’s Health and Cancer Rights Act passed in 1998, mandates that all insurance companies cover these procedures.
Your consultation with Dr. Steele
We recommend that you arrange for your spouse, a family member, or friend to accompany you to your initial consultation visit to provide support. During your consultation, your surgeon will spend time discussing reconstruction as well as procedure options that he recommends for you based on: your personal desires and needs, physical examination and your health history. They will also discuss your recovery time and what to expect following the surgery. You will be given an opportunity to discuss your insurance coverage and scheduling options with our patient care coordinator following your consultation.
Reconstruction procedures performed by Dr. Steele
There are three major categories of breast reconstructive procedures: alloplastic (breast implants), autologous (your own tissue), or a combination of the two. The use of permanent breast implants is typically preceded by the use of tissue expanders that gradually stretch the skin to make room for the implants. Autologous tissue flaps involve transferring your own skin and fat to construct a breast mound. In some cases, an implant is necessary in addition to a tissue flap to increase the volume of the reconstructed breast.
Tissue Expanders and Implants
Use of tissues expanders and implants are the most common procedures for breast reconstruction. Tissue expanders can be placed at the time of mastectomy (immediate reconstruction) or in a delayed fashion. The expanders are similar to balloons and are gradually inflated with saline (salt water) over time until the patient’s desired volume is attained. Once the patient is satisfied with the volume, the tissue expander is replaced with saline or silicone gel implants. Patients frequently choose alloplastic reconstruction because of the shorter surgery and recovery time as well as the avoidance of the surgical donor site required for harvest of a tissue flap. Many patients who undergo alloplastic reconstruction will benefit from grafting of their own fat to camouflage the implants and improve size, shape, and symmetry.
Autologous Reconstructive Options
There are several advantages to using your own (autologous) tissue for breast reconstruction: avoidance of a foreign body (implant), more natural look/feel, fewer complications in those patients requiring radiation therapy, and better symmetry with the remaining breast. The disadvantages include longer operative times, longer recovery, and the need for surgery on another part of the body to harvest the tissue.
Transverse Rectus Abdominis Muscle Flap (TRAM Flap)
The TRAM flap takes advantage of the excess tissue (skin and fat) in the lower abdomen to create a breast mound. This type of flap provides a generous amount of tissue in properly selected patient. Therefore, in most cases a breast implant is not required. However, this procedure is not recommended for patients with a history of previous abdominal surgery or for patients with minimal excess abdominal tissue. Additionally, smokers, obese or very overweight patients, and diabetic patients should also consider other reconstructive options. The TRAM flap procedure typically takes between three to four hours in the operating room and most patients go home from the hospital in three to four days. Patients should expect six weeks of recovery time to return to normal activities.
Latissimus Dorsi Flap
The latissimus dorsi muscle is the largest muscle in the body and runs from the top of the armpit down the back. It is the muscle that gives a competitive swimmer that muscular “V” shape to their torso. This type of reconstruction can be used for immediate or delayed breast reconstruction and has excellent outcomes, even in the face of radiation therapy. The latissimus dorsi flap is typically combined with a tissue expander because most patients do not have enough volume (skin and fat) on their back to create a breast of sufficient volume. Once the tissue expander reaches the desired volume, a permanent implant can be placed. Occasionally, in overweight or obese patients, a latissimus flap is large enough and an implant is not necessary. This procedure takes about three to four hours in the operating room and most patients go home from the hospital within 2-3 days. Patients should expect four to six weeks of recovery time to return to normal activities.
Nipple and Areola Reconstruction
Nipple and areola reconstruction is completed during the final stage of reconstruction and is typically preformed several months after the final shaping of the breast mound. The new nipple is shaped from tissue used to make the new breast. In some cases, a skin graft is needed. Dr. Steele is able to reconstruct the nipple and areola of an appropriate size, shape and projection. Nipple reconstruction can also be combined with fat grafting of the breast if necessary to optimize shape and symmetry. Nipple reconstruction is performed as an outpatient, same day surgery and requires minimal recovery time. Following the nipple reconstruction, nipple/areola tattooing may be done to provide a natural color to the nipple and areola.