Life After a Mastectomy: Breast Reconstruction Options

Breast HealthFor many women who have braved a mastectomy (the surgical removal of one or both breasts usually because of cancer), recovery involves rebuilding the self emotionally as well as physically.  Advances in medical research have made breast, nipple, and areola reconstruction a safe, realistic possibility for many cancer survivors.

We would like to take a few moments here to review some frequently asked questions regarding mastectomy and breast reconstruction surgery in order to help better assist you in your decision-making process.

Breast Reconstruction

When Will Surgery Occur?

There are a few different options from which cancer patients can choose for breast reconstruction.  If you have not yet undergone your mastectomy, you may be a candidate for one-stage reconstruction.  In this procedure, the surgeon immediately reshapes the breast with an implant following the mastectomy.  Usually, this surgery is only performed if the doctor does not anticipate that the patient will need additional radiation treatment to the chest area following mastectomy. For those who have already undergone a mastectomy or for whom only surgery can determine whether further radiation will be necessary, the two-stage reconstruction is more likely.  In the first step, the surgeon places a tissue expander beneath the pectoral muscle; if additional radiation treatments are not warranted, this may occur immediately after mastectomy. This expander has a tiny valve to allow your doctor to add a saline solution over the course of four to six months.  By stretching the skin, the expander creates a pocket that will later accommodate the implant, which is added in the second stage.  In some cases, the expander can, itself, function as the implant.

What Procedures Are Available?

Breast reconstruction procedures include tissue-flap procedures and implant procedures.  Tissue-flap procedures use tissue from other locations on your body, such as your buttocks (superior gluteal artery perforator flap), back (latissimus dorsi flap), belly (the transverse rectus abdominis muscle flap), or thighs, to reconstruct the breast. A primary advantage of tissue flap procedures is that it will continue to behave like your own body tissue: growing with weight gain and shrinking with weight loss, for example.  In addition, risk of rupture, leakage, or replacement is eliminated. Among the disadvantages, however, are multiple scar sites and weakness at the location from which the tissue was taken.  Women who smoke or have vascular diseases, diabetes, or connective tissue diseases may not be eligible for tissue flap procedure.

By contrast, implant procedures use implants filled with either silicone gel or saline solution; implant surgeries are the most common kind of breast reconstructive surgery. Some women claim that silicone implants have a more natural feel than the saline implants.  One disadvantage of both types of implants is that they could leak or rupture, which may necessitate replacement in the future.  Silicone implants in particular may require that you have MRIs performed routinely to detect a rupture. Both saline and silicone-gel implants have been approved by the FDA, and neither type of implant has an age restriction for breast reconstruction.

Nipple and Areola Reconstruction

Like breast reconstruction, nipple and areola reconstruction will depend on when the mastectomy occurred or will occur.  If you underwent or plan to undergo a nipple-sparing mastectomy (usually for early-stage cancer), you may not need to have an additional nipple or areola reconstruction surgery.  Otherwise, nipple and areola reconstruction is commonly the last step and occurs a few months after breast reconstruction.  Usually an outpatient procedure, this type of reconstruction utilizes tissue of similar color, texture, and shape; the surgeon may employ tissue from the eyelid, groin, other nipple, ear, or other regions.

Being well informed of your options is extremely helpful while going through such a difficult process.  Take the time to have your questions fully answered, get to know your doctors, and make sure to explore the many options available to determine which one is best for you.

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