Breast reconstruction is a type of surgery for women who have had a mastectomy (surgical removal of a breast) as part of their cancer treatment. The surgery rebuilds or reconstructs the breast, making it about the same size and shape as it was before the mastectomy. Breast reconstruction is performed by a plastic surgeon.
Most women who have had a mastectomy are candidates for reconstruction. Women who have had only part of their breast removed (lumpectomy) to treat their cancer may not need reconstruction.
To reconstruct the breast, the surgeon creates a breast mound by using a synthetic implant or tissue taken from other areas of the body such as the abdomen, back or buttocks. Implants are silicone sacs most commonly filled with saline (a salt water solution) or silicone gel. The type of reconstruction depends on a number of factors including the patient’s body type, age, overall health and cancer treatment. A reconstructed breast looks like a natural breast but it does not have the same natural sensations of a breast.
Additional procedures following reconstruction may be performed to add a nipple or to further change the shape of either the reconstructed breast or the opposite breast, so that both breasts more closely resemble each other.
A non-surgical alternative to breast reconstruction following a mastectomy is to wear a prosthesis (breast form) inside the bra. However, many women also choose not to have reconstruction surgery nor to wear a prosthesis. This decision is one that will be made by the patient.
When a patient chooses to have breast reconstruction, this decision will be incorporated into her overall treatment plan and therefore should be discussed with doctors prior to the mastectomy. This will help determine the timing and type of reconstruction. The patient should have a full understanding of the procedural steps, expectations, risks, benefits and recovery involving reconstruction surgery as it fits into her treatment plan.
Timing of Breast Reconstruction
When breast reconstruction is done at the same time as the mastectomy it is called immediate. When it is done as a separate surgery some time following the mastectomy it is called delayed. The timing depends on a patient’s specific situation and her post-operative treatment.
An advantage to having immediate reconstruction is that it requires less time in the hospital for the patient, as the two procedures are done at once. It also results in less scarring.
Following this surgery, however, there are often follow-up procedures that need to be performed to complete the reconstruction such as nipple reconstruction or reshaping of the breast.
Not all women are candidates for immediate reconstruction, especially those who will be undergoing radiation treatment following their surgery. Radiation treatment can cause tissue shrinkage and discoloration of the skin creating less than optimal results for reconstruction. Delayed reconstruction is often a better choice for these women.
Types of Breast Reconstruction
Breast reconstruction mainly falls into two categories of surgery: those that use implants and those that rely on tissue from other parts of the body. This second type of surgery is called a tissue flap procedure. Some surgeries use a combination of the two to reshape the breast.
There is no one best reconstruction method as there are pros and cons to each. Factors such as a patient’s body type, overall health and cancer treatment will be taken into consideration to determine which type of reconstruction likely will produce the best results.