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Breast Reconstruction Options

Pink Ribbon - Breast Reconstruction - Breast Cancer

Breast cancer is a very difficult journey. In the beginning, there is so much information being thrown at the patient at once, and it is never easy to make the big surgical decisions in the face of breast cancer. And all the information is overwhelming and it comes in all directions, from  physicians to family and friends. One of the first decisions you will be presented with is what type of surgery you will need. Depending on the size, location, and characteristics of your tumor, your breast surgeon can present you with several surgical options. 

The range of emotions one goes through include anger to confusion, so it is important that you know your risk factors and what is the best course of treatment for your case. 

 

  • Fear - about going through surgery or losing a breast

  • Anger - about getting cancer in the first place

  • Sadness - about losing a part of your body

 

Breast cancer patients find themselves thrown into the war of fighting this disease with a team of physicians, each one having an equally important role in you becoming a survivor. The surgical advances in the last couple of decades have been phenomenal with finding the best cutting edge technology to perform the latest techniques in breast reconstruction. Medical science has advanced so much with fighting this disease, with their commitment to find a cure - patients now have better odds of winning over cancer. 

Losing a breast in any capacity is something no woman wants to go through and it can tend to overshadow the concern for your health. The most important goal is to live a long life "cancer free"; however, just as important is holding on to your femininity. If your plastic surgeon recommends a mastectomy, many women can have immediate reconstruction! The main goal of breast reconstruction is to give the woman a sense of feeling whole again. There are no right or wrong answers with what is going to be right for you.

The standard of care for most mastectomy patients are for immediate breast reconstruction. This surgery is done at the time of the mastectomy, so the patient can wake up with a lesser deformity and know that she is on the reconstruction path. The psychological and aesthetic benefits of having this done at the time of mastectomy outweighs delaying the reconstruction. The drawbacks of having this surgery done at the time of the mastectomy is that it is a longer surgery and recovery, and if the patient needs radiation then this alone can compromise the reconstructed breast.

Patients facing breast reconstruction are concerned how the new breast will be in terms of shape, size, symmetry and of course, scarring.  Due to the surgery, reconstructed breasts can sometimes appear flatter, more round, or have less projection than a patient's natural breast.  A lot depends on whether your breast will be reconstructed with your own tissue or an implant. 

From a surgical perspective, bilateral reconstruction presents a better chance for symmetry, because the surgeon is starting with a clean slate. Unilateral reconstruction is harder, because it tends to be more difficult to match the natural droop of the opposite breast.

Restoring the breast is not considered cosmetic surgery - this is plastic reconstructive surgery.  This surgery is performed to restore a woman's anatomy and symmetry that she may have lost after a mastectomy. Breast reconstruction not only improves your physical appearance but has psychological benefits as well. 

 

                          Image of Cancer Cells

                                      Licensed image for CosmeticSurgeryForums.com

 

 

There are two types of breast reconstruction for the mastectomy patient:    

     Breast Implants
      •
Muscle Flap Reconstruction


Breast Reconstruction involves a surgeon forming a breast mount by using either an implant or actual tissue from the patient located from the abdomen, back or buttocks area. The choice of breast reconstruction type will depend on the patient’s body type, age and cancer treatment.

Breast reconstruction takes more than one surgery, including:

  • Adding a nipple
  • Changing the shape or size of the reconstructed breast
  • Operating on the opposite breast for a better match

 

 

 

 

 

 

 

                           Surgical Tools for Breast Reconstruction with a Breast Implant

 

                                              Licensed image for CosmeticSurgeryForums.com

 

 

 

 

 

Breast Implants

One of the options of reconstruction from breast cancer; is using breast implants. Almost one half of all the breast reconstructive procedures involves breast implants. Some patients are able to have the mastectomy and the placement of breast implants all done at once, providing that your chest wall is not too tight. 

The pectoralis muscle, which the implant will have to be placed behind, can sometimes be very strong and thick.  The thicker the muscle is, the harder it is going to be to place an implant immediately.  If this is the case, the plastic surgeon will insert a balloon-like tissue expander to stretch the tissue and muscle wall to gradually accommodate an implant.

 

                             Breast Reconstruction with a Breast Implant - placed completely behind the muscle

                                  Copyright 2008 Nucleus Medical Art, Inc. - Used with permission

             Breast Reconstruction with an implant placed completely behind the muscle

 

Having expanders will mean that the patient will go in regularly once a week for a period of anywhere from six to eight weeks, to have the expanders filled with injections of saline solution.  There is a port that the plastic surgeon will use (normally near the arm pit area) that the injections of the saline will go to fill the expander to prepare it for the actual implant surgery.

 

             Patient after Mastectomy        Patient with Reconstruction with a Breast Expander

                                  Copyright 2010 ADAM, Inc. - Used with permission                                       

 

This procedure is much less invasive that autologous reconstruction, and normally can be a choice for most breast cancer patients. However, if the patient will need radiation therapy then they are not a good candidate for reconstruction with implants. The surgery time for breast reconstruction with an implant is a much shorter than other methods, and may not require as much hospital time, providing it can be done at the time of the mastectomy.

If the patient elects to only reconstruct one breast with an implant, the chances are the implanted side will appear different. The shape of a breast reconstructed with an implant is going to have a different shape and feel to it. This is because as a woman ages her natural breast tissue changes shape. This procedure, if you are only having one breast reconstructed is better for women with small to medium sized breasts with little to no sagging. If a patient decides to have this done, then the surgeon can also either augment the other side or perform a reduction, so that the size will be more symmetrical.

As with breast augmentation, implants offered for reconstruction are two specific types – either saline or silicone. The use of silicone in reconstruction can sometimes yield a much better result rather than saline, as the incidence of rippling is not as much with the cohesive gel implants. 

The difference of silicone versus saline filled implants

 

                                         Image of adding saline to the breast expander                       

                                                       Licensed image for CosmeticSurgeryForums.com

 

 

 

 

Breast reconstruction sometimes requires the use of a tissue expander which will be placed beneath the skin and chest muscle. The expander is a saline filled device with a valve that will allow the volume to be added over a period of several weeks or months.

                                       

                      Smooth Shell Tissue Expander - External Port               Textured Shell Tissue Expander with Internal Port

                     Smooth Shell Tissue Expander                  Textured Shell Tissue Expander

                                    External Port                                                   Internal Port                     

 

 

Type of Expanders:

  • Some expanders have a separate injection port that is placed under the skin of the axilla or armpit area and is connected to the tissue expander body via a thin silicone rubber tube.

  • Other tissue expanders have an internal or integrated injection port built directly into the expander itself.  Incorporating the injection port into the expander helps in eliminating the risk of separation of the injection port from its connecting tubing.  This problem can cause the tissue expander to leak and to deflate and that requires additional surgery to correct.

  • Some plastic surgeons support the use of a post operative adjustable breast implant as an alternative to placement of a tissue expander followed by a conventional breast implant.   This adjustable implant resembles a saline filled breast implant.  It comes with a silicone rubber tube and remote port.  Although somewhat similar in functionality as the expander, the benefit of this device is that there would be no further surgery. The surgeon closes off the adjustable breast implant port, removes the tubing and the port and stitches up the tiny incision. 

 

                                            Breast reconstruction using a tissue expander

                                                Copyright 2010 ADAM, Inc. - Used with permission
 

                                                                                      

Your plastic surgeon will want to expand the skin until the reconstructed side is about 10 percent  larger than the opposite breast to compensate for the fact that the expanded tissues can shrink or recoil slightly after the expander is removed. Enlarging the reconstructed side larger also helps with trying to prevent capsular contracture. The shrinkage is not a problem if the patient is able to have immediate reconstruction with an implant in place.

There will be some discomfort with having the expanders, as the plastic surgeon will normally put in more ccs of saline than the actual size of the implant he or she might use. There usually is not a lot of pain associated with this, however.

After the patient has reached the desired size which is done with repeated office visits over a period of several months, the skin muscle envelope is slowly stretched to accommodate the new implant size.

 

 

 

 

The last step of this process is an out-patient procedure done in a surgery center or hospital where the expander is removed and replaced with a permanent implant. Once the implant is in place, the size of the reconstructed breast cannot be changed without a surgical replacement.

Most implants will need to be replaced at some point eventually, because breast implants are not life time devices. Scarring and Capsular Contracture are the most common complications with using implants.

This procedure entails a series of visits to your plastic surgeon – a balloon like device or a silicone shell implant previously inserted into the breast area is repeatedly filled with saline over a period of time. This process slowly stretches the tissue until the desired breast mound size is achieved. Once tissue expansion is achieved, the implant valve is sealed shut. Or another implant is used to give the desired shape and size of the breast mound, which is a more permanent method.  Implant techniques are usually shorter procedures that require the least amount of recovery and downtime.

There are some women who will not need to have a tissue expander at all, in which the surgeon will precede directly to the permanent implant surgery. Because breast implants are not lifetime devices, the patient will be facing subsequent surgeries to replace these devices as they age. Implants are available in saline and silicone, and come in a variety of shapes (round implant or anatomical shape implants), sizes, and textures.

 

 

 

                                           Breast Reconstruction using a prosthesis - breast implant

 

                                            Copyright 2010 ADAM, Inc. - Used with permission
 

                                                

 

  • Breast Reconstruction with just an Implant

Some women are fortunate in order not to need to have tissue expansion and are able to have the saline or the silicone implant inserted immediately after mastectomy. This depends on whether the size of the skin-muscle envelope is large enough to accommodate the implant.

The surgeon performs the implant based reconstruction by creating a pocket or cavity so the tissue expander or the implant can be placed beneath the pectoral muscle.  Blood transfusions are not necessary with this procedure. Creating the pocket under the muscle will cause some pain in the breast area for a few days after surgery. The pain is normally controlled with no problem with oral narcotic pain medication.

 

                                                      Placement of the breast implant - completely behind the muscle

                                       Copyright 2008 Nucleus Medical Art, Inc. - Used with permission

                                                   Placement of the Breast Implant

 

 

 

Women who are thin and athletic and are in need of breast reconstruction due to a mastectomy sometimes are faced with the breast implant rippling or the edges of the prosthesis showing because they do not have much tissue left.  Plastic surgeons are finding that the hip area or the "love handle area" can be an adequate source of body fat for "grafting" over the implant to help disguise the implant.

When implants are not used, flap reconstruction is another option. The TRAM Flap is the most commonly used procedure to help reconstruct breast tissue and skin from the abdominal area.  If the patient is thin and athletic - most women will not have enough tissue in that area, however; they are finding more excess fatty tissue in the space between the hip and the waist called "love handles".
 

 

                            Patient with a single mastectomy and breast reconstruction with a breast implant and fat grafting

                                         Copyright 2010 - CosmeticSurgeryForums.com                       

                     Patient with a single mastectomy and breast reconstruction with a

                                                         breast implant and fat grafting.

  

 

 

Implants that are used in reconstruction will not interfere with diagnosing a recurrence of cancer in that breast. Most surgeons and oncologist do not do mammograms of a reconstructed breast, simply because there is no breast tissue left. The implants are right against the chest wall and any recurrence is likely to be on the skin, so it is unlikely that an implant would mask any recurrence.

 

ADVANTAGES OF BREAST RECONSTRUCTION USING IMPLANTS:

  • Same mastectomy incision is used to insert the tissue expander and or implants, no additional scars on the breast

  • Less post operative pain

  • Shortest amount of time in the operating room

  • Shortest amount of recovery time 

 

RISKS OF BREAST RECONSTRUCTION USING IMPLANTS:

LESS COMMON RISKS OF BREAST RECONSTRUCTION WITH IMPLANTS:

 

RADIATION AND BREAST RECONSTRUCTION WITH IMPLANTS

Radiation increases the risk of Capsular Contracture, and also has a tendency to compromise the existing tissue that is left on the chest wall from the mastectomy that was performed. Radiation therapy often leaves the skin and underlying tissue discolored or damaged.  Most surgeons tend to recommend breast reconstruction with a tissue flap instead if the patient needs Radiation Therapy.

 

 

 

 

 

  • Member Stories                                                  

Member Stories about their journey with Breast Reconstruction: 

  • Cheryl's personal story of breast cancer with the BRCA Positive Gene - bi-lateral mastectomy and reconstruction with implants - here

  • Donna Hiskey's personal story of mastectomy and reconstruction with the Latissimus Dorsi Flap technique - here

  • PatriciaELa's personal story of a lumpectomy and breast reduction - here

  • Pat's personal story of BRCA Positive Gene and elective bi-lateral mastectomy and reconstruction with breast implants - here

 

 

 

 

 


 

More Breast Reconstruction and Breast Cancer Information:

 








    

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