If you have had a mastectomy because of breast cancer, you may choose to have breast reconstruction. It can restore symmetry between the two breasts by replacing skin, breast tissue and the removed nipple. The amount of reconstruction will depend on the mastectomy and the width, size, and location of the removed tumor
Restoring the breast isn’t considered a cosmetic procedure. It’s reconstructive surgery. Since it’s considered part of the treatment of a disease, the law says insurance providers must provide coverage.
Candidates for surgery
You may be a candidate for breast reconstruction if:
‣ You are able to cope well with your diagnosis and treatment
‣ You do not have additional medical conditions or other illnesses that may impair healing
‣ You have a positive outlook and realistic goals for restoring your breast and body image
Step 1 - Anesthesia : Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.
Step 2 - Flap techniques reposition a woman's own muscle : Flap techniques reposition a woman's own muscle, fat and skin to create or cover the breast mound.
Sometimes a mastectomy or radiation therapy will leave insufficient tissue on the chest wall to cover and support a breast implant. The use of a breast implant for reconstruction almost always requires either a flap technique or tissue expansion. A TRAM flap uses donor muscle, fat and skin from a woman's abdomen to reconstruct the breast. The flap may either remain attached to the original blood supply and be tunneled up through the chest wall, or be completely detached, and formed into a breast mound. Alternatively, your surgeon may choose the DIEP or SGAP flap techniques which do not use muscle but transport tissue to the chest from the abdomen or buttock. A latissimus dorsi flap uses muscle, fat and skin from the back tunneled to the mastectomy site and remains attached to its donor site, leaving blood supply intact. Occasionally, the flap can reconstruct a complete breast mound, but often provides the muscle and tissue necessary to cover and support a breast implant.
Step 3 - Tissue expansion : Tissue expansion stretches healthy skin to provide coverage for a breast implant.
Reconstruction with tissue expansion allows an easier recovery than flap procedures, but it is a more lengthy reconstruction process. It requires many office visits over 4-6 months after placement of the expander to slowly fill the device through an internal valve to expand the skin. A second surgical procedure will be needed to replace the expander if it is not designed to serve as a permanent implant.
Step 4 - Surgical placement of implant : Surgical placement of a breast implant creates a breast mound.
A breast implant can be an addition or alternative to flap techniques. Saline and silicone implants are available for reconstruction. Your surgeon will help you decide what is best for you. Reconstruction with an implant alone usually requires tissue expansion.
Step 5 - Grafting : Grafting and other specialized techniques create a nipple and areola
Recovery after breast reconstruction
Following your breast reconstruction surgery gauze or bandages may be applied to your incisions.
An elastic bandage or support bra will minimize swelling and support the reconstructed breast. A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid.
You will be given specific instructions that may include: How to care for your surgical site(s) following surgery, medications to apply or take orally to aid healing and reduce the risk of infection, specific concerns to look for at the surgical site or in your general health and when to follow up with your plastic surgeon.
Healing will continue for several weeks while swelling decreases and breast shape/position improve. Continue to follow your plastic surgeon's instructions and attend follow-up visits as scheduled.