Breast Reconstruction Surgery

Breast cancer is the second major cause of death in women in the United States, and 1 in 8 will be diagnosed with it at some time in their life. Breast reconstruction can help erase the physical deformity and psychological effects of losing a breast to cancer. Using a synthetic implant or the skin, muscle and fat from another part of the body, the procedure involves the creation of a breast mound and nipple similar in size and shape to the opposite breast. All of which can help a woman cope with cancer while restoring her self-confidence and sense of femininity.

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The Procedure
Several methods, typically involving more than one operation, are available for rebuilding a breast after mastectomy. In many cases, surgery can be performed at the same time the breast is removed. Your doctor will thoroughly discuss the various techniques in helping you select the one that is best for you.

Tissue Expansion and Breast Implantation
The most common method of breast reconstruction involves the use of an implant. Occasionally, the implant can be inserted directly, with no preliminary surgery. Typically, however, removal of the cancerous breast leaves insufficient healthy chest muscle and skin to do so; in which case a tissue expander must first be used to stretch the area.

In this method, a tissue expander—balloon-like device with an attached tube and valve—is inserted behind or on top of the chest muscle and filled with sterile saline. Additional solution is injected over the next several months. When the area has been sufficiently expanded, the device is removed and a permanent silicone-gel implant is inserted in its place. The nipple and areola can be reconstructed at a later stage by means of skin grafting or tattooing.

Alternative Approaches
Breast reconstruction can also be performed by means of flap reconstruction. In one approach, skin, fat and muscle are left attached to their original blood supply (usually from the abdomen or back), then tunneled under the skin to the chest. In another approach, tissue is completely detached from the donor site (usually the abdomen, back, buttocks or thigh) then reconnected to the blood supply at the chest. Skin grafting or tattooing can be used at a later date to reconstruct the nipple and areola.

Recovery
How you feel after surgery is influenced by many factors, including the method of reconstruction performed; whether the mastectomy was performed at the same time; what, if any, surgery was performed on the opposite breast; and if cancer treatments have been involved. In general, however, you can anticipate feeling tired and sore for a month or longer. This is typically controlled with rest, cold compresses and pain medication.

A surgical bra must be worn for several weeks to minimize bruising and swelling. If a thin drain tube was inserted during surgery to remove any excess fluid, it will be removed during the first week of recovery. Surface sutures come out in the course of two weeks, depending on the specific procedure(s) performed.

The degree of bruising, amount of swelling, and length of time required before returning to work can vary greatly between reconstruction methods and from one patient to another. Your Doctor will discuss at length the specifics of your case and what can be expected afterward.