Breast Cancer is unfortunately quite common is Southern California. The incidence is about 1 in 8 American women over the course of a lifetime. Breast Reconstruction offers women treated by Mastectomy the opportunity to approach normalcy once again. Some interesting facts: Breast reconstruction until the mid-eighties to nineties was almost always performed in a delayed fashion - meaning years following Mastectomy. The surgery can be performed in a number of different manners, but almost always requires multiple operations (Stages). Breast reconstruction is quite a bit more difficult than cosmetic breast surgery in the majority of cases. Breast reconstruction is usually covered by health insurance. Then again breast reconstruction offers hope to many women who have lost a breast to cancer. The alternative to breast reconstruction after mastectomy sits to the right.

Patient following Mastectomy without Reconstruction

As might be unexpected, breast reconstruction is controversial....in the media and even amongst physicians. Early in its history, physicians were concerned that surgery to restore the breast was potentially problematic to the continued screening of the patient for recurrent cancer. Advanced breast cancer should be treated aggressively. In these women it might be best to delay or even withhold breast reconstruction. For the majority of women presenting with early disease. immediate reconstruction is low risk.

Breast Reconstruction Basics

(1) Immediate versus Delayed Reconstruction

(2) Implant-based versus Tissue-based Reconstruction

Immediate Reconstruction starts at the time of mastectomy. In this case breast mound reconstruction directly follows the cancer operation. Obviously, Delayed Reconstruction occurs some time following mastectomy either because of patient preference, patient health or extensive cancer at mastectomy.

Implant-based Reconstruction involves the use of breast implants and tissue expanders. Breast mound reconstruction is facilitated by stretching the skin with a balloon (Expander). A later operation is performed to remove the expander and place a permanent implant. Tissue-based Reconstruction involves the use of the patient's own tissues most often moved from the abdomen or back to provide volume for a breast mound. In some cases, one or the other type will be recommended. The tissue-based versions provide a better aesthetic result but require a larger operation and more disability to get there. At this point in the United States, about 70% of breast reconstructions are performed using Expanders and implants. A example of an implant reconstruction follows:

An Immediate Breast Implant Reconstruction

  

This young woman had an early invasive breast cancer. She chose mastectomy and wished an immediate reconstruction with as little as possible opposite breast surgery. She was neither a smoker nor a diabetic and it was not predicted that she would need post-operative radiation therapy. A skin-sparing mastectomy was performed after which a small breast implant was placed. This is sometimes possible in patients with healthy skin following mastectomy A year later, she chose to have nipple-areolar reconstruction, an outpatient operation.

Tissue Expansion Technique

Breast Reconstruction Surgery and Risk

• Skin Necrosis - After mastectomy the skin of the breast is compromised as the underlying breast has been completely removed. If this skin is unable to heal, additional surgery is frequently required. Furthermore, in these cases implants can be lost and scar can result in a good deal of distortion and therefore a poor aestheic outcome.
• Capsular Contracture - The size of the wound at mastecomy and reaction of the patient's tissues to breast implants (if used) put reconstructive patients at higher risk of significant breast hardening or capsular contracture. Patients can develop distortion and pain which may lead to the need for further surgery.
• Scarring, Hernia and Distortion - Tissue-based reconstructions leave a second wound with the possibility of hernia formation, poor scarring and other complications related to the size of the wound.
• Immediate Reconstruction leads to better aesthetic results when implant-based techniques are employed.

More Information on Breast Implants in Reconstruction

FDA Consumer Statement On Breast Implants-Get it from the source!
McGhan Medical's Patient Informed Consent Brochure - FDA  PDF format
Mentor's Patient Informed Consent Brochure - FDA  PDF format
 

Please note that this information (as well as that on all my pages) is offered freely to individuals considering surgery. No rights are granted (this is my intellectual property) and it is not to be reprinted or copied without the author's prior written consent. Understand that some of the information presented may be a matter of professional opinion. Although efforts have been made to assure accuracy, no guarantees are expressed or implied.