Breast reconstructive surgery is generally achieved through a number of techniques that attempt to restore a breast to near normal shape, appearance, and size, following a mastectomy or lumpectomy. The surgery will however not give you a breast that looks and feels exactly the same as the breast that was removed.
Breast reconstructive surgery is a type of plastic surgery used to get back the shape of the breast after undergoing a mastectomy, or lumpectomy. The aim of the surgery is to match the existing breast as well as possible. There are generally three types of surgery. The first involves creating a breast through the use of an implant, which is put under the skin and chest muscles. The other two involve using skin, fat, and sometimes muscle from other parts of the body. The type of surgery that best fits you depends on:
- The amount of breast tissue removed
- The health of the tissue at the operation site
- Whether or not you have had radiation therapy to the breast or chest wall
- Your general health and body build
- Your wishes and lifestyle
The first, and probably most important step towards breast reconstruction, is to choose a surgeon that you trust, and feel comfortable with. When choosing your surgeon you should look at his background, and how much experience he has in plastic surgery. You should also ask the surgeon about scaring, and the length of recovery.
As mentioned there are three types of breast cancer reconstruction:
- Reconstruction using an implant
- Tissue Flap: This type of reconstruction involves skin, muscles and tissue from your back or stomach being tunneled through the chest to create a new breast. The skin, muscle and fat stays connected to the area from which it is taken.
- Free Flap: Similar to the Tissue Flap surgery, this form of reconstructive surgery involves skin, muscles and tissue, but these more often extracted from the buttock and lower stomach. Instead of leaving the tissue connected to the original area, the tissue is separated, and a new blood supply is created for the new breast using microsurgery.
There are two types of reconstruction using an implant. All three types are only suitable for women who have fairly small breasts.
The first type is referred to as subcutaneous (under the skin) surgery. In this type of reconstruction, the surgeon removes all the breast tissue, but leaves the skin and nipple intact. An implant is then placed directly under the skin to replace the removed tissue. Scaring is often visible when using this type of surgery, with the scar sometimes running from the side of the nipple to the side of the breast. The implant is sometimes easy to feel under the skin, giving it a less natural soft texture.
The second type of surgery is called submuscular. This is where the implant is placed underneath the chest muscles. This type of surgery is not suitable for everyone, especially if you:
- have had radical mastectomy (the chest muscles have been removed)
- have large breasts (difficult to match the two breasts)
- have had radiotherapy (your skin and muscles won't stretch enough for the implant)
The scaring that is left by this form of reconstructive surgery is often side to side, or at an angle following the line of the original mastectomy. A disadvantage of this type of reconstructive surgery is that the shape of the breasts changes, as the overlying muscles contract.
As with all types of surgery, there are complications that can occur. Through advances in modern medicine these complications are less than they used to be. Some examples of complications include: bleeding, seroma (fluid build-up under the scar), and keloid scarring (excessive scar tissue). But there are also possible long-term problems that can occur as a result of breast reconstruction:
Whenever a foreign object is inserted into the human body, such as an implant, the immune system responds by forming fibrous tissue around it. Over time, this tissue can contract as part of the natural healing process. Sometimes, when the contraction is severe, tightening, hardening and changes to the shape of the breast might occur. This can create discomfort, and spoil the match to the natural breast. The majority of contractions occur within the first year, but it can sometimes take up to 3 years.
If the contraction is so severe, or creates so much discomfort, the implant might have to be surgically removed, and a replacement inserted simultaneously. The risk of needing surgery to remove the implant as a result of capsular contracture is 10-20%, and is more likely needed if you have had radiotherapy prior to the implant.
The main problem with using tissue to replace the removed breast is that the flap might die. This is less likely to happen if Tissue Flap is used. When undergoing a Free Flap surgery, a new blood line has to be created. This is a difficult procedure, and therefore about 1 in 10 flaps develop some problem with the blood supply within the first 48hrs after surgery. About 3-5% Free Flap surgeries fail completely. When this happens the flap will have to be removed, and 6-12 months are needed to recover before a new try can be made.