Breast Reconstruction
Reconstruction of a breast that has been removed due to cancer or other disease is one of the most rewarding surgical procedures available today. New medical techniques have made it possible for surgeons to create a breast that can come close in form and appearance to matching a natural breast. Frequently, reconstruction is possible immediately following breast removal (mastectomy), which is the most convenient procedure for the patient. There are often many options to consider as you and your team of physicians decide on the best procedure for you.
This information will give you a basic understanding of the procedure -- when it's appropriate, how it's done, and what results you can expect. It can't answer all of your questions, since much depends on each patient's individual circumstances. Irvine, Riverside, and Newport Beach breast reconstruction candidates should be sure to ask Dr. Smith if there is anything you don't understand about the procedure. Take a minute to request a complimentary surgical consultation with Dr. Smith or call us at 949.450.2755 in Irvine or 951.734.2500 in Corona. You can also email your questions about breast reconstructions to our Orange County plastic surgeon.
Candidates for Breast Reconstruction Surgery
Most mastectomy patients are medically appropriate for reconstruction, many at the same time that the breast is removed. This is called immediate breast reconstruction. The best candidates, however, are women whose cancer, as far as can be determined, stands to be eliminated by mastectomy.
In any case, being informed of your reconstruction options before surgery can help you prepare for a mastectomy with a more positive outlook for the future.
Insurance Coverage for Breast Reconstruction
Most women who have health insurance and have undergone or are planning to undergo mastectomy are eligible for insurance coverage of their breast reconstruction procedure. In fact, Federal law requires that in most cases your insurance carrier cover the reconstruction. Dr. Smith and his office staff can check on your insurance coverage and help you with any necessary paperwork. With so much on your mind suring breast cancer treatment, Dr. Smith believes you should not have to spend a lot of time worrying about paying for your procedure and hoping it will be covered by insurance.
Check your policy to make sure you're covered and to see if there are any limitations on what types of reconstruction are covered. Also, get educated about the law so you know your rights when it comes to insurance coverage of breast reconstruction.
Planning Your Surgery
You can begin talking about reconstruction as soon as you're diagnosed with cancer. Ideally, you'll want your breast surgeon and your plastic surgeon to work together to develop a strategy that will put you in the best possible condition for reconstruction.
After evaluating your health, your surgeon will explain which reconstructive options are most appropriate for your age, health, anatomy, tissues, and goals. Be sure to discuss your expectations frankly with your surgeon. He or she should be equally frank with you, describing your options and the risks and limitations of each. Post-mastectomy reconstruction can improve your appearance and renew your self-confidence -- but keep in mind that the desired result is improvement, not perfection.
Your surgeon should also explain the anesthesia he or she will use, the facility where the surgery will be performed, and the costs.
Preparing For Your Surgery
Dr. Smith and your breast surgeon will give you specific instructions on how to prepare for surgery. This will include guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications.
While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days afterward.
Where Your Surgery Will Be Performed
Breast reconstruction usually involves more than one operation. The first stage is usually performed in a hospital. Dr Smith operates at Saddleback Memorial Medical Center, Orange Coast Memorial Medical Center, and Irvine Regional Hospital. An overnight stay is common after a mastectomy and immediate reconstruction.
Secondary surgeries are usually performed on an outpatient basis. This may be at either one of the above hospitals or at the Laguna Hills Surgery Center.
Types of Anesthesia
The first stage of reconstruction, creation of the breast mound, is almost always performed using general anesthesia, so you'll sleep through the entire operation.
Follow-up procedures may require only a local anesthesia, combined with a sedative to make you drowsy. You'll be awake but relaxed, and may feel some discomfort.
Types of Implants - Saline and Silicone
If your surgeon recommends the use of an implant, you'll want to discuss what type of implant should be used. A breast implant is a silicone shell filled with either silicone gel or a salt-water solution known as saline.
Silicone implants have the primary advantage that they are softer and feel more like a normal breast as compared to saline implants. This is particularly important when a breast is being reconstructed after a mastectomy. Silicone implants are currently available as part of a FDA study. This includes women with breast cancer undergoing reconstruction or women who already have a gel-filled implant and need it replaced for medical reasons. Eventually, all patients with appropriate medical indications may have similar access to silicone gel-filled implants.
The alternative saline-filled implant, a silicone shell filled with salt water, continues to be available on an unrestricted basis.
As more information becomes available, these FDA guidelines may change. Be sure to discuss current options with your surgeon.
The Surgery
There are many options available for post-mastectomy breast reconstruction. Dr Smith will thoroughly discuss the options available to you at your consultation.
The two types of reconstruction currently available can be divided into implant based reconstruction and reconstruction that uses your own tissue (flap).
Implant Reconstruction
The most common technique combines skin expansion and subsequent insertion of an implant.
Following mastectomy, Dr Smith will insert a tissue expander beneath your skin and chest muscle. Through a tiny valve mechanism buried beneath the skin, Dr Smith will periodically inject a salt-water solution to gradually fill the expander over several weeks or months. After the skin over the breast area has stretched, the expander is removed in a second operation and a more permanent implant will be inserted. The nipple and the dark skin surrounding it, called the areola, are reconstructed in a subsequent procedure.
Flap Reconstruction
An alternative approach to implant reconstruction involves creation of a skin flap using tissue taken from other parts of the body, such as the back, abdomen, or buttocks.
In one type of flap surgery, the tissue remains attached to its original site, retaining its blood supply. The flap, consisting of the skin, fat, and muscle with its blood supply, are tunneled beneath the skin to the chest, creating a pocket for an implant or, in some cases, creating the breast mound itself, without need for an implant.
Another flap technique uses tissue that is surgically removed from the abdomen, thighs, or buttocks and then transplanted to the chest by reconnecting the blood vessels to new ones in that region. This procedure requires the skills of a plastic surgeon who is experienced in microvascular surgery as well.
Regardless of whether the tissue is tunneled beneath the skin on a pedicle or transplanted to the chest as a microvascular flap, this type of surgery is more complex than skin expansion. Scars will be left at both the tissue donor site and at the reconstructed breast, and recovery will take longer than with an implant. On the other hand, when the breast is reconstructed entirely with your own tissue, the results are generally more natural and there are no concerns about implants. In some cases, you may have the added benefit of an improved abdominal contour.
Risks and Complications
Most women who must lose her breast to cancer can have it rebuilt through reconstructive surgery. However, there are certain risks associated with any surgery and complications that are specific to this procedure.
There are general problems such as bleeding, fluid collection, infection, excessive scar tissue, or difficulties with anesthesia which can occur, although they're relatively uncommon. As with any surgery, smokers should be advised that nicotine can delay healing and smoking should be stopped prior to surgery.
Implant specific problems also can occur. The most common of these problems is called capsular contracture. This can occur if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. This may be treated in several ways, including either removal or releasing the scar tissue or sometimes replacing the implant.
Reconstruction has no effect on the recurrence of cancer. It also does not interfere with chemotherapy or radiation treatment, which is sometimes needed after surgical treatment of breast cancer.
Your surgeon may recommend continuation of periodic mammograms on both the reconstructed and the remaining normal breast. If your reconstruction involves an implant, be sure to go to a radiology center where technicians are experienced in the special techniques required to get a reliable x-ray of a breast reconstructed with an implant.
Delayed Breast Reconstruction
Women who postpone reconstruction may go through a period of emotional readjustment. Just as it took time to get used to the loss of a breast, a woman may feel anxious and confused as she begins to think of the reconstructed breast as her own.
Still, there are some legitimate reasons to delay reconstruction until a later date. Some women are not comfortable weighing all the reconstructive options while they are struggling to cope with a diagnosis of cancer. Others simply do not want to have any more surgery than is absolutely necessary. Women with other health conditions, such as obesity, high blood pressure, or smoking, may also be advised to wait.
Follow-up Procedures
Most breast reconstruction involves a series of procedures that occur over time. Usually, the initial reconstructive operation is the most complex. Follow-up surgery may be required to replace a tissue expander with an implant or to reconstruct the nipple and the areola. Most surgeons recommend an additional operation to enlarge, reduce, or lift the natural breast to match the reconstructed breast. But keep in mind, this procedure may leave scars on an otherwise normal breast.
After Your Surgery
You are likely to feel tired and sore for a week or two after reconstruction. Most of your discomfort can be controlled by medication prescribed by your doctor.
Depending on the extent of your surgery, you'll probably be released from the hospital in a day or two. Usually a surgical drain is used to remove excess fluid from surgical site immediately following the operation. These drains are typically removed within the first week or so after surgery. Most stitches are dissolvable and do not need to be removed.
Recovery
It may take you up to six weeks to recover from a combined mastectomy and reconstruction. If implants are used without flaps and reconstruction is done apart from the mastectomy, your recovery time is usually less.
Reconstruction can not restore normal sensation to your breast, but in time, some feeling may return. Most scars will fade substantially over time, though it may take as long as one to two years. The better the quality of your overall reconstruction, the less distracting you'll find those scars.
Follow your surgeon's advice on when to begin stretching exercises and normal activities. As a general rule, you'll want to refrain from any overhead lifting, strenuous sports, and sexual activity for several weeks following reconstruction.
Chances are your reconstructed breast may feel firmer and look rounder or flatter than your natural breast. It may not have the same contour as your breast before mastectomy, nor will it exactly match your opposite breast. But these differences will be apparent only to you. For most mastectomy patients, breast reconstruction dramatically improves their appearance and quality of life following surgery.
If you have more questions or if you're ready to talk to Dr. Smith about breast reconstruction surgery in Orange County, click to schedule your free consultation or call our Irvine plastic surgery office at 949.450.2755 or contact us in Coroan at 951.734.2500. If you prefer, you can send us an email online with your breast reconstruction surgery questions.
Dr. Andrew Smith, providing cosmetic procedures and plastic surgery to those in the Orange County area including Newport Beach, Irvine, Huntington Beach & Riverside.