Why Have Breast Reconstruction?
Women who choose to undergo breast reconstruction desire restoration of their breast(s) to near normal shape, appearance and size after mastectomy. Breast Reconstruction typically refers to several procedures in multiple stages. These procedures can be a physically and emotionally rewarding process for a woman who has lost her breast(s). Recreating breast mounds helps to lessen the physical and emotional impact of mastectomy. It is important that in considering breast reconstruction that you undergo this process for your own wishes only.
Breast reconstruction often represents the final stage in a woman’s battle with breast cancer; however many are not given the opportunity to speak to a plastic surgeon prior to undergoing treatment of their breast cancer. Dr. Wong prefers that her patients who are diagnosed with breast cancer speak with her at the time of diagnosis to discuss options for reconstruction. In some circumstances, reconstruction may not be necessary, but in many instances, the best overall results can be obtained by exploring breast reconstruction options early on and having a comprehensive plan prior to cancer treatment. Many options exist for reconstruction after mastectomy, lumpectomy or partial mastectomy, with or without radiation.
Your Consultation with Dr. Wong
At your breast reconstruction consultation with Dr. Wong, she will discuss the options for breast reconstruction with you. A physical examination will be performed and chest/breast measurements taken for surgical planning. Medical photographs will be used for surgical planning and discussion. Dr. Wong will answer any questions you have. No matter where you are in the battle against breast cancer, Dr. Wong is happy to speak to you about your reconstructive options.
Timing of Breast Reconstruction
There are 2 main types of breast reconstruction: immediate breast reconstruction and delayed breast reconstruction. The advantages of immediate breast reconstruction include decreased emotional difficulties as patients do not have to experience the physical outcome of their mastectomy defects. Also, obtaining a better cosmetic result may be possible. However, immediate breast reconstruction makes it more difficult to detect mastectomy skin problems as patients may experience skin sores around their incisions. Immediate breast reconstruction may require a longer hospitalization and recovery as well.
Delayed breast reconstruction has the advantages of allowing the patient to have more time for decisions. Also, additional necessary cancer therapy does not cause problems directly to the reconstruction. Sometimes, delayed breast reconstruction can be challenging due to the scarring of the tissues, leading to less optimal cosmetic results. Overall, there is no difference in the rate or ability to detect local cancer recurrence between immediate and delayed breast reconstruction. It is never too late to undergo breast reconstruction. Even women who have undergone lumpectomy, mastectomy, or radiation treatment many years ago have options for correcting the shape of the breast.
Radiation is a necessary part of cancer treatment for some women as it damages cancer cells and stops their growth. Your oncologist and surgical oncologist will discuss whether this is needed for you or not. In regards to breast reconstruction, radiation also damages the blood supply to normal skin at a microscopic level. As a result, women who have had radiation have an increased risk of complications with breast reconstruction such as infection, delayed healing, wound breakdown, implant exposure and capsular contracture.
Options for Breast Reconstruction
Each reconstructive option has its own risks and benefits and may not be suitable for all women.
Option “A” for Breast Reconstruction: Using an Implant
One form of breast reconstruction is with breast implants. People have wondered whether breast implants are safe. After extensive research with tens of thousands of women, breast implants were found to not impair breast health. Scientific research has found no proven link between implants and autoimmune or other systemic diseases. All breast implants are made with a silicone shell and there are 2 types of filling material: silicone and saline. Silicone implants feel natural and do not cause rippling. If the silicone implant has a leak, there is no immediate breast deformity or deflation. However, because of this, there is a need for monitoring of the implant if there are leaks; the FDA recommends women to get an MRI every few years as these leaks may not be noticeable on physical exam. Saline implants have the advantage of knowing when it is ruptured. However, they feel unnatural, almost like a water bag, and can cause rippling under thin skin. Regardless of the type of implant, both silicone and saline implants typically need to be replaced in the future (approximately every 10 years).
Tissue expansion is typically used in breast reconstruction. Mastectomy surgeries remove a majority of skin with removing the breast cancer. Placing a tissue expander underneath the skin and chest muscle stretches the skin to provide coverage for a breast implant. The tissue expander is similar to a balloon that is slowly inflated with saline (salt water) in the office over the course of a few months after the first surgery until the desired breast size is reached. A needle is placed through the skin into the expander and saline is injected; typically, this does not cause much pain. This is typically an easier recovering than surgeries where the patient’s own tissues are used, but is a longer reconstruction process overall. The sequence of the surgeries is as follows:
- First Surgery: Place the tissue expander under the skin and pectoralis muscle
- Surgery time: 1 – 2 hours
- Hospital time: 0 – 2 days
- Recovery time: 2 – 4 weeks
- Second Surgery: Replace the expander with an implant
- Surgery time: 1 – 2 hours
- Hospital time: 0 days (outpatient surgery)
- Recovering time: 1 week
The risks of using an implant for breast reconstruction are: capsular contracture ( a firm scar around the implant), implant rupture (needing MRI monitoring with silicone implants), implant exposure, implant infection, needing implant removal, bleeding, infection, poor healing of incisions, and reaction to general anesthesia.
Option “B” for Breast Reconstruction: Using Your Own Tissue
There are several options for using your own tissue (skin, fat and/or muscle). The first is using your abdominal tissue either with or without the abdominal muscle. In this surgery, the abdominal tissue is completely detached from the abdomen and transferred to the chest region to form a breast mound. An advantage of this surgery is that excess abdominal tissue is removed so that women get a “tummy tuck” in addition to breast reconstruction. This surgery is one initial major surgery which requires a longer initial recovery time. The typical surgery and postoperative recovery times are as follows:
- Operative Time: 4 – 6 hours per breast
- Typical Hospital Time: 3 – 5 days
- Recovery Time: 4 – 6 weeks
The second option in using your own tissue is using your back tissue. Specifically, the latissimus dorsi muscle from your back is used for coverage and padding of the breast. The function of this muscle is typically not missed unless you are in competitive sports such as row boating. In this type of breast reconstruction, the skin and muscle remains attached to its blood supply and is rotated through a tunnel across the chest and into the breast area. Although this tissue supplies some extra padding, a small implant may still be needed for an optimal result.
The risks of using your own tissue for breast reconstruction are: loss of the flap (or the tissue not surviving), loss of sensation (or numbness) at the reconstruction and donor sites, bleeding, infection, poor healing of incisions, and reaction to anesthesia.
*Individual Results May Vary
*Individual Results May Vary
*Individual Results May Vary
Preparing for Your Breast Reconstruction Surgery
Prior to your surgery, Dr. Wong will order necessary laboratory testing and other tests to check your heart and lungs. These are to screen for your safety of going under general anesthesia. Depending on your history of radiation, personal history of family history, Dr. Wong may have your overall medical health be evaluated by your primary care physician. She will advise you to avoid smoking, aspirin, ibuprofen and vitamins. If you are taking Tamoxifen, you will need to stop that medication 3 weeks prior to your breast reconstruction surgery. One of the most important things to prepare in breast reconstruction surgery is to have plenty of emotional support from your family and friends.
Gauze and bandages will be applied to your incisions immediately after surgery. A small thin tube may be placed in your surgical sites under the skin to remove any excess blood or fluid. These drains will be removed at your clinic visit. You will be given pain medications to control the discomfort and muscle spasms. Strenuous activities and heavy lifting are to be avoided for at least a month following surgery.
Breast Reconstruction Results
As each woman’s body structure, anatomy and journey with breast cancer is different, this makes results highly variable. In other words, no two women are exactly the same. In addition, any previous surgery can change your outcomes. The reconstructed breast will not have the same sensation as a normal breast. Visible incision lines (scars) on the breast from mastectomy or reconstruction are common. These scars may also be on any donor site, such as the abdomen or the back. While these are trade-offs, most women feel that these are reasonable compared to the large improvement in their quality of life and ability to feel whole again.
Asymmetry is likely, especially if only one breast is being reconstructed. Symmetry may be improved by lifting, reducing or augmenting the other breast with an implant. Multiple stages of surgery may be necessary for other components of reconstruction if the patient desires such as nipple and areolar reconstruction and fat transfer.
Breast reconstruction surgery can be rewarding to both the patient and the surgeon. Call and schedule an appointment with Dr. Wong today so she can optimize this surgery to your medical history, body frame and size. She looks forward to meeting you!