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Care of the Breast Cancer Patient

Breast Reconstruction

What is breast reconstruction and why should I consider this option?
Breast Reconstruction surgery is performed to recreate a woman’s breast after a mastectomy. Many women decide to have reconstructive surgery for a variety of reasons. Some women find that having reconstruction improves their body image and self-esteem, improves their posture and balance, improves their comfort in clothing, and eliminates their need to wear breast prosthesis.

Equally, some women choose not to have reconstruction because there is additional surgery involved or they may have conflicting medical problems. It is a personal choice, but it is helpful to get the guidance of your whole medical team (surgeon, oncologist, radiation oncologist, as well as a plastic surgeon), so that you can make the decision that is right for you.

Can breast reconstruction be done at the same time as the mastectomy?
Breast reconstruction is usually done at the same time as the mastectomy, but it is important to meet with a plastic surgeon to discuss this prior to your mastectomy. Some advantages of having reconstruction at the time of the mastectomy include:
Having a breast immediately after mastectomy
Fewer operations and less anesthesia
Personal preference

However, breast reconstruction can be done months or even years after your mastectomy. Some women choose to wait because they may need additional treatment for breast cancer, or they just choose to wait for personal reasons.

Are there different types of breast reconstruction that can be done?
There are various types and approaches to breast reconstruction surgery. Your plastic surgeon will recommend an approach based on your preferences, body shape, and type of treatment you may require in the future.

The most common types of Breast Reconstruction are:
Implants
TRAM Flap
Latissimus Dorsi Muscle Flap
Nipple/Areola Reconstruction

What are some of the advantage or considerations in choosing a reconstructive breast surgery procedure?
Implants: Implants are usually the simplest and most convenient form of breast reconstruction. Breast reconstruction with an implant is usually a two-step process. It is usually a one-hour procedure for the plastic surgeon to place a tissue expander. The tissue expander is like a balloon. It requires multiple trips to the plastic surgeon’s office to instill saline through a port until the skin is stretched enough to allow the implant to be inserted. This usually takes several months. Once the appropriate size is achieved, the surgeon will remove the expander and replace it with the implant, filled with either salt water or silicone gel. Implants sometimes need to be replaced, since they can shift, move, or break. Some women experience breast hardness, pain, or infection, although these are not common occurrences.

TRAM Flap (Transverse Rectus Abdominis Musculocutaneous Flap): A TRAM Flap is a surgical procedure that takes about 3 hours for the plastic surgeon to complete. his procedure can be done at the same time as a mastectomy or can be delayed. The surgeon takes excess abdominal tissue which receives its blood supply from the rectus abdominis muscle and slides it under the skin to form a breast mound. Moving muscle and tissue from the lower abdomen results in a flatter abdomen (tummy tuck). There are two incisions: an abdominal incision and a breast incision. The recovery is 4 – 6 weeks, and requires a 2 – 3 day hospital stay. An advantage of this procedure is that when all surgery is completed, the breast has a natural looking appearance.

Latissimus Dorsi Muscle Flap: The Latissimus Dorsi Flap is a surgical procedure that the surgeon uses to move a muscle from the back to the chest area to reconstruct the breast. This procedure is sometimes used with an implant. The surgery takes 2 – 3 hours. You will be in the hospital from 2 – 3 days. You will have a back scar, and recovery will take about 4 – 6 weeks.

Nipple areola reconstruction: This is an outpatient procedure usually done when a reconstructive procedure is completed to give a natural appearance to the reconstructed breast. Skin can be grafted from the inner thigh (forming an areola). Tattooing is also done to add more color to the areola. There will be a small scar on your inner thigh from where the skin graft was removed.

What if my breasts are two different sizes after surgery?
In general, the unaffected breast can be made smaller or larger to match the side of the reconstructed breast.

What are the risks of reconstructive surgery?
As with any surgery, there are risks of bleeding, infection, and poor wound healing. Fluid or blood can accumulate near the incision and can require drainage. There may be some numbness at the incision site. As with other surgeries there are risks associated with anesthesia.

Will reconstructive surgery be covered by my insurance plan?
You should always check with your insurance company to determine the extent of coverage. However, in most cases, reconstructive surgery is covered by insurance after breast cancer surgery, mandated by state law.

If you have additional questions or concerns, please call us at 847-797-9000.

 
 
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