BREAST RECONSTRUCTION PROCEDURE
|Return To Daily Activities||6-8 Weeks|
|Return To Work||4-6 Weeks|
|Average Procedure Time||2-6 Hours|
CHOOSE THE RIGHT TIME
Patients who have had breast cancer surgery are presented with an option for breast reconstruction. Breast reconstruction is the formation of a breast mound to replace the removed breast tissue. The first choice for the patient is whether this is done immediately at the time of the breast removal or delayed until a later time. The initial discussion with the patient is often overwhelming for them as there is so much information being presented for their consideration. It is very important for each patient to understand each option; the timing of the reconstruction is simply the first decision the patient must make. When radiation therapy has been recommended for the patient, it is probably best that reconstruction be delayed. Chemotherapy treatment, however, does not affect the decision to delay the reconstruction.
AUTOLOGOUS TISSUE VS. IMPLANT
After the patient has determined their preference for immediate or delayed reconstruction, they must understand the options between using autologous tissue or an implant. Autologous tissue reconstruction refers to the use of your own tissue to build the breast mound. These are known as flaps which most often come from the abdomen (TRAM flap) or the back (latissimus muscle flap). These muscle flaps have the advantage of utilizing your own tissue and seem to improve the ability to provide a more natural shape to the breast.
SURGERY & RECOVERY
These surgeries are typically more technically demanding and therefore have more potential complications associated with them. Patients usually take longer to recover from these surgeries as well. For the latissimus flap, a patient may expect to spend 2-3 days in the hospital; a TRAM flap may spend 3-5 days in the hospital. For both of these surgeries one can expect to take several weeks to return to the activities of daily living. When it is determined that the latissimus flap may be the best option, this often requires an implant in addition to provide adequate volume. This option then takes on the additional complications associated with implants.
Patients who choose to have implants typically do so for lifestyle reasons. The initial recovery is shorter and usually only requires a single night stay in the hospital. In this option, the patient has an expander placed into the breast area and then is filled with fluid over a period of several weeks. The expander has either a port which is integrated into the device or has a port placed beneath the skin several inches away from the expander. The expander functions as a “spacer” and provides a mechanism to shape the skin in preparation for a permanent implant.
For the patient undergoing implantation, a choice of implants is provided to the patient. They can be offered saline filled or gel filled implants for their reconstruction. To add to the confusion, there are combination implants which are filled with both silicone gel and saline, and expanders which also function as permanent implants. From my standpoint, I present the patient with the option of using either the gel filled implant or a saline filled implant. A second procedure in the operating room is required to remove the expander and place the permanent prosthesis. It is usually an outpatient procedure and takes 7-10 days before the patient is performing routine activities easily.
RECONSTRUCTION IS A PROCESS
The reconstruction of the breast is a process. It may require several procedures to produce the shape of the breast desired. The opposite breast may need to be altered as well in order to produce better symmetry. It is not unusual to perform a breast reduction or breast lift to the opposite breast. The opposite breast may or may not need a breast implant to match the volume of the reconstructed breast. Insurance companies are required to provide benefits for alteration of the opposite breast following reconstruction for breast cancer.
NIPPLE AREOLA RECONSTRUCTION
The final step is reconstruction of the nipple-areolar complex. I usually utilize small skin flaps in the area of the site determined for the location of the nipple. This can be done as an outpatient procedure and can easily be performed with sedation. After this has healed 6-8 weeks after the procedure, pigmentation may tattooed in the office. This may require 2 or 3 applications. Topical anesthetic may be used.