Breast reconstruction after mastectomy is cosmetic surgery to rebuild the breast. It may also be needed following breast-conserving procedures that result in one breast being disproportionate to the other. The goal is to create a breast mound with a natural form and appearance that matches the opposite breast as closely as possible. If both breasts are removed, the surgeon creates a natural shape in keeping with the proportions of the woman’s body and her own preferences.
Breast reconstruction can be done using saline or silicone implants or tissue from other parts of the woman’s body. In most cases, the elected procedure is performed at the same time as the mastectomy, but may be delayed to allow the chest to heal or until the conclusion of other needed treatments, such as radiation therapy.
Considerations in electing breast reconstruction include:
- The woman’s health and past medical history
- A past history of breast surgery
- The amount of breast tissue to be removed
- The health of the tissue at the site of the surgery
- Risk factors such as heart disease, diabetes, smoking, obesity and other illnesses
- The probability of complications
- The woman’s desires
For various reasons, some women opt out of breast reconstruction. Instead, some choose a prosthesis worn under the bra, and others do nothing at all. Consulting with a plastic surgeon experienced in breast reconstruction can help determine the best treatment option.
Prognosis of Breast Reconstruction
The prognosis for breast reconstruction using either implants or natural tissue is usually very good. Neither procedure can restore sensation to the nipple if it is lost. Surgery involving implants is usually shorter and recovery often faster than reconstruction with tissue. Implants tend to result in less blood loss than tissue reconstruction, but requires more visits to properly perform correctly. Using natural tissue results in some additional discomfort at the site where tissue is taken, but has the advantage of a breast that can be matched closely to the other breast and is softer and more natural than implants provide.
Follow-up care for breast reconstruction is necessary to watch for possible complications such as leaking implants. Physical therapy may be needed for women with natural tissue reconstruction to rebuild strength and flexibility in the area that supplied the donor tissue.
Like any surgery, breast reconstruction carries some rare but possibly serious risks. Among these are heart attack or stroke during surgery, loss of blood, infection in at the surgical site or in the lungs, bladder or kidneys, and blood clots in the legs that move to the lungs. The doctor’s examination and the woman’s medical history will reveal the relative risks of breast reconstruction and help the surgeon and patient decide the best course of action.