Treatments Related to Breast Reconstruction
The procedures for breast reconstruction include either using implants made of saline or silicone, natural tissue to rebuild the breast. In most cases, reconstruction is performed at the same time as a mastectomy, but may be delayed to allow time for the chest to heal or until the conclusion of other needed treatments, such as radiation therapy. When done at the same time, the doctor uses a skin-sparing technique to preserve enough skin to cover the reconstruction. When delaying reconstruction, the surgeon removes more skin to be able to close the incision.
In most cases, the procedure for implants occurs in two stages under general anesthesia. In the first stage, the surgeon places a pouch known as an expander under the chest muscle. Starting a few weeks later, every one or two weeks, the surgeon injects small quantities of saline (sale) solution through the skin into the expander. Over time, the pouch grows until it reaches the right size. Then one to three months are allowed to pass while the breast tissue heals.
In stage two of implant reconstruction, the surgeon removes the tissue expander and inserts the implant in a procedure usually lasting one to two hours. A third procedure to remake the nipple and areola may be performed at a later time.
The procedure using implants is typically shorter than using natural tissue and has a faster recovery period. However, on average implants in one in 10 women break or leak within the first 10 years after surgery, requiring follow-up monitoring and an additional procedure. In some instances, your surgeon may be able to place the implant immediately at the time of your mastectomy.
In this surgery to reconstruct a breast, the surgeon uses tissue with skin, fat, blood vessels and sometimes muscle taken from the abdomen or back and side, and occasionally the buttocks or thighs. The two procedures most often used for natural tissue reconstruction are transverse rectus abdominus muscle flap (TRAM), and latissimus muscle flap with a breast implant. Just as in reconstruction involving implants, general anesthesia is used.
In TRAM surgery, the doctor makes an incision across the lower belly. One technique loosens skin, fat and muscle leaving blood vessels attached, then tunneled to the breast area to reconstruct the breast. Another technique removes the tissue from the abdomen, cutting the blood vessels that supply the tissue, and then reattaching them to vessels under the arm.
The latissimus muscle flap procedure takes tissue from the upper back near the side of the breast that was removed. The surgeon then tunnels that tissue to the breast area to rebuild the breast. In some cases, an implant is placed under the chest wall to help match the size of the rebuilt breast to the existing one. A new nipple and areola can be created in a follow-up surgery.
Natural tissue breast reconstruction often results in a softer, more natural feeling breast than implants, but the procedure often requires transfusions to make up for blood loss and recovery in the hospital and at home can take longer.
Other treatments options for loss of a breast include a prosthesis that is worn under the bra, providing a natural shape. In some cases, women elect not have breast reconstruction surgery or use a prosthesis.