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Reconstructive Breast
Breast Reconstruction
[ Patient Photos ]The breast is the most common site of cancer in American women and breast cancer will develop in 1 of every 8 to 9 women in their lifetime. Although a cure has not yet been found, breast cancer is now detected earlier and there are now improved modes of treatment. Still, being informed that you have breast cancer is frightening, confusing and earth shattering. Many women eventually undergo a mastectomy, but remain ill prepared or uninformed about reconstructive options. It is understandable that most are just happy to be alive, but why not restore the body to feel whole and complete once again?
Women who have undergone breast reconstruction have said that the procedure alleviates the pain of loosing a breast and improves their self-esteem and confidence. In fact, many can have an immediate breast reconstruction performed at the time of a mastectomy therefore, minimizing the feeling of loss associated with a mastectomy. Conversely, other women may choose to proceed with breast reconstruction months or even years after their mastectomy (delayed reconstruction). With the many options and advances available today, every woman diagnosed with breast cancer should seriously consider her reconstructive options, as well as the cancer treatment options. Everyone should also be aware of The Women's Health and Cancer Rights Act of 1998, signed into law in October 1998, requiring group health plans and health insurers to cover the cost of reconstructive breast surgery for women who undergo mastectomy for breast cancer. Coverage also includes surgery on the other breast to achieve symmetry.
Some common myths about breast reconstruction must be clarified:
- Immediate breast reconstruction will NOT delay or interfere with chemotherapy.
- There is NO evidence that breast reconstruction increases the risk of cancer recurrence or hides the presence of cancer.
What
reconstructive options does a woman have? Breast
implants (silicone gel or salt water
filled) have been used successfully for many
years and newer designs have lead to a more
natural appearing breast. Recent studies have
demonstrated that a woman with silicone
implants is no more likely than the rest of the
population to develop cancer or immunologic
diseases. In November 2006, the FDA lifted the
moratorium on gel implants, allowing their use
for both reconstructive and cosmetic breast
surgery. However, some women remain
concerned about using silicone gel filled
implants. Typically, a tissue "expander" is
placed under the skin and pectoralis major
muscle of the chest wall. Over the next 4 to 6
weeks, saline solution is placed into the
expander, during office visits, until
sufficient expansion of the skin has occurred
to create a breast mound. After several months
time to allow softening of the tissues, the
expander is removed and replaced with the long
term breast implant. An alternative approach
available to some women is to use a single
stage expander/implant that is left in place
after being expanded to the appropriate size.
This may avoid the second stage surgical
procedure necessary when a temporary expander
is used.
Alternatively, many women can
avoid implants altogether by having a "flap
reconstruction." This method uses a woman's own
tissue from the abdomen, back or buttocks to
create the breast mound. Most commonly, lower
abdominal tissue (TRAM flap) is used to create
a new breast that often feels and looks more
natural than one reconstructed using an
implant. A secondary effect of this
reconstruction is a tummy tuck. The Latissimus
Dorsi Flap uses muscle and skin from the back
to create the breast mound, often with
simultaneous use of an implant to provide
additional volume. Either of these flap
reconstructions can be performed immediately at
the time of mastectomy or in a delayed fashion
at a future date.
Finally, nipple reconstruction can be performed to complete the reconstructive process. And tattooing can add the color neaded to simulate the nipple/areola appearance.