Reconstruction

Most patients with breast cancer can benefit from breast reconstruction. If you would like information about the possibility of having your breast reconstructed, ask as soon as your cancer diagnosis is confirmed and the decision is made to proceed with an ablation. Ideally, the surgeon who is treating your cancer will be working closely with a qualified plastic surgeon to offer you the best options. Breast reconstruction may be performed using an implant, your own tissues, or a combination of the two.  

THE INITIAL CONSULTATION

Your consultation with the plastic surgeon is a crucial step in getting all the information you need about having your breast reconstructed. Bear in mind that the decision to have breast reconstruction is a very personal choice, a decision you will make after obtaining the necessary information and giving the matter some thought.

The plastic surgeon has a wide range of breast reconstruction surgery techniques to choose from as a way of giving each patient a custom-made solution. Based on many different factors (what the patient wants, the condition of local tissue, donor tissue sites that could be used, medical and surgical history and comorbidities, complementary chemotherapy or radiology treatments, the other breast), the plastic surgeon and the patient will decide together which of the available techniques is best suited to her particular case.

During the consultation, your surgeon will explain which of the various surgical options is best for your situation, your age, your anatomy, your tissues and your wishes. The surgeon will point out the advantages, disadvantages and risks of each type of procedure.

PLANNING THE OPERATION

The planning process begins with an overall assessment of your health and a clinical examination designed to reduce the risks of the chosen procedures as much as possible.

The discussion will cover the following points: the chosen surgical procedure, risks and complications, results you can anticipate after the operation, instructions for convalescence, restrictions, and physical activity before and after the procedure.

Breast reconstruction involves more than one procedure. To make sure the reconstructed breast and the other breast are symmetrical, the surgeon needs to either enlarge the remaining breast with a prosthesis or make it smaller through mammary reduction, in other words lifting sagging breasts.  It is advisable to wait for three to six months after the last operation before considering surgery to make your breasts symmetrical. The length of hospitalization will vary depending on the technique used.

If there will be radiation therapy along with the mastectomy, breast reconstruction is sometimes postponed to the end of the proposed treatment schedule.

LIMITATIONS

Breast reconstruction after a mastectomy can substantially improve your physical appearance and your quality of life, but there are limitations. You need to understand that you may never regain your original silhouette.

ADVICE TO FOLLOW

The surgeon will give you specific instructions to reduce the risk of complications during and after the operation. The most important advice is to stop smoking (six weeks before the procedure) and stop taking medication that can cause bleeding and hematomas (specifically, AspirinTM – based drugs and anti-inflammatory drugs, one week before the operation).

BREAST RECONSTRUCTION, STEP BY STEP

Except in a few rare cases, complete breast reconstruction requires more than one procedure, spread over a period of about a year.  This provides better control over different variables that can affect the healing process, with the goal of obtaining the best possible result in esthetic terms. Here are the three main stages in breast construction, which generally follow in this sequence.

First stage: Creating the breast mound is the first stage in breast reconstruction. The operation may take place immediately after the mastectomy or as a second procedure. It may be reconstruction with a prosthesis or tissue expander or with the patient’s own tissues. The goal is to restore the volume of the breast that has been removed.

Second stage: Making the breasts symmetrical is a procedure performed about six  months after the first stage. The delay gives the reconstructed breast time to become more flexible and assume a more natural position due to the effects of gravity. If the breast was reconstructed with a tissue expander, the expander is replaced by a prosthesis in the second stage. Adjustments are made if necessary so that the two breasts are symmetrical. This may involve a lift, a reduction or an augmentation of the unreconstructed breast, or touch-ups to the reconstructed breast.

Third stage: Reconstruction of the nipple and areola are relatively minor operations, performed under local anesthesia. Nipple reconstruction is sometimes performed during the second stage if there are no plans to adjust the reconstructed breast. It is important not to proceed with nipple and areola reconstruction until the very end of the process, when no further changes in shape or volume are required.