You can begin to talk about and plan for breast reconstruction following your diagnosis of breast cancer. It is best if you, your cancer team (surgeon and oncologist) and your plastic surgeon work together to plan a course of action specific to your needs. For some it will be appropriate to perform immediate reconstruction at the initial time of breast removal. For others delayed reconstruction might be a better option due to health conditions like heart disease, diabetes, and obesity or due to a need for radiation following surgery, or for personal reasons. Open and honest conversations between you and your surgeon to discuss goals, expectations, surgical options and risks are the perfect place to start.
Types of Breast Reconstruction
Breast reconstruction can be achieved through several surgical techniques that each attempt to restore the size, shape, and appearance of the breast. These techniques include:
- Placement of a breast implant to restore volume and appearance of a breast mound.
- Tissue expansion which involves placement of an expander that through a series of injections, stretches the remaining healthy skin to allow for the future placement of a breast implant.
- Flap reconstruction that uses the woman’s own muscle, fat and skin to create a new breast. This can be done with or without the additional use of an implant.
- Specialized nipple and areola replacement with grafts and local flaps of skin.
One of the more common techniques, tissue expansion involves the placement of a tissue expander (adjustable balloon) following mastectomy to gradually stretch the remaining healthy tissue. The recovery from the procedure can be easier than with flap reconstruction, but it can be a more lengthy process due to the need for multiple office visits to slowly fill the device. The expander device is slowly filled over several months through an internal valve with saline (salt-water solution) injections. At a second surgical procedure the expander is removed and a permanent breast implant is placed.
Flap reconstruction that uses the woman’s own muscle, fat and skin to create a new breast can be used in those who do not desire the use of implants or those who want a softer more natural feeling breast replacement. These procedures require a much longer operation and a more lengthy recovery process when compared to implant reconstruction. The tissue can be taken from various locations including the abdomen (TRAM flap) and back (latissimus dorsi flap). Incision lines/scars will appear at both the donor site and at the reconstruction site, but one added benefit of using tissue from the abdomen can be an improved contour. The flap of tissue can be moved to its new location in the chest by either leaving it attached to its original blood supply (pedicled) or it can be removed completely (free tissue transfer) and re-attached to a new blood supply in the chest by microscopic surgery. This technique will require that your plastic surgeon also has experience in microvascular surgery.
Flap reconstruction showing tissue taken from the back (latissimus dorsi muscle) and tunneled to the chest for recreation of a breast mound. Depending on the amount of tissue, this is performed with or without an implant.
Preparing for surgery
Dr. Geoghegan will carefully explain your breast reconstruction procedure and prior to surgery you will be given specific instructions on medications to avoid before and after surgery, pre-surgical testing and clearances that may be indicated and day of surgery related information. You will also be asked to sign consent forms after all of the risks and benefits of your procedures have been explained to your satisfaction. It is important that you discuss all of your questions directly with Dr. Geoghegan. Feelings of anxiety and pre-operative stress can be quite natural and discussing these issues with your plastic surgeon can insure that you are both on the same page.
Many of the surgical techniques used for breast reconstruction are performed in the hospital setting and require a short hospital stay, depending upon which reconstructive technique has been chosen. These procedures are usually performed under general anesthesia, although certain touch-up procedures and nipple creation can be done under local anesthesia and sedation. These decisions will be made between you and Dr. Geoghegan with your comfort and safety in mind.
After surgery you will be given instructions on your follow-up care. We will provide you with specific instructions on what to do with the bandages, how to care for incisions, when to shower, what medications to take, areas of concern to look out for, when to follow-up with Dr. Geoghegan and how to care for and record drains if they are required for your procedure.