Right now it is estimated that 1 in 8 women will be affected by breast cancer during their lifetime. The diagnosis of breast cancer can be a physically and emotionally terrifying diagnosis. However, modern surgical advances in technology make it possible to reconstruct a natural-appearing breast after breast removal (mastectomy) due to cancer and other diseases. Breast reconstruction can be a very rewarding procedure that not only creates a new breast but can dramatically improve your self-confidence and quality of life. While the results can be a significant improvement in the appearance and feeling of the breast, a reconstructed breast will never be exactly the same as the breast that was removed.
Dr. Geoghegan feels strongly that every woman deserves the opportunity for breast reconstruction and enjoys working with each patient to achieve their individual goals for recovery. There are many techniques for breast reconstruction available, with most involving several procedures performed at various stages. The information here will present an overview of breast reconstruction, but the best way to learn which method is best suited for your goals is to schedule a personal consultation with Dr. Geoghegan.
Through the advocacy efforts of many society’s and breast cancer support groups, insurance companies are required by law to provide coverage for breast reconstruction and the related procedures to adjust the opposite breast. Pre-certification will most often be required and checking with your individual policy to confirm your coverage and any limitations is always advised.
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.
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:
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.
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.
For more information on having breast reconstruction with Dr. Geoghegan call (480) 860-2173 today.
If you are considering a Breast Reconstruction procedure, here is what you should expect:
Highly variable depending on technique
Bleeding, infection, temporary or permanent numbness, uneven positioning or shape of breasts, poor incision healing, partial or complete loss of the flap, breast hardening, capsular contraction or implant failure and need for revision surgery.
Usually back to work 1-4 weeks, avoid strenuous activity for 3-6 weeks