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Reconstruction can help you heal
Breast reconstruction can be a critical component of healing and regaining your femininity. Whether you are looking at a lumpectomy, mastectomy or bilateral mastectomy, there are many options available to you. Breast reconstruction is best undertaken with a team approach whereby the oncologist, surgical oncologist and plastic surgeon work together to achieve an R0 or complete resection and achieve long term remission or cure.
Options for Reconstruction
The two methods for breast reconstruction are implant based or autologous tissue reconstruction. If your breast surgeon has recommended a lumpectomy, then oncoplastic reduction may be an excellent option in order to minimize scarring, as well as potential complications that can distort the breast shape in the years to come. If you are considering a mastectomy, then both implant and autologous tissue methods can be used at the time of mastectomy or months after your original procedure.
Implant based Reconstruction
Most implant based reconstructions are performed in a stepwise process. At the first operation, the breast tissue is removed and a tissue expander, a tougher, fillable implant, is used to shape and preserve an ideal pocket for the final implant.
Just like breast augmentation, tissue expanders can be placed in front or behind the pectoralis muscle. There is a growing body of evidence that shows that implants can be placed in front of the chest muscle (Prepectoral) and thereby minimize post operative pain and shorten the period between the 1st and 2nd stage reconstruction. Prepectoral implant reconstruction can also reduce the number of visits after surgery that are needed to fill your tissue expander to the desired volume. Once you have achieved the desired volume, the breasts are allowed to heal for 3 months.
The second stage operation will be easier than the first stage and does not require an overnight stay in the hospital. The tissue expander is removed, small modifications are made to the implant pocket, and the final breast implant is then placed. This can be done with or without fat grafting, but fat grafting will typically improve the final outcome.
In light of advances in medical tattooing, many women choose to not proceed with surgical reconstruction of the nipple, though that can be performed during a 3rd operation.
Autologous Breast Reconstruction
If implant reconstruction is not an attractive option, then skin and fat from other parts of your body can be used to reconstruct the breast. Most of these require microsurgery in order to transplant your tissue and make a new breast. Microsurgery entails detaching an area of tissue that is still attached to an artery and vein and then reconnecting that artery and vein in its new location. These blood vessels are typically 2-3 millimeters in diameter.
The lower abdomen can be used with the Deep Inferior Epigastric Perforator (DIEP) flap. This has become the most popular form of completely autologous breast reconstruction since it usually produces enough tissue to make an appropriately sized breast and the scar in the donor area (abdomen) is similar to an abdominoplasty (tummy tuck).
Other donor options include the upper buttocks (SGAP), lower buttocks (IGAP), and inner thigh (TUG/ DUG/ VUG).
Pros and Cons
There are pros and cons to avoiding a breast implant. One advantages is that it is your tissue. If you gain weight, it will also gain weight and vice versa. There is very little maintenance after the initial operation.
The cons are that not everyone is a candidate depending on whether or not they have enough tissue to “donate” to build a new breast. If you had larger breasts but very little abdominal or thigh fat, it may not be possible to create the breast size that you desire without an implant. The initial operation is quite a bit longer than implant based reconstruction with operative times anywhere from 6-12 hours. During the first couple of days, you will recover in either an ICU or a specialized monitoring floor in the hospital where the blood supply to the new breast can be monitored every hour.
Selecting the best method for breast reconstruction can be a very daunting task, but we are here to help guide you through the process. Together, we will design the best path for you.