If you're considering breast reconstruction...
Reconstruction of a breast that has been removed due
to cancer or other disease is one of the most rewarding surgical procedures
available today. New medical techniques and devices have made it possible
for surgeons to create a breast that can come close in form and appearance
to matching a natural breast. Frequently, reconstruction is possible
immediately following breast removal (mastectomy), so the patient
wakes up with a breast mound already in place, having been spared
the experience of seeing herself with no breast at all.
But bear in mind, post-mastectomy breast reconstruction is not a simple
procedure. There are often many options to consider as you and your
doctor explore what's best for you.
This information will give you a basic understanding of the procedure
-- when it's appropriate, how it's done, and what results you can
expect. It can't answer all of your questions, since a lot depends
on your individual circumstances. Please be sure to ask your surgeon
if there is anything you don't understand about the procedure.
The best candidates for breast reconstruction
Most mastectomy patients are medically appropriate for reconstruction,
many at the same time that the breast is removed. The best candidates,
however, are women whose cancer, as far as can be determined, seems
to have been eliminated by mastectomy.
Still, there are legitimate reasons to wait. Many women aren't comfortable
weighing all the options while they're struggling to cope with a diagnosis
of cancer. Others simply don't want to have any more surgery than
is absolutely necessary. Some patients may be advised by their surgeons
to wait, particularly if the breast is being rebuilt in a more complicated
procedure using flaps of skin and underlying tissue. Women with other
health conditions, such as obesity, high blood pressure, or smoking,
may also be advised to wait.
In any case, being informed of your reconstruction options before
surgery can help you prepare for a mastectomy with a more positive
outlook for the future.
All surgery carries some uncertainty
and risk
Virtually any woman who must lose her breast to cancer can have it
rebuilt through reconstructive surgery. But there are risks associated
with any surgery and specific complications associated with this procedure.
In general, the usual problems of surgery, such as bleeding, fluid
collection, excessive scar tissue, or difficulties with anesthesia,
can occur although they're relatively uncommon. And, as with any surgery,
smokers should be advised that nicotine can delay healing, resulting
in conspicuous scars and prolonged recovery. Occasionally, these complications
are severe enough to require a second operation.
If an implant is used, there is a remote possibility that an infection
will develop, usually within the first two weeks following surgery.
In some of these cases, the implant may need to be removed for several
months until the infection clears. A new implant can later be inserted.
The most common problem, capsular contracture, occurs if the scar
or capsule around the implant begins to tighten. This squeezing of
the soft implant can cause the breast to feel hard. Capsular contracture
can be treated in several ways, and sometimes requires either removal
or "scoring" of the scar tissue, or perhaps removal or replacement
of the implant.
Reconstruction has no known effect on the recurrence of disease in
the breast, nor does it generally interfere with chemotherapy or radiation
treatment, should cancer recur. Your surgeon may recommend continuation
of periodic mammograms on both the reconstructed and the remaining
normal breast. If your reconstruction involves an implant, be sure
to go to a radiology center where technicians are experienced in the
special techniques required to get a reliable x-ray of a breast reconstructed
with an implant.
Women who postpone reconstruction may go through a period of emotional
readjustment. Just as it took time to get used to the loss of a breast,
a woman may feel anxious and confused as she begins to think of the
reconstructed breast as her own.
Planning your surgery
You can begin talking about reconstruction as soon
as you're diagnosed with cancer. Ideally, you'll want your breast
surgeon and your plastic surgeon to work together to develop a strategy
that will put you in the best possible condition for reconstruction.
After evaluating your health, your surgeon will explain which reconstructive
options are most appropriate for your age, health, anatomy, tissues,
and goals. Be sure to discuss your expectations frankly with your
surgeon. He or she should be equally frank with you, describing your
options and the risks and limitations of each. Post-mastectomy reconstruction
can improve your appearance and renew your self-confidence -- but
keep in mind that the desired result is improvement, not perfection.
Your surgeon should also explain the anesthesia he or she will use,
the facility where the surgery will be performed, and the costs. In
most cases, health insurance policies will cover most or all of the
cost of post-mastectomy reconstruction. Check your policy to make
sure you're covered and to see if there are any limitations on what
types of reconstruction are covered.
Preparing for your surgery
Your
oncologist and your plastic surgeon will give you specific instructions
on how to prepare for surgery, including guidelines on eating and
drinking, smoking, and taking or avoiding certain vitamins and medications.
While making preparations, be sure to arrange for someone to drive
you home after your surgery and to help you out for a few days, if
needed.
Where your surgery will be performed
Breast
reconstruction usually involves more than one operation. The first
stage, whether done at the same time as the mastectomy or later on,
is usually performed in a hospital.
Follow-up procedures may also be done in the hospital. Or, depending
on the extent of surgery required, your surgeon may prefer an outpatient
facility.
Types of anesthesia
The first stage of reconstruction, creation of the breast mound, is
almost always performed using general anesthesia, so you'll sleep
through the entire operation.
Follow-up procedures may require only a local anesthesia, combined
with a sedative to make you drowsy. You'll be awake but relaxed, and
may feel some discomfort.
Types of implants
If your surgeon recommends the use of an implant, you'll want to discuss
what type of implant should be used. A breast implant is a silicone
shell filled with either silicone gel or a salt-water solution known
as saline.
Because of concerns that there is insufficient information demonstrating
the safety of silicone gel-filled breast implants, the Food & Drug
Administration (FDA) has determined that new gel-filled implants should
be available only to women participating in approved studies. This
currently includes women who already have tissue expanders (see below
under Skin Expansion), who choose immediate reconstruction after mastectomy,
or who already have a gel-filled implant and need it replaced for
medical reasons. Eventually, all patients with appropriate medical
indications may have similar access to silicone gel-filled implants.
The alternative saline-filled implant, a silicone shell filled with
salt water, continues to be available on an unrestricted basis, pending
further FDA review.
As more information becomes available, these FDA guidelines may change.
Be sure to discuss current options with your surgeon. (Above guidelines
are current as of July 1992.)
