Your Reconstruction Options After Mastectomy

Choosing to undergo a breast reconstruction is a decision that merits serious consideration. You may know right away that reconstruction is right for you, but when it comes to picking the kind of surgery you want, there are new factors at play. Since every woman’s experience with their mastectomy is different, there are many types of reconstruction surgeries that are suited to different women’s bodies and health. Certain procedures will be a better fit for women who are still receiving radiation therapy, for example, while others may be better for women who underwent a double mastectomy. Your plastic surgeon will discuss your options with you during your initial consultation. You can expect to hear about three main kinds of reconstruction surgeries: implant reconstruction, tissue transfer reconstruction and a combination of the two.

Implant Reconstruction

An implant reconstruction works much the same way as a breast augmentation: you choose the type of implant you want — silicone or saline — and your surgeon uses the implant to restore volume to your breast area. If you are having your reconstruction after you have fully healed from a full mastectomy, your surgeon will likely use a multi-step process called tissue expansion for your implant reconstruction. During tissue expansion, a temporary saline device is inserted into your breast area and gradually enlarged over the course of several weeks. When it has expanded to create a space the same size as your desired implant, the temporary implant is replaced with a permanent one.

Implant reconstructions are a common choice because they are more widely available, and the procedure itself is less invasive with shorter recovery times. Additionally, the results of an implant reconstruction are highly customizable and very symmetrical. However, this kind of reconstruction also has some downsides: implants usually need to be replaced after some time, so you will likely need surgery in the future to replace them; and if you are still undergoing radiation therapy, you will have a higher chance of your body forming distorting scar tissue around your implant or other complications.

Another factor to consider is that for women who have had a single mastectomy, using an implant often makes it difficult to achieve symmetry with the remaining natural breast. Typically, surgeons will recommend reshaping your natural breast with a combined breast lift and implant so that it matches your new breast.

If you enjoy the perky, symmetrical look of breast implants; if you do not feel comfortable with the extent of a tissue transfer surgery; and if you are not undergoing radiation therapy, this kind of procedure may be a good option for you.

Tissue Transfer Reconstruction

These procedures are widely thought to create a more natural-looking breast that, in the long run, comes with fewer risks. Tissue transfer uses tissue from elsewhere on your body — typically the abdomen, buttocks or upper back — to rebuild your breast or breasts. There are two types of tissue transfer: pedicle flap transfer, which moves the new tissue to the site of the breast under the skin so that it does not detach from nerves and blood vessels; and free flap transfer, which fully detaches the tissue and relocates it to the breast area.

These procedures are more involved than implant reconstruction, which results in a few considerations. First, finding a qualified surgeon can be a little harder; second, your procedure will be longer and more invasive; and third, the site of your tissue removal will need to heal along with your new breast, which means recovery times tend to be longer and riskier. But for many women, the pros of tissue transfer outweigh the cons. You do not need to worry about concerns that come with implants like distorting scar/contracture, rupture or replacement. Since your new breast is made of your body’s own tissue, the likelihood of long-term complications is very low, even if you are still undergoing radiation therapy. Your breast will also feel more natural since it is made out of natural tissues, and it will change with your body the way a natural breast would. And, if you underwent a single mastectomy, it is often easier to match the new breast to your remaining breast with this kind of procedure.

One other consideration with a tissue transfer reconstruction is that creating a new breast requires removing a significant amount of tissue from somewhere else on your body. If you do not have sufficient extra tissue to spare, you may not be able to undergo this kind of reconstruction unless you are able to gain weight before your surgery.

Tissue transfer surgery might be right for you if you prefer a very natural look and feel over the appearance of implants; if you have enough body tissue to rebuild breasts in a satisfactory size and shape; and if you are healthy enough to undergo a more involved procedure and can take the time away from work to recover.

Combination Reconstruction

Using a combination of implants and tissue transfer is highly customizable, and your procedure will vary based on your needs and your surgeon. In some cases, it will involve a tissue transfer to ensure that there is enough skin and fat to cover a full-sized implant. More commonly, it will involve a smaller tissue expansion process that makes room for an implant to supplement natural tissue transfer.

Since this kind of procedure does involve some amount of tissue transfer, it is still a more invasive procedure with a longer recovery time when compared to implant reconstruction. However, transferring smaller amounts of tissue and boosting breast size with a small implant may be less risky for some women than using tissue alone. Additionally, using a smaller implant that is well-covered by muscle and can also reduce some of the risk associated with rupture or contracture.

This kind of reconstruction can be a great option for women who prefer the look and feel of tissue transfer but do not have enough natural body tissue to create a new symmetrical breast (in the case of a single mastectomy) or to create two new breasts (in the case of a double mastectomy). It also makes sense for women who want implants but do not have enough fat and skin tissue over their breast area to expand and cover an implant in the size they want.

Restoring women’s confidence and sense of wholeness after breast cancer and mastectomy is rewarding and humbling. At Dr. Andrews Plastic Surgery, we are dedicated to helping women find a reconstruction procedure that will give them the results they want. We are proud to provide reconstruction surgeries that we tailor to each of our clients’ needs. If you are interested in learning more about the breast reconstruction procedures that we offer, contact us at 319-800-6877.

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