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. Breast reconstruction options are a key consideration for patients, as they encompass a range of procedures tailored to individual needs. 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.
All About Breast Reconstruction
Breast reconstruction is a surgical procedure designed to restore the shape and appearance of the breast following a mastectomy, which is often performed to treat or prevent breast cancer. For many breast cancer patients, breast reconstruction surgery can play a vital role in the healing process, helping to rebuild confidence and a sense of wholeness after breast cancer surgery. The primary goal of breast reconstruction is to create a natural-looking breast that closely matches the opposite breast in size, shape, and appearance.
There are several types of breast reconstruction techniques available, each tailored to meet the unique needs of individual patients. The most common options include implant reconstruction, which uses breast implants to recreate the breast mound, and flap reconstruction, which uses tissue from another part of the body to form the new breast. These procedures can be performed at the same time as the mastectomy (immediate breast reconstruction) or delayed until after other treatments, such as radiation therapy, are complete.
Choosing the right breast reconstruction method is a highly personal decision that depends on factors like your overall health, cancer treatment plan, and personal preferences. Consulting with a skilled plastic surgeon and breast surgeon is essential to explore the types of breast reconstruction that may be best for you. Together, you can develop a surgical plan that supports your recovery and helps you achieve your desired results.
Implant-Based Breast Reconstruction
An implant reconstruction works much the same way as a breast augmentation: you choose the type of breast implant you want (silicone or saline implants), 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 tissue expander 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. The breast implant is often placed beneath the chest muscle, specifically the pectoralis major muscle, to create a natural contour. 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. In some cases, an acellular dermal matrix is used as a supportive scaffold to help maintain implant position and improve outcomes.
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 Flap 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 lower abdomen, upper inner thigh, or latissimus dorsi muscle, to rebuild your breast or breasts using donor tissue. This approach is known as autologous reconstruction, meaning your own tissue is used for breast reconstruction. These tissue flaps are harvested from donor sites and can closely mimic the look and feel of a natural breast. 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. In flap surgery, the blood supply to the transferred tissue is critical for the success of the procedure, as it ensures the viability and healing of the new breast.
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, known as the donor site, will need to heal along with your new breast, which means recovery times tend to be longer and riskier. If your donor tissue is taken from the abdomen, you may experience effects similar to those of abdominal surgery, such as changes in core strength or scarring. 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. There are several types of flap procedures, including DIEP flap, SIEA flap, TRAM flap, PAP flap, and GAP flap procedures, each differing in terms of abdominal muscle involvement and donor site location.
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. Previous abdominal surgery may also affect your eligibility for certain flap procedures, as it can impact the availability and quality of donor tissue.
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. Implant surgery can be used in conjunction with tissue transfer to achieve optimal results for reconstructed breasts, offering patients more breast reconstruction options to meet their expectations.
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.
Delayed Breast Reconstruction
Delayed breast reconstruction refers to performing reconstructive surgery at a later time, rather than immediately following a mastectomy. This approach is often chosen by breast cancer patients who need to complete additional treatments, such as radiation therapy or chemotherapy, before undergoing breast reconstruction. Delaying the procedure allows the body to heal from the initial breast cancer surgery and ensures that any necessary cancer treatments do not interfere with the healing process of the reconstructed breast.
For some women, delayed breast reconstruction provides extra time to consider their options and make informed decisions about the types of breast reconstruction that best fit their needs and lifestyle. It can also be beneficial for those who want to focus on their cancer treatment and recovery before addressing reconstructive surgery.
The process typically involves a separate surgical procedure to create the breast mound, using either implant-based breast reconstruction or tissue flap reconstruction techniques. Your plastic surgeon will work closely with your breast surgeon to develop a personalized plan, taking into account your medical history, body type, and desired breast shape. While delayed reconstruction may require additional surgeries and a longer overall timeline, it offers flexibility and can still achieve natural-looking, satisfying results for many breast cancer patients.
Nipple and Areola Reconstruction
After the breast mound has been reconstructed, many women choose to complete their breast reconstruction journey with nipple and areola reconstruction. This final step helps restore the natural appearance of the breast and can have a significant impact on self-confidence and body image.
There are several breast reconstruction techniques available for recreating the nipple and areola. Surgical nipple reconstruction involves using small flaps of skin from the reconstructed breast to form a new nipple, which is then shaped and positioned to match the opposite side. Once the area has healed, medical tattooing can be used to add color and create the appearance of the areola, blending seamlessly with the surrounding breast tissue.
Some patients may opt for 3D nipple and areola tattooing alone, which uses advanced shading techniques to create a realistic, three-dimensional look without additional surgery. Your plastic surgeon will discuss the timing and options for nipple reconstruction surgery, as well as what to expect during the healing process.
Nipple and areola reconstruction is typically performed several months after the initial breast reconstruction surgery, once the new breast has fully healed and settled into its final shape. This step is optional, but for many women, it provides a sense of completion and helps the reconstructed breast look and feel more natural.
After Breast Reconstruction
Recovery after breast reconstruction is a unique journey for every patient, and understanding what to expect can help you feel more prepared and confident as you heal. Immediately following your reconstructive surgery, you may experience swelling, bruising, and discomfort, which your surgical team will help you manage with appropriate pain relief and care instructions.
Your plastic surgeon will provide detailed guidance on caring for your incisions, monitoring for signs of infection, and gradually resuming normal activities. Most patients can return to light activities within a few weeks, but full recovery may take several months, especially after more complex procedures like flap reconstruction or when tissue expanders are used.
Follow-up appointments are essential to monitor your progress and address any concerns. Over time, your reconstructed breast will settle into its final shape, and any additional procedures, such as nipple reconstruction or adjustments to improve symmetry, can be planned as needed.
Emotionally, it’s normal to experience a range of feelings after breast reconstruction, from relief and satisfaction to anxiety or uncertainty. Support from your healthcare team, loved ones, and breast cancer support groups can be invaluable during this time. Remember, breast reconstruction is a process, and your plastic surgeon is there to support you every step of the way, helping you achieve the best possible outcome for your health and well-being.
Schedule a Consultation
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 319-220-4644.
