Why is it important for women to know about the option of breast reconstruction?

Many cancer specialists believe and our experience would suggest that knowing that breast reconstruction is an option will save many women’s lives because they will not procrastinate in seeking care for breast problems for fear of breast loss.

What are the psychological benefits of breast reconstruction?

Each woman benefits from breast reconstruction in her own personal and individual manner. Patients having immediate breast reconstruction often say they appreciate not having to deal emotionally and physically with the mastectomy deformity. Many women who have had their breasts rebuilt have said that this operation made them “feel better about themselves . . . normal or whole again.” Some women indicated that it relieved them of a constant reminder of the cancer and the mastectomy. Other women were pleased at the freedom it afforded them compared to wearing an external prosthesis.

What are the different options for breast reconstruction?

Basically, breast reconstruction can be performed with implants and tissue expanders or with flaps of the patient’s own tissues (autologous tissues). Implant and expander reconstructions are simpler, shorter, less expensive procedures with less downtime. However maintenance surgery is required over time. Autologous flap procedures are more extensive, bigger procedures that take longer to perform and have a longer recovery period. However, they have no long-term maintenance. Both types of reconstructive surgery can produce very satisfactory results.

What is the best placement of a mastectomy scar for the woman who desires breast reconstruction?

When skin-sparing mastectomy is to be done for immediate reconstruction, the best placement for this scar is usually around the areola with a 1- to 2-inch (3 to 5 cm) extension of the scar to the side or below the areola. For delayed reconstruction, the best placement of the mastectomy scar is in a low oblique position, extending from below the axilla (armpit) to the inner lower breast area. Either of these scars is easily covered by a brassiere.

What can be done if the mastectomy scar is in a bad location?

Breast reconstruction can be done with a mastectomy scar in any position. The scar position cannot be changed, but the reconstructive implant or flap can be positioned through this scar and the scar revised to provide the best possible appearance.

What areas can be reconstructed? Can large deformities and chest hollowness be filled in?

Predictably good restoration of the breast shape, contour, and size can now be achieved though breast reconstruction. It often improves the appearance of (but may not eliminate) scars, skin grafts, or radiation damaged skin. Fat injections using the patient’s own fat can be used to fill small hollows or indentations that exist next to the reconstructed breast.

Can partial defects after lumpectomy and quadrantectomy be reconstructed?

After completion of the lumpectomy or quadrantectomy, the general or oncologic surgeon checks the margins of resection to ensure complete tumor removal. He also assesses the area of tumor excision to determine if it will leave an unsatisfactory breast shape or size after healing and/or radiation therapy. If this is the case, the volume of the breast may be restored using oncoplastic surgical techniques or with injections of the woman’s own fatty tissue.

What is the role of fat grafting in reconstructing lumpectomy or mastectomy defects?

Fat injections taken from areas of tissue excess (such as the abdomen, buttocks, and thigh) and then reinjected into the breasts after the fat has been filtered of blood and other elements, represent an exciting new option for improving the results of breast restoration after lumpectomy and mastectomy. These grafts are used to fill hollows, to soften the tissues around breast implants and to improve skin quality after radiation therapy because of the stem cells that they contain which have a regenerative effect on the overlying skin.

What is the value of breast implants?

Breast implants have been an integral part of breast surgery for almost 45 years. They have been successfully used to restore breast shape and contour after mastectomy, correct breast and chest wall deformities and asymmetries, augment small breasts, and lift sagging ones.

Does a woman who has an implant breast reconstruction still need to have mammograms?

Mammograms are usually not necessary after a mastectomy and breast reconstruction. However, if an implant is placed in the opposite breast for symmetry or balance, this breast still needs to be monitored. Women should inform the breast imager that they have a breast implant or expander so that additional displacement views can be taken to help visualize the extent of the breast tissue.

How does aging or weight loss affect the results of breast reconstruction?

Every woman’s breasts age differently. Generally, however, there is gradual settling and lowering of the breast with time. Breast size also changes with aging; these changes are influenced by weight loss or gain, body fat content, and hormonal changes. When a woman’s breast has been rebuilt with her own tissues, it tends to age more like her natural breast ages, with better long-term symmetry. This symmetry is not as predictable over the long term with implant reconstruction.

In what ways will a woman’s rebuilt breast differ from her original breast?

It will be less mobile and have less sensation. It cannot produce milk. There are scars from the mastectomy and reconstruction. Furthermore, the nipple-areola does not totally match the other natural one and does not respond to stimuli.

When can a woman resume an exercise program after breast reconstruction? Will any activities be permanently restricted?

Although each patient recovers at a different rate, most women who have implant reconstruction can resume normal upper extremity activity after 3 to 4 weeks. After a flap procedure, activity can be resumed in 6 to 8 weeks.