Breast reconstruction is for mastectomy patients, who may choose to undergo breast reconstruction surgery immediately or at a later time. Because a number of choices are involved, some patients prefer to delay the decision while others prefer to complete all their surgeries at once. Regardless of when it is completed, many women experience a sense of restored wholeness as a result of this procedure.
There are three techniques used for breast reconstruction:
- Tissue Expansion - This technique is similar to that used for breast implants. The surgeon inserts a silicone "balloon" into the breast beneath the chest muscle. Either during the surgery or later, the balloon is filled with a saline solution. Over a period of weeks or months, more saline solution is added while the surrounding skin and muscle is given time to stretch and accommodate the implant. When the desired size is reached, an outpatient surgery replaces the temporary implant with a more permanent one.
- Breast Implant - For women with smaller breasts, a permanent implant can be inserted immediately into the breast without tissue expansion. Again, a silicone outer shell is filled with saline solution until the desired size is reached.
- Flap Reconstruction - Flap procedures use the patient's own tissue to rebuild the breast. The surgery is more extensive and takes longer to recover from than the other procedures, but there is no foreign body implanted and no potential for an allergic reaction. Three flap procedures are most commonly used:
- Latissimus Flap. The latissimus dorsi muscle runs across the back from the spinal column and upper hip to the arm just below the shoulder. The muscle is large in size and obtains its blood supply from the arm, making it a convenient choice for breast reconstruction surgery. Essentially, the surgeon tunnels through to the front of the chest and pulls the needed skin and fat to the front.
- TRAM Flap. TRAM stands for transverse rectus abdominis mycutaneous, the flat muscle group that runs from the rib cage to the pubic bone in the front of the body. Again, this muscle group's close proximity to the breasts and plentiful blood supply make it a good choice for this surgery. The surgeon cuts the muscle above the pubic bone and tunnels the needed skin, fat and tissue to the chest wall.
- Free Flap. In some cases, a surgeon may opt to use skin and fat that is supplied by a single artery and vein from a remote area, such as the buttocks or lateral thigh. In these cases, the tissue is completely removed from the body and reattached to the chest. At times, this technique is applied to a TRAM flap.
Regardless of the approach, once the incision is made, the surgeon gently pulls the skin away from the muscle and soft tissue and creates a pocket either in or below the pectoralis major or between the muscle and the breast gland tissue. An implant made of a silicone outer shell is inserted into the pocket and centered beneath the nipple. The implant is slowly filled with a saline solution until the desired size is reached. The incision is closed with sutures and the area may be draped with bandages. Drainage tubes may be inserted to help remove excess liquid over the next 1 to 2 days. The surgery generally lasts between 1 and 3 hours.
Breast reconstruction surgery is major surgery and requires inpatient hospitalization for 2 to 5 days. Drains are usually inserted to help remove excess fluid over the first 2 to 3 days. Stitches are removed in 7 to 10 days. While patients are encouraged to get up and move in the first 24 to 48 hours, recovery from breast reconstruction surgery can be slow. Patients are back to normal activity in 3 to 4 weeks, but overhead lifting and strenuous activities are limited for up to 6 weeks. Scars from incisions are permanent, but are generally located where they can be concealed. They do fade over time. Breast reconstruction cannot restore normal nipple or breast sensation, but some feeling may return in time.