Breast Reconstruction for Breast Cancer Patient with a Mastectomy
What are the risks and benefits of immediate breast reconstruction?
There are sometimes findings on the final pathology report that make chest-wall radiation advisable in order to reduce the risk of local recurrence. If a prosthesis for the breast has been implanted, the radiation treatment will still work, but the radiation may significantly compromise the cosmetic appearance of the prosthesis. There may also be healing problems that delay chemotherapy, potentially increasing the risk of breast-cancer recurrence. These and other factors should be discussed and carefully considered before committing to immediate breast reconstruction.
Quick facts about breast augmentation (breast implants)
- Smooth implants have less chance of rippling (waviness of skin) than textured (roughened) implants.
- Smooth implants have a higher incidence of capsule contracture (hardening of the implant) than textured implants.
- Implants placed under the muscle result in more pain postoperatively but have a lower incidence of capsule contracture and rippling.
- Infection and bleeding are rare but must be treated promptly.
- A certain number of patients may need another surgery to correct a problem.
- The aesthetic results of breast implants are best appreciated by the patient who feels the need for larger breasts.
What is breast augmentation?
Augmentation of the breast consists of insertion of a silicone bag (prosthesis) under the breast (submammary) or under the breast and chest muscle (subpectoral) and then filling the bag with saline (salt water). This prosthesis expands the breast area to give a fuller breast (increased cup size), give a better contour, and give more cleavage.
How is the incision made for breast implants?
The incision (cut) may be placed at various locations such as: under the breast at the breast fold; periareolar which is at the edge of the areola (brown area consisting of nipple and surrounding area); within the areola; in the armpit (axillary); or in the umbilical area.
The thinnest scar is usually in the areola. The umbilical incision approach is used with an endoscope (tube with a light for visualization and placement of the breast implant).
What are smooth and textured breast implants?
The smooth surface implant requires a large pocket and is associated with a 10% incidence of capsule contracture (tightening of the scar around the implant causing firmness or hardness). The smooth implant has only an occasional occurrence of rippling or wrinkling which gives the overlying skin a wavy appearance.
A textured (roughened surface) implant is associated with a 3% incidence of capsule contracture but has a 7-9% occurrence of rippling.
What are the choices of implant positions? The easiest surgical placement of the implant is under the breast tissue (submammary).
A slightly more difficult surgical placement is under the chest muscle (submuscular or subpectoral) but this position is associated with a lower incidence of capsule contracture and slightly less occurrence of rippling. There is more pain postoperatively than with a submammary placement.
Medically Reviewed by a Doctor on 10/27/2016