What is breast reconstruction surgery?
Breast reconstruction is a surgical procedure to recreate symmetrical, natural-looking breasts after complete (mastectomy) or partial (lumpectomy) removal of the breasts of breast cancer patients. Breast reconstruction is also considered for patients with inborn deformities of the breasts and certain patients who have had a serious injury to the breast.
What type of breast reconstruction is best?
Breast reconstruction falls into three broad types:
1. Implant-based reconstruction: This procedure uses breast implants to help form a new breast mound. In expander-implant breast reconstruction, a balloon-like sac is used. The expander-implant starts flat and is slowly expanded to the desired size to allow the skin to stretch. Once the skin over the breast area has stretched enough, a second surgery is done to remove the expander and put in the permanent implant. Expander-implant breast reconstruction allows time for other cancer treatment options to be given. For example, the expander can be filled during chemotherapy. However, the final placement of the implant is postponed if radiation treatment is needed until radiation treatment is complete.
Two types of expanders are available. In one type, the surgeon injects a salt-water solution through a tiny valve under the skin at regular intervals (every 1, 2, or 3 weeks) to fill the expander over several months. In the other type, the expander uses compressed carbon dioxide gas. The patient uses a remote control to release small amounts of the gas into the expander several times a day over 2 to 3 weeks.
2. Flap (autologous) reconstruction: This procedure uses the patient's tissue from another part of the body for breast reconstruction.
3. Reconstruction of the nipples and areolae
Several factors are considered when choosing which breast reconstruction option is best:
- Type of original breast removal: Complete/partial
- Cancer treatments planned
- Patient's body type
- Whether the patient wants reconstructive surgery on one or both breasts
- Desire to match the look of the other breast
What to expect before the breast reconstruction surgery?
- The patient is evaluated in the upright position.
- The surgeon evaluates the patient’s general health status and any pre-existing health conditions or risk factors.
- Breasts are examined and measurements are taken of their size and shape, skin quality, and placement of nipples and areolas.
- Photographs are taken.
- The doctor will discuss the likely outcomes of breast reconstruction and any risks or potential complications.
- The size of the tissue expander is estimated.
- Routine preoperative precautions, such as antibiotic prophylaxis and deep vein thrombosis (DVT) prevention therapies, are used as needed.
What happens during an expander-implant breast reconstruction?
- After the completion of the mastectomy, a pocket is created below the chest muscles for placement of the implant.
- Care is taken to preserve or recreate the fold below the breasts.
- The upper two-thirds of the implant is covered with muscles while the lower one-third has only skin over it.
- Following complete expansion, the expander-implant is removed through a cut.
- The permanent implant is inserted and filled with saline.
- The wound is closed in layers.
What are the complications of an expander-implant breast reconstruction?
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