What is Breast Reconstruction?
Breast reconstruction is partial or complete reconstruction of a breast that has been partially or completely removed secondary to cancer. As the complexity of breast cancer treatment grows, so do the options for breast reconstruction. The main goals of breast reconstruction are to create a breast that appears similar to the opposite breast, and to alleviate the feelings of self-consciousness and deformity that can come from having an absent breast. Beyond the basics of reconstruction, though, Dr. Rovelo listens to her patients’ desires and takes pride in creating breasts that are also beautiful and unique to each patient.
Breast cancer treatment and reconstruction can be an overwhelming process. Dr. Rovelo would be honored to assist you with the process and to be there with you throughout the journey.
Who is a candidate for Breast Reconstruction?
Breast reconstruction is a complex process that needs to be performed in coordination with your surgical, medical, and radiation doctors. Breast reconstruction can be performed at the same time as your mastectomy (immediate reconstruction) or after treatment protocols are completed (delayed reconstruction).
Patients that are undergoing a partial mastectomy may also be candidates for reconstruction. Reconstruction is performed in these cases if the partial mastectomy creates a deformity or significant size discrepancy. Oncoplastic techniques including breast reduction and breast lifts can be used to minimize and obscure the resulting deformity.
How is Breast Reconstruction Performed?
There are multiple techniques for breast reconstruction, and how a reconstruction is performed is determined by many factors including patient preference, body habitus limitations, mastectomy techniques, and whether or not radiation has been administered or will be required. Dr. Rovelo performs many techniques of breast reconstruction including oncoplastic reconstruction, implant based reconstruction, and fat grafting.
- Oncoplastic reconstruction is performed in the setting of a partial mastectomy (lumpectomy). Surrounding breast skin and tissue is rearranged in a reduction or mastopexy (breast lift) pattern to allow for removal of a large amount of breast tissue without compromising the overall shape of the breast. Typically, a contralateral symmetrizing reduction or lift is performed.
- Two-Stage implant based reconstruction can be performed in either an immediate or delayed fashion. A two-stage reconstruction requires placement of a tissue expander that will be gradually inflated over several weeks, until a desired volume is achieved. Once the inflated expander has adequately stretched the overlying skin, it is exchanged for a permanent implant. Implants and tissue expanders can be placed either under the muscle (subpectoral) or over the muscle (prepectoral).
- Single-stage implant based reconstruction is performed in select patients that meet the requirements for a direct-to-implant reconstruction. In this situation, the implant is placed immediately at the time of the mastectomy, and no expansion is required. Typically, these are patients who are undergoing a nipple-sparing mastectomy, have small to moderate sized breasts, and do not wish to be a larger size. Implants can be placed either under the muscle (subpectoral) or over the muscle (prepectoral).
- Latissimus dorsi flap reconstruction can be performed with or without an expander or implant. This reconstruction is utilized when the mastectomy skin has been compromised by radiation and undamaged, nonradiated tissue is required to complete the reconstruction. In this surgery, skin and muscle from the back is rotated around to the front of the chest wall and used to create a breast mound, with or without an underlying implant.
- Fat grafting is typically used as an adjunct technique to all of the above forms of reconstruction. Fat grafting involves harvesting your own fat through standard liposuction techniques, washing the fat, and then immediately reinjecting it into the breasts. Fat grafting in breast reconstruction is typically used to camouflage small contour deformities. It can also be used to alleviate some of the side effects of radiated breast tissue.
Risks of expander/implant reconstruction include infection, skin flap necrosis, nipple necrosis, delayed healing, capsular contracture, and loss of the implant. Flap reconstruction complications include loss of the flap, delayed healing, scarring, seromas (fluid collections), and the risks associated with implants (if used in combination). It is important to talk with your surgeons about the risks of your surgery and how the risks can be minimized to provide both the best oncologic and reconstruction outcomes.
Recovery depends on the type of reconstruction performed. Expander/implant reconstruction patients will typically spend one night in the hospital. They will be discharged with drains and seen in clinic every week until their drains are removed. At that time, if it is an expander reconstruction, expansion will occur every week until the desired volume is achieved. Patients that have a latissimus dorsi flap reconstruction will have a similar recovery, although they may stay in the hospital for several days longer until their pain is adequately controlled. They will also be seen in clinic every week until all drains are removed and then on a weekly basis if tissue expanders have been utilized.