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 goal of breast reconstruction is 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.
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 oncologists. 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. If the partial mastectomy creates a deformity or significant size discrepancy, oncoplastic techniques 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.
- 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. In select circumstances, a patient may be a candidate for immediate implant placement. 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 breasts, and do not wish to be a larger size.
- 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, unradiated 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.
- Abdominally based free tissue transfer brings a flap of skin and fat from the abdomen, and transfers this flap of tissue to the chest wall. This transfer requires that the blood vessels that supply the abdominal flap be harvested with the flap. These vessels are then connected to blood vessels in the chest, to allow for survival of the transferred flap. This procedure is time and labor intensive, and requires a hospital stay of several days. The benefit of this procedure is that it provides the most natural result, and on some occasions, is the only reconstructive option available.
Risks of expander/implant reconstruction include infection, skin flap necrosis, nipple necrosis, delayed healing, and loss of the implant. Free tissue transfer carries the risk of partial or complete flap loss, as well as donor site complications including bleeding, infection, scarring, and delayed wound healing. 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. Patients who have a free tissue transfer will stay in the hospital for 3-5 days. They will also be seen in clinic every week until all drains are removed.