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What Are My Breast Reconstruction Options?
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Trying to make informed, reasonable, and significant decisions regarding breast reconstruction when you have recently learned that you have breast cancer can be more than overwhelming. The multitude of choices to contemplate can be difficult enough without having the “C” word always in your mind.
For this reason, the following will outline a few basic issues to consider when you want to pursue breast reconstruction.
When Should I Have a Breast Reconstruction?
In general, there are two options when it comes to the timing for breast reconstruction: immediate and delayed.
When the reconstruction is done during the same surgical setting as the mastectomy or lumpectomy, this is known as immediate reconstruction. The general surgeon and plastic surgeon coordinate the procedure so that both do their part during one operative time. There are many advantages to this approach, including avoiding a separate surgical setting to perform the reconstruction. This also translates into one postoperative course versus two and less overall time off from work and other activities. In addition, depending on the procedures performed, you will either have a reconstructed breast or at least a portion of one compared to a deformity or flat chest wall if there is no immediate reconstruction.
A downside issue of immediate reconstruction is that not every woman is a candidate, and several factors will determine this. There are other increased risks for some potentially significant problems, including poor blood supply of the remaining skin following the mastectomy, which can jeopardize the reconstruction itself.
This is where the breast reconstruction is performed at a later date—typically six months or more following the mastectomy or rarely, lumpectomy. This can result in a lower risk of some problems, like healing issues, and allow for improved precision with some techniques—provided that there has not been radiation therapy.
There are also many downsides to selecting delayed breast reconstruction as opposed to undergoing reconstruction immediately. A second surgical setting is needed, which means undergoing a second anesthetic and another recovery period that will affect physical activities and time off from work, school, or other important engagements. The tissues would have scarred, which may lead to the need for additional procedures, such as tissue expansion, which otherwise might not have been necessary if the reconstruction had been done concurrently with the mastectomy or lumpectomy. Then there also is the negative psychological toll on many patients who go six months or more without their breast(s) following a mastectomy.
What Are the Types of Breast Reconstruction?
There are two categories of reconstructive techniques that are used for breast reconstruction. These are implant-based and flap reconstruction.
Breast Implants and Tissue Expanders
If there is an adequate skin envelope available for reconstruction of the breast to the desired size, then breast implants can be considered as the method of choice. This would be far more likely in the case of immediate reconstruction. Women with small breasts may not be candidates for this approach, as there may be an inadequate amount of skin needed to obtain the desired cup size.
When there is not enough breast skin present to accomplish the desired reconstruction, or a delayed breast reconstruction is selected, tissue expanders may be necessary. In essence, they are temporary inflatable implants that stretch the skin out over time to allow for the later placement of a larger implant than otherwise could have been used. These expanders are inflated in the office over a period of one to several months and then are surgically removed and replaced with the desired sized breast implant.
The technique utilizes tissue from another area of the body, such as the back or abdomen, to re-create a breast. This tissue can be moved into the area either with its blood supply remaining intact or with microsurgery—attaching it to a new blood supply. In some situations, a breast implant is used as well.
Unfortunately, this technique is far more complicated than using tissue expanders/implants and has a much higher risk for complications, both medically and aesthetically, including complete failure. The recovery period is generally longer as well. It creates wounds, possible functional and aesthetic deformities, and scars in the location where the tissue is taken from. However, this approach can be very helpful in failed implant-based reconstruction situations, especially where previous radiation therapy has been a factor.
Interested in Learning More?
If you are considering breast reconstruction surgery, contact the Arizona Center for Breast Surgery to schedule your consultation with Dr. Turkeltaub. Reach us by calling (480) 451-3000 or filling out our online contact form.