Breast Cancer: Surgical Reconstruction
Surgical reconstruction is a form of cancer-related surgery that is often a part of breast cancer surgery and recovery. Breast reconstruction surgery is an option for women who have undergone breast cancer surgery and would like to minimize the effects of breast cancer treatment on their bodies. There are a variety of breast reconstruction surgery options, which carry benefits and side effects that are unique to each case.
What is Surgical Reconstruction?
Breast cancer reconstruction surgery is the reconstruction of the breast that has been removed during breast cancer surgery. Breast reconstruction may either be performed promptly following a mastectomy or can otherwise be delayed, meaning that the reconstructive surgery occurs at a date later than that of the mastectomy. Frequently, a breast mound is implanted immediately following a mastectomy.
Mastectomy reconstructive surgery enables the breast shape and size to be reconstructed through recent technology. This means that breast reconstruction surgery may result in a close match to a patient’s natural breast in both form and appearance.
There is no known effect of breast cancer reconstruction on the recurrence of breast cancer, nor does it generally interfere with chemotherapy or radiation treatment in cases when there is recurrence.
Types of Surgical Reconstruction Options for Breast Cancer
In some cases, an implant will be recommended. Implants used during breast cancer reconstruction surgery can either be a silicone shell filled with silicone gel or a saline (salt-water) solution. However, because of the FDA’s warning on the lack of information regarding the safety of silicone gel implants, these new implants are available only to women participating in approved studies. Currently, saline-based implants are available on an unrestricted basis, pending further FDA review.
There are two types of breast reconstruction surgery:
- Skin Expansion: This is the most common type of post-mastectomy surgery. During this procedure, a balloon expander is inserted between the skin and the chest muscle. A saline solution is then injected through a tiny valve mechanism inserted below the skin so as to fill the expander over a period of a few weeks or months. Once stretched, the expander may be removed through a second surgical procedure. However, in some cases the expander serves as a permanent implant. A subsequent surgery is used to reconstruct the nipple and the dark skin surrounding it (areola). In cases when a patient does not require the initial step of preliminary tissue expansion, the insertion of the implant is the first step of skin expansion surgery.
- Flap Reconstruction: This form of breast cancer reconstructive surgery involves the creation of a skin flap using tissue that is taken from elsewhere in the body, such as the abdomen, back or buttocks. There are two types of flap reconstruction surgery:
- In one type of flap surgery, the tissue stays attached to the original site, along with its blood supply. The flap, comprised of skin, fat and muscle containing blood supply, is tunneled beneath the skin to the chest so as to create a pocket into which the implant or the breast mould will be inserted.
In another type of flap surgery, the tissue used for breast reconstruction is taken from another part of the body and transplanted to the chest by reconnecting blood vessels to new ones in the region. This is a more complex form of flap surgery and results in scarring both at the donor site and at the location of the reconstructed breast; recovery time associated with this type of surgery is also longer. However, as this process does not use silicone implants, it is sometimes viewed as a safer option, and also allows for more natural contouring.
An anesthesia is administered prior to reconstructive surgery.
Is Surgical Reconstruction For Me?
The best candidates for breast cancer reconstruction surgery are patients whose cancer, as far as can be determined, has been eliminated by a mastectomy.
You should talk to your oncologist as soon as possible if you are considering breast reconstruction surgery so that with the help of a plastic surgeon, he or she may decide what the best surgery options are for you. Factors that may be considered in these cases include age, overall health, the stage of breast cancer and the amount of tissue available on the body (thin women often lack body fat needed for skin grafting used in flap reconstructive surgery).
When Should I Have Breast Reconstruction Surgery?
Generally, surgical reconstruction is medically safe for women at the same time as the breast is removed.
However some patients may prefer to wait before having breast reconstruction surgery in order to allow themselves to heal from breast cancer surgery, both physically and emotionally.
In some cases, patients may be advised to delay breast reconstruction surgery, particularly when a more complicated procedure is used to replace the breast- for instance, cases when flaps of underlying skin are used. Women with special health concerns will also usually be advised to postpone surgical reconstruction, including those with conditions such as high blood pressure, obesity, and women who smoke.
Surgical Reconstruction: Side Effects, Risks and Complications of Breast Reconstruction Surgery
As with other surgeries, there are certain risks associated with breast reconstruction surgery. Although uncommon, these risks can include bleeding, fluid collection, excessive scar tissue and a negative reaction to anesthesia. If implants are used, there is a low risk of infection, which in some cases occurs within two weeks of surgery. If infection occurs, this may require the removal of the implant until the infection subsides.
Smokers are particularly prone to problems related to breast reconstruction surgery, including excessive scarring and prolonged recovery, as nicotine can delay the natural healing process. In some cases, a second surgery is needed.
The most common complication associated with surgical reconstruction is capsular contracture, in which a scar or capsule around the implant tightens so that there is tension in the breast. Capsular contracture may be treated in a number of ways, including the removal (scoring) of the scar tissue, or the removal or replacement of the implant.
Following breast reconstruction surgery, a series of follow-up procedures will be take place in order to monitor the body’s recovery. In some cases follow-up surgery will be performed in order to reconstruct the nipple or areola.
Recovery from breast cancer reconstructive surgery can take up to 6 weeks; your doctor will advise you to avoid strenuous physical activity, overhead lifting and sexual activity for a period of 3 to 6 weeks. Patients are usually released from the hospital after 2 to 5 days and stitches are removed 7 to 10 days after surgery.
Benefits of Surgical Reconstruction
Breast cancer reconstruction surgery can be an important part of physical and emotional healing and recovery for many women, and is offers one way by which to regain self-confidence and a sense of normalcy in a woman's life.
Costs of Surgical Reconstruction
Generally, federal law requires that insurance companies cover the cost of breast reconstruction surgery for individuals who have had a mastectomy for the treatment of breast cancer.