What is Breast Reconstruction?
Breast reconstruction surgery is intended for restoring the shape and size of the breasts after mastectomy. It is recommended in patients having undergone a mastectomy after cancer-induced chemo or post chemoprophylaxis. Often confused with breast augmentation, breast reconstruction after a mastectomy is a completely different procedure. In breast reconstruction, as the breast is surgically removed before the procedure, expanders are applied to the remaining breast tissue before inserting the implants. Apart from implantation, the nipples and the areola are also reconstructed during the procedure. Unlike normal breasts, a patient having undergone breast reconstruction after mastectomy cannot feel any pain or sensation in their reconstructed breasts.
Benefits of Breast Reconstruction After Mastectomy
- It is often noticed by clinical practitioners that cancer survivors post-mastectomy go into depression and suffer long-term self-esteem issues.
- In a study conducted with around 419 women under the age of 40 having been diagnosed with breast cancer, researchers found a majority of them with improved body image post breast reconstruction after mastectomy.
- Women with reconstructed breasts feel comfortable with a tight dress such as bathing and swimming suits. More importantly, they feel better about their body with mastectomy reconstruction.
- This leads to increased self-esteem giving them a survival advantage. The reason why people seek breast reconstruction after a mastectomy is needed to increase the overall quality of life.
Choosing the Right implant for Breast Reconstruction Surgery?
Post-mastectomy, the doctor can reconstruct your breasts either through implants or flap surgery. Flap surgery uses tissues from your body for the reconstruction purpose while implants are inserted by first inserting an expander for the shape followed by transferring the implants.
Implants are silicone devices filled with saline solution or silicone gel. Shape-wise implants are either round or teardrop-shaped designed to be fitted on the basis breast sag of the patient. Post-mastectomy, surgeons usually choose a silicone gel implant because of its natural appearance and softer feel.
Textured implants, though used at one time for breast reconstruction surgery, have been discontinued because of greater incidences of anaplastic large cell lymphoma; a type of breast cancer associated with implants. The final decision regarding the implant is taken based on the patient’s needs with the treatment plan of the surgeon.
Changing the Size of an Implant
The style of the preferred breast size changes with time. Sometimes women with bigger implants want smaller ones while the ones with smaller implants prefer larger sizes. This can be done through revision breast surgery. Usually, healthy candidates unhappy with their breast implants or concerned with the condition of their present implants, are ideal candidates for this procedure. The role of breast revision surgery is to change or improve the appearance of breasts through implants. It can either be performed individually or also as a combination of procedures as well.
Apart from changing the size of the implants, revision surgery addresses other issues like breast asymmetry and drooping. Other problems like implant infection, capsular contraction, and complications like a ruptured or leaking implant can be solved during the change. Changes in the type of implants like the filling and the texture can also be made while changing their size.
When is the Best Timing to have Breast Reconstruction Surgery?
Breast reconstruction can be done simultaneously with the mastectomy or after the completion of cancer treatments including mastectomy, radiation, chemo, and other procedures.
An immediate reconstruction is a feasible option only if all your cancer treatments have been previously completed. This makes it convenient for you to simultaneously go for breast reconstruction after mastectomy. Immediate reconstruction is also preferred in cases of prophylactic mastectomy i.e. mastectomy performed to reduce the risk of breast cancer. Mastectomy when performed after completion of other treatments is called delayed reconstruction. It is performed in cases where there are chances of cancer returning post-mastectomy. Not just that, the cancer-induced radiation treatment tends to be affected by the process of reconstruction. Because of these reasons, breast reconstruction surgery is often delayed till the completion of other procedures post-mastectomy.
There is also another procedure named Delayed-immediate Reconstruction that involves some breast reconstruction during mastectomy and more after additional treatments. However, you will be recommended the ideal treatment plan taking account of several factors such as your current stage of cancer, your overall state of mind, and available clinical modalities.
In this regard, Stage I or Stage II cancers indicate early stages. Patients going through mastectomy in this stage may hardly require any additional treatment in the future. Therefore, patients can simultaneously go for breast reconstruction surgery and mastectomy. But in advanced stages, Delayed reconstruction i.e. breast reconstruction after a mastectomy is recommended.
Immediate reconstruction can be done either using your body tissue or via implants. For that, it is necessary to find a hospital having an oncologist and a plastic surgeon who can work side by side. That is easier said than done. Not a lot of clinics are equipped with cancer and reconstruction facilities in one place. Finding a hospital with these facilities plays a crucial role in the timing of the reconstruction surgery. However, in this regard, Bizrahmed could be your ideal bet if you are looking for breast reconstruction surgery in Dubai.
Women undergoing breast reconstruction surgery also need to go through periodic follow-ups to keep the implants in check. There is a good chance of cancer coming back in which case the implants need to be removed for chemo and radiation treatment. Since mastectomy is not emergency surgery, it is important to decide whether or not you are prepared for the surgery before proceeding forward.
Types of Breast Reconstruction
Breast reconstruction as discussed previously can be done by placing implants or through autologous fat transfer from your own body. It is important to note that while implants and fat transplants are the basic reconstructions, the process is not limited to these options. When it comes to mastectomy reconstruction, areola and nipple reconstruction are also essential.
Sometimes breast reconstruction is done through Partial Mastectomy i.e. just an expander placed for the shape to be filled after completion of the treatment procedures. That said some women have a breast deformity or dimpling caused by the removal of a particularly large tumor from the breast. In such cases, partial reconstruction is done during the mastectomy reconstruction by means of smaller flaps, implants, grafting, or through scar revision surgeries. The type of breast reconstruction depends largely on the size of your breasts, the extent, and location of your breast cancer, your recovery rate, and overall health conditions. Other factors like your surgeries done so far and those to be conducted ahead decide the ideal type of mastectomy reconstruction surgery for you.
How Long Does Breast Reconstruction Surgery Take?
The breast reconstruction surgery takes one to six hours to complete, depending on the type of surgery you have been selected for. But the preparation takes around two hours.
Autologous Fat transplant uses tissues from your inner thighs, buttocks, abdomen and upper backs and the approximate time duration for the entire process is about 2 hours for the mastectomy followed by another six to twelve hours for the reconstruction procedure. It is said to yield more natural-looking results and they last lifelong as you do not need to change them after a period of time.
On the other hand, reconstruction through implants is quicker and gets over in three to four hours with around two hours taken for the preparation and the anesthetics to set in. Implant reconstruction has a shorter downtime as well in comparison to fat transfer with a faster healing time. Additionally, in either of these procedures, a nipple transplant or graft, if done sidewise, takes another 3-4 hours.
As breast reconstruction surgery is an invasive procedure, it is performed under general anesthesia. In reconstruction using breast implants, the breast skin is stretched with a tissue expander inside the breast. After an interval of a week, saline or silicone gels are placed inside with repeat procedures extending for the next ten weeks for the desired reconstruction. After an interval of a few months, after the tissue has healed, the expander is removed and implants are placed.
Sometimes implants are placed directly in the breast during mastectomy reconstruction without using any expanders. In this regard, Acellular Dermal Matrix has been increasingly used for implant-based breast reconstruction these days. Autologous Fat Transplant makes use of fat from your body parts for the reconstruction surgery. Usually, abdominal fat is the first choice for the plastic surgeon. But tissues are taken from the thighs and buttock in the case of women with prior abdominal surgery or without enough abdominal fat. In some cases, implants and autologous tissues are used together. This procedure mode is preferred when there isn’t enough skin left after mastectomy for expansion when tissue via fat transfer is used to place the implant inside the breast. It is natural for you to feel anxious while reading about the procedure. We recommend booking a consultation with an expert surgeon at Bizrahmed to get all your doubts cleared regarding breast reconstruction surgery.
Recovery After Mastectomy Reconstruction
After surgery, there will be a pain, discomfort, and soreness. This will persist for a week during which you will need to restrict your movement and take other precautions for a successful recovery.
You will be discharged within a few days post-surgery, once the surgeon is satisfied with your recovery rate. Compression garments and be required to wear drains to remove extra fluid from the surgery site while it heals. It is believed that it was taken around 8 weeks for the inflammation to completely subside. Light exercises can be started 4-5 weeks post breast reconstruction after mastectomy.
Implant reconstruction heals faster than autologous fat transplant in which case the healing of the breast incision and that of donor incision sites has to be considered. The tissues will completely heal and scars to fade completely by one year. There may not be any sensation in your breasts post-reconstruction. Some feelings may return after some years but it will be minimal. While recovering from breast reconstruction after mastectomy, it is recommended to go for therapy for mental health and depression.
Frequently Asked Questions
What is considered in breast reconstruction surgery?
Surgical rebuilding of the breasts to improve their size, shape, and the overall texture is considered breast reconstruction surgery. Patients are recommended breast reconstruction after mastectomy or breast excision as a part of chemo or as chemoprophylaxis for breast cancer treatment. Breast reconstruction can be done through implants insertion, fat transfer methods, or as a combination of both.
Is breast reconstruction a major surgery?
Breast reconstruction is definitely a major surgery. Firstly, the surgery is performed after mastectomy as a reconstructive procedure. It is completed in sessions or phases instead of in one sitting. Depending on the type of reconstruction, the surgery extends for 6-12 hours. That, with the increased downtime and slow recovery rate, deems it to be termed a major surgery.
How long does it take to recover from breast reconstruction surgery?
It takes around 7-10 days for the pain to subside and around 8 weeks for the inflammation to completely subside. You can rejoin work after 4 weeks and stop wearing compression garments and tubes 2 weeks after the surgery. But complete healing of the tissues and fading of the surgical scars takes more than a year with even more time taken for some of the breast sensations to return.
Does a mastectomy include reconstruction?
In immediate reconstruction, the mastectomy and the reconstruction procedures are performed one after the other. Immediate reconstruction is usually preferred in women in the first and second stages of breast cancer who are undergoing mastectomy as a prophylactic measure and in whom removal of implants for chemo treatments will not be required.
What percentage of mastectomy patients get reconstruction?
While going for breast reconstruction after mastectomy, it is important to understand the whole concept of reconstruction. Unfortunately, less than half of the women requiring mastectomy are actually offered the procedure. Among them, less than 20% undergo immediate reconstruction. Out of 100, only 42 women opt for breast reconstruction after mastectomy, and of the remaining, 30 women pass it on for ignorance about implants.
Is breast reconstruction painful?
The surgery, though painless because of being conducted under the effect of anesthetics, you will not feel any pain during the summer surgery. Post-surgery, there will be pain and discomfort which will gradually wear down in the next few weeks. But it is difficult to even after completion of reconstruction for the breast sensation to return. After a period of some years, there may be mild sensation felt but the complete sensation will never return back.
What does breast reconstruction involve?
Breast reconstruction involves using implants or tissues from your own body to reconstruct the breasts. While implants involve using an expander followed by insertion of implants, fat transfer uses fat from your abdomen, buttocks, and thighs to be used in breast reconstruction. Either of these processes is done in phases and it takes a long time to see the results post-surgery.
Is breast reconstruction the same as implants?
Implants are only a part of breast reconstruction. Implants are silicone devices filled with silicone or saline solution to be fitted inside the breasts. Implants are used in breast augmentation done for enhancing the size of the existing breasts or in cases of reconstruction done to reconstruct breasts after their removal post-mastectomy. Apart from implants, tissues from your body can also be used as a reconstruction procedure.