Breast Reconstruction

breast reconstructionFor many women, body image is an important part of ones identity and contributes to their feeling of well-being. When a woman is diagnosed with breast cancer, the possibility of losing a breast and how that will affect their body image can be devastating. The diagnosis is typically sudden and many body-altering procedures are being considered and decisions are being made at a swift pace. This can cause considerable anxiety. The most important decision is to ensure all cancer is removed and the necessary treatment modalities are being used. However, because many women are being diagnosed earlier and are treated sooner, the disease free survival rate has greatly improved. Today, there are several breast reconstruction centers available in Tampa which can decrease the anxiety and limit the negative body image impact the disease traditionally caused. Once you have been diagnosed with breast cancer, you should start thinking about reconstructive surgery.

Which surgery is right for me?

During your consultation, a discussion about the type and extent of your breast cancer diagnosis will be performed. These factors will dictate the recommendations for treatment by the breast surgeon and possibly the oncologist. In some cases, a lumpectomy will be recommended as necessary treatment. In others, removal of the entire breast (mastectomy) will be the only option. In some cases, a patient may wish to have a mastectomy for prophylactic reasons. In many cases, chemotherapy and radiation therapy will be recommended either before or after surgery. All of this information will be gathered and discussed with you in order to construct an individualized plan for your reconstruction options.

What are the breast reconstruction options?

There are two main categories of breast reconstruction procedures: tissue expansion with implants and flap reconstruction.

Tissue expansion with implant reconstruction is the most common procedure. During this procedure, expanders are placed under the chest muscle (pectoralis major) and skin. This is usually done at the same time of the mastectomy. Over the next several weeks, the expanders are filled with water allowing the skin and muscle to stretch. Once this process is complete, the expanders are removed and exchanged for soft silicone implants. There are many slight differences in technique that can have significant impact on the results. Dr. Polecritti uses the most cutting edge techniques including use of a dermal matrix sling allowing for a much more natural result.

Flap reconstruction uses tissues from other parts of your body to create a flap. The tissue is commonly taken from the back, abdomen or buttocks. In some cases the tissue is stretched and rotated into place. In others, the tissue is separated and reattached to the breast defect area with use of the microscope. The former is called a pedicle-flap, the later is called a free-flap. In either case, these procedures are usually more complex. They typically take significantly longer to perform and have an additional donor site to heal. In some cases, an implant is needed in addition to the flap to provide adequate size. This option is very useful in cases when there is suspect tissue that has been damaged from the radiation treatment. This procedure is also useful is cases where there just isn’t enough skin to stretch with an expander. The most common flaps used for breast reconstruction are the Latissimus flap, the TRAM flap and the DIEP flap. During your consultation, Dr. Polecritti will discuss with you the best reconstructive option based on your individual case.

Will the reconstructed breast match the non-operated one?

Each patient’s disease and treatment process is unique and it is difficult to predict how every patient will heal. Most patients are quite pleased with the reconstruction results and feel comfortable wearing feminine clothing. In some cases the non-operated breast is sagging or excessively large. When this is the case, it may be an option to perform a lift or reduction on this side resulting in a nicer shaped breast and better symmetry to the reconstructed side.

How many reconstruction surgeries will I need?

It depends on many factors during your treatment. With the expander/implant reconstruction; one surgery to place the expander performed at the same time of the mastectomy, and a second smaller surgery several months later to remove the expander and place the implant. Many patients wish to have a nipple reconstructed on top of the reconstructed breast. This is an optional third surgery that in many cases can be performed in the office. With flap reconstruction, the initial flap insertion is done at the same time of the mastectomy. If expanders are not also used, the only other procedure offered is the nipple reconstruction after the breast heals. However, with either reconstruction, differences in healing, scarring, and mal-position can occur. When these occur, minor surgical correction may be needed and will ultimately add to the total number of procedures needed to get an ideal result.

What is the recovery period?

In most cases the initial reconstruction is performed at the same time of the mastectomy. Adding the reconstruction to the procedure does not add much to the patient’s discomfort or surgical risk. After surgery, one or two drains will remain under the skin to drain fluid and residual blood. These remain in for 1-2 weeks to assist with the healing process. Most patients remain in the hospital for a couple days for monitoring and pain control. Upon discharge, the patient is given a prescription for antibiotics and pain medication. You will also be asked to wear a surgical support bra. Discomfort typically subsides over the first week and activity can be gradually increased over this time. Once your incision has healed, expansion of the expanders can start if they were used in your reconstruction. They are gradually filled over the next couple months. The expander to implant exchange is a same day outpatient procedure usually performed at a surgery center. The discomfort is minimal with this procedure and patients return to normal activity typically within a day or two.