If you're considering breast reconstruction...
Breast Reconstruction is performed using a variety of methods to recreate a breast mound and nipple-areolar complex. The most common type of procedure performed utilizes an implant to replace the volume of the breast and create a new mound. Other techniques involve using tissue transplanted from the abdomen or back. Frequently, reconstruction can be initiated immediately following breast removal (mastectomy), sparing the patient a seperate operation and recovery. But bear in mind, post-mastectomy breast reconstruction is often more than one stage. There are often many options to consider as you and Dr. Monteiro explore what’s best for you.
The best candidates for breast reconstruction
Most mastectomy patients are medically appropriate for reconstruction. Often the first stage of your breast reconstruction can be performed at the same time that the breast is removed. The best candidates for immediate reconstruction, however, are women whose cancer, as far as can be determined, seems to have been eliminated by mastectomy. Still, there are some legitimate reasons to wait, and have reconstruction performed in a delayed fashion. Many women aren’t comfortable weighing all the options while they’re struggling to cope with a diagnosis of cancer. Others simply don’t want to have any more surgery than is absolutely necessary. Some patients may be advised by their surgeons to wait, particularly if the cancer is more advanced and Radiation Therapy and Chemotherapy are planned
In any case, being informed of your reconstruction options before surgery can help you prepare for a mastectomy with a more positive outlook for the future.
All surgery carries some uncertainty and risk.
Typically any woman who must lose her breast to cancer can have it rebuilt through reconstructive surgery. As with any type of surgery, breast reconstruction has certain risks and complications, such as bleeding, fluid collection, excessive scar tissue, or difficulties with anesthesia, can occur although they’re relatively uncommon. And, as with any surgery, smokers are at increased risk of wound problems and delayed healing, possibly resulting in conspicuous scars and prolonged recovery. Occasionally, these complications are severe enough to require a second operation. If an implant is used, there is a remote possibility that an infection will develop, usually within the first two weeks following surgery. In some of these cases, the implant may need to be removed for several months until the infection clears. A new implant can later be inserted, or Dr. Monteiro may suggest a method that does not utilize an implant.
One common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or “scoring” of the scar tissue, or perhaps removal or replacement of the implant.
Reconstruction has no known effect on the recurrence of disease in the breast, nor does it generally interfere with chemotherapy or radiation treatment, should cancer recur.
Women who postpone reconstruction may go through a period of emotional readjustment. Just as it took time to get used to the loss of a breast, a woman may feel anxious and confused as she begins to think of the reconstructed breast as her own.
Planning your surgery
You can begin talking about reconstruction as soon as you’re diagnosed with cancer. Ideally, you’ll want your cancer surgeon and Dr. Monteiro to work together to develop a strategy that will optimize both your cancer treatment and your reconstruction. After evaluating your health, Dr. Monteiro will explain which reconstructive options are most appropriate for your age, health, anatomy, tissues, and goals. Be sure to discuss your expectations frankly with him. He will be equally frank with you, describing your options and the risks and limitations of each. Post-mastectomy reconstruction can improve your appearance and renew your self-confidence – but keep in mind that the desired result is improvement, not perfection.
Preparing for your surgery...
Dr. Monteiro will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.
Where your surgery will be performed?
Types of Anesthesia
Reconstructive methods and procedures
Some patients do not require preliminary tissue expansion before receiving an implant. For these women, the surgeon will proceed with inserting an implant as the first step.
Follow-up procedures : Most breast reconstruction involves a series of procedures that occur over time. Usually, the initial reconstructive operation is the most complex. Follow-up surgery may be required to replace a tissue expander with an implant or to reconstruct the nipple and the areola. Many surgeons recommend an additional operation to enlarge, reduce, or lift the natural breast to match the reconstructed breast.
After your surgery...
You are likely to feel tired and sore for a week or two after reconstruction. Most of your discomfort can be controlled by medication prescribed by the doctor. Depending on the extent of your surgery, you may require a brief hospital stay. Many reconstruction options require a surgical drain to remove excess fluids from surgical sites immediately following the operation, but these are removed within the first week or two after surgery. Most stitches either dissolve themselves, or are removed in a week to 10 days.
Getting back to normal...!
It may take you up to six weeks to recover from a combined mastectomy and reconstruction or from a flap reconstruction alone. If implants are used without flaps and reconstruction is done apart from the mastectomy, your recovery time may be less. Reconstruction cannot restore normal sensation to your breast, but in time, some feeling may return. Most scars will fade substantially over time, though it may take as long as one to two years, but they’ll never disappear entirely. The better the quality of your overall reconstruction, the less distracting you’ll find those scars.
Follow the doctor’s advice on when to begin stretching exercises and normal activities. Get plenty of rest and allow your body to spend its energy on healing.
Your new look
Chances are your reconstructed breast may feel different, and may not have the same contour as your breast before mastectomy, nor will it exactly match your opposite breast. For most mastectomy patients, breast reconstruction dramatically improves their appearance and quality of life following surgery.