Breast Reconstruction
After a mastectomy, women may choose breast reconstruction to restore symmetry to their appearance, to restore a sense of femininity or to avoid the day-to-day hassle of wearing a prosthesis.
A mastectomy is when the entire breast is removed because of cancer or pre-cancerous growths. A lumpectomy involves only a partial amount of breast tissue removal. The amount of tissue removed will vary depending on the size and stage of your cancer, your body type and your personal preferences.
What are my breast reconstruction options?
Reconstruction can be done at the same time as your mastectomy, which is called immediate reconstruction. The benefit to immediate breast reconstruction is that you have one less operation and recovery period. It also means you can avoid the experience of having only one or no breasts.
You can also choose breast reconstruction weeks, months or even years after your mastectomy, which is called delayed reconstruction. Delayed reconstruction allows you to focus on your recovery and rebuild your strength. It also gives you more time to consider your options and make an informed decision about your reconstruction options. Complications are less common with delayed reconstruction.
You may choose reconstruction with an implant. This involves stretching the skin first and later inserting an implant, similar to breast enhancement (augmentation) surgeries. In this type of reconstruction, the size and shape of the remaining breast may also need to be adjusted to match the reconstructed one.
Another option is to replace the missing breast tissue with tissue from somewhere else in the body. This is called a flap. Common sources are skin, fat and muscle from the stomach or back.
Nipple reconstruction, which is often done through a skin or tissue graft and/or by tattooing, is normally performed after the initial reconstruction is complete.
How does breast reconstruction work?
Tissue expansion and implant
During a mastectomy, the General Surgeon removes skin and breast tissue, leaving the chest tissue flat and tight. Before an implant can be inserted, the breast tissue needs to be stretched to make space for it, a process called tissue expansion. This is where the Plastic Surgeon takes over.
The tissue can be stretched in two phases. In the first phase, a temporary tissue expander is placed in the chest. Over a few months, your Plastic Surgeon will gradually fill the expander with saline, usually every two or three weeks. Your skin will stretch and grow to make room for the implant as it expands. Once the expander has reached the desired size, Dr. O'Grady allows the tissues to rest and recover for several months. The tissue expander is then removed and a long-term implant inserted in its place.
Flap Reconstruction
Reconstruction can also be achieved by moving a flap. A flap is a section of skin, fat and muscle that is transplanted from the abdomen or back to the breast area through a tunnel under the skin. This flap is called a "pedicled flap" because it is still attached to its original blood supply. Your doctor may also choose to do a "free flap" procedure that involves completely removing the tissue flap and reattaching it to the breast area.
Flap surgery requires several days in hospital and causes scarring in the area from which the flap is taken as well as on the reconstructed breast. The advantage to flap surgery is that it replaces tissue in the chest area and alteration to the unaffected breast is often not needed to improve symmetry. Also, as you gain and lose weight, your reconstructed breast will gain and lose weight as well, just like your natural breast. Flap reconstruction does not require a breast implant in most cases.
Dr. O'Grady will work with you and evaluate the state of the remaining tissue, including surgical scars, skin thickness, radiotherapy treatments and the shape and volume of the breast to be reconstructed, to choose the best technique for your reconstruction.
