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Breast Reconstruction: Is the procedure right for you?

By Karoline S. Nowillo, MD | Plastic and Cosmetic Surgery

Breast Reconstruction: Is the procedure right for you?

More than 230,000 women in the United States will be diagnosed with breast cancer this year, according to estimates by the American Cancer Society. Many of those women will have surgery to remove all or part of the breast. Breast reconstruction, performed by a plastic surgeon, aims to restore the breast to a normal appearance. If a patient is a candidate for breast reconstruction, many choices are available. Options include saline or silicone-gel implants, natural tissue flaps (using tissues from the patient’s own body), or a combination of these techniques. Each option has benefits and potential risks. Implants are usually a two-stage procedure. The surgeon puts a tissue expander under the skin and chest muscle to stretch out the area. For weeks to months, the surgeon injects saline into the expander through a valve in the skin. After the chest tissue has stretched enough, the surgeon removes the expander and puts in a saline or silicone-gel implant.

Pros: Shorter hospital stay and recovery

Cons: Scar tissue may harden, implants may rupture

Natural tissue flap procedures use a patient’s own tissue (fat, skin, and sometimes, muscle) from the abdomen, back, thigh, or buttocks. The tissue is transplanted to the chest and used to reconstruct the breast.

Pros: Breast may look more natural and feel softer

Cons: Longer hospital stay and recovery, potential for abdominal weakness or hernia (if muscle from the abdomen was used for the procedure)

On occasion, a combination of the two techniques is performed. It may be necessary when there isn’t enough skin and chest muscle to cover an expander. The procedure allows a surgeon to transfer a patient’s own tissue to the breast area to cover an implant.

Most breast reconstruction surgeries are performed at the same time as the breast cancer surgery (“immediate”). Patients can also have the reconstruction done at a later date (“delayed”). The timing depends on a patient’s individual situation and should be discussed with her plastic surgeon, breast surgeon, and oncologist. For example, patients who require radiation are often advised not to have immediate reconstruction until their treatment is over. Radiation can damage the appearance of a reconstructed breast.

The decision to have breast reconstruction is personal. “Some people only wish to take care of the cancer, and not have to undergo any additional surgery at that point,” explains Dr. Karoline Nowillo, Plastic Surgeon and Reconstructive Microsurgeon at MKMG. “For those patients, having a discussion with a plastic surgeon is helpful, even just to confirm that they don’t want breast reconstruction surgery at the time. Sometimes, there is misinformation out there on the Internet or from second-hand information from friends.”

At an initial appointment, the plastic surgeon reviews a patient’s goals, treatment, medical history and pathology reports, and provides a physical exam. The physician will then offer options individualized to a patient’s specific needs. Although recovery time varies, most patients can resume normal activity in about six to eight weeks. The whole reconstruction process can take several months to a year.

Body Image After Reconstruction

For many breast cancer patients, reconstruction surgery is an important part of their treatment. Dr. Nowillo’s patients fill out surveys describing how they feel about their breasts and body throughout the stages of reconstruction. Results show that most patients are happy they decided to undergo the surgery. “It makes them feel more whole,” explains Dr. Nowillo.

“Women are coming to my office with this devastating diagnosis of cancer,” says Dr. Nowillo. “For me, it’s a very important thing I can give back to these women, restoring that very important aspect of body image. As a woman, it’s easy for me to connect to these patients.”