The Mastectomy Surgery
While there are many options available in post-mastectomy reconstruction, you
and your surgeon should discuss the one that's best for you.
Skin
expansion. The most common technique combines skin expansion and
subsequent insertion of an implant.
A tissue expander is inserted
following
the mastectomy to prepare for
reconstruction.
Following mastectomy, your surgeon will insert a balloon expander beneath your
skin and chest muscle. Through a tiny valve mechanism buried beneath the skin, he or she will periodically inject a
salt-water solution to gradually fill the expander over several weeks or months.
After the skin over the breast area has stretched enough, the expander may be
removed in a second operation and a more permanent implant will be inserted.
Some expanders are designed to be left in place as the final implant. The nipple
and the dark skin surrounding it, called the areola, are reconstructed in
a subsequent procedure.
The expander is gradually filled
with
saline through an integrated or separate
tube to stretch the skin enough to
accept an implant beneath the chest
muscle.
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.
After surgery, the breast mound is
restored. Scars are permanent, but will
fade with time. The nipple and areola
are reconstructed at a later date.
Flap
reconstruction. An alternative approach to post-mastectomy
implant reconstruction
involves creation of a skin flap using tissue taken from other parts of the
body, such as the back, abdomen, or buttocks.
In one type of flap surgery, the tissue remains attached to its original site,
retaining its blood supply. The flap, consisting of the skin, fat, and muscle
with its blood supply, are tunneled beneath the skin to the chest, creating a
pocket for an implant or, in some cases, creating the breast mound itself,
without need for an implant.
With flap surgery, tissue is
taken from
the back and tunneled to the front of the
chest wall to support the reconstructed
breast.
Another flap
technique uses tissue that is surgically removed from the abdomen, thighs, or
buttocks and then transplanted to the chest by reconnecting the blood vessels to
new ones in that region. This procedure requires the skills of a plastic surgeon
who is experienced in microvascular surgery as well.
The transported tissue forms a
flap for
a breast implant, or it may provide
enough bulk to form the breast mound
without an implant.
Regardless of
whether the tissue is tunneled beneath the skin on a pedicle or transplanted to
the chest as a microvascular flap, this type of surgery is more complex than
skin expansion. Scars will be left at both the tissue donor site and at the
reconstructed breast, and recovery will take longer than with an implant. On the
other hand, when the breast is reconstructed entirely with your own tissue, the
results are generally more natural and there are no concerns about a silicone
implant. In some cases, you may have the added benefit of a improved abdominal
contour.
Tissue may be taken from the
abdomen
and tunneled to the breast or surgically
transplanted to form a new breast mound.
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. But keep in mind, this procedure may leave scars on an otherwise normal breast and may not be covered by insurance.
After surgery, the breast mound, nipple,
and areola are restored.