In the unfortunate event where a full mastectomy is required to treat breast cancer, reconstruction is often a much welcomed option. With modern technology, techniques, and materials that are available it is possible to restore the breasts appearance to its original form with hardly any visible scarring. When this procedure is carried out it is done so by plastic surgeons specializing in restoration. It has now become a commonplace following a full mastectomy.



There are a variety of approaches and each case is unique. Consultation with a physician is required in order to select the one that is right for you.

One commonly chosen reconstruction technique is breast implants. Today implants are commonly saline filled bags contained within a silicon shell. They are placed in front of the chest wall muscles and under the skin which covers the breast area.

In years past, silicon filled implants were more typical. There was a concern for the possibility of silicon leaking into the body and causing immune system problems. But the FDA recently announced, after years of careful study, that there was little basis for worry and silicon breast implants are now legal again. Some prefer them for their different behavior.

In some cases, reconstruction is done during the mastectomy. In others, physicians recommend a waiting period to allow the body to heal before any further surgery. Each case is individual and can only be decided on its own merits.

Typically, though, two-stage delayed reconstruction is performed if the skin and chest wall tissues are flat. An implant, called a tissue expander that functions like a balloon under the tissue, is placed beneath the muscle. The surgeon then injects saline in stages over a period of time to gradually fill the sac. In some instances, the expander itself becomes the implant. In other cases, in a later procedure, the expander is removed and replaced with a permanent implant.

Another method of breast reconstruction is a tissue flap procedure. These procedures use skin from the stomach, the thighs, or other areas as part of the entire process.

TRAM (transverse rectus abdominis muscle flap) is one of the most common types, which uses tissue from the lower abdominal wall. A pedicle flap leaves the tissue attached to the original blood supply and stretches the tissue up the breast area. A free flap procedure removes the tissue entirely, along with muscles, fat, and blood vessels and reattaches them to blood vessels under the chest.

Another, about equally common, uses tissue from the upper back. A flap is moved in front of the chest wall to create a pocket. A breast implant is then inserted into the pocket. There are other procedures as well, such as one that uses gluteal muscle tissue.

In each instance nipple and/or areola reconstruction may or may not be in order. In some instances it will be done simultaneously with breast reconstruction, in others it might be done later, sometimes it is not even done at all. The original nipple is rarely used as a replacement as it has yet to be determined whether or not it can regenerate cancer.

Reconstructive surgery is not entirely without risks, of course.

You can have the typical surgical complications including infection, and scarring. Breast implants also are not guaranteed to last a lifetime and depending upon your age may need to be replaced via another surgery at a later time. The final result might not be what the patient was expecting. Only a complete in depth consultation with a physician can provide a realistic assessment of what to expect.