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[B873]Breast Reconstruction After Mastectomy

by Annabel Cruz, Ann

The decision of whether to have breast reconstruction arises at a very emotional time usually at the same time a woman learns she has breast cancer and needs surgery. It is a time when many questions come up about reconstruction, the most common of which are answered here briefly:

Is age a factor?
As long as a woman is in good general health and chooses a procedure that is compatible with her physical condition, age is usually not a factor. Breast reconstruction is frequently done for women in their 70s.

Who should not have breast reconstruction?
Women who are in poor general health, who have psychological problems that would be exacerbated by the surgery, or who have severe diabetes, Alzheimer's disease, a recent stroke nine-art attack, or severe lung disease usually should not have breast reconstruction.

Do I have to make a decision about having reconstruction before I have the mastectomy?No, but the best time to think about breast reconstruction and to consult with a reconstruction surgeon is before you have your mastectomy. Depending on the type of mastectomy you have, you may be able to undergo immediate reconstruction while you're still on the operating table. There are advantages and disadvantages to having immediate reconstruction (see below). Not all mastectomies lend themselves to this approach, however, which means it is important for you to understand all your options prior to mastectomy. Then if you choose to delay reconstruction, you at least were given the opportunity to make an informed decision.

Are there any health conditions that could have a negative effect on reconstruction?Women who smoke are more susceptible to postoperative infections and slow healing, so if you smoke it is best to quit before surgery. Obesity is associated with an increased risk of pneumonia, blood clots in the legs, and complications related to anesthesia. The results of both types of reconstruction (implant and flap, both described below) are frequently unsatisfactory in obese women.

How many operations are involved in breast reconstruction?
Most breast reconstructions can be completed in two operations. The majority of the work is done during the first procedure, and the second usually involves reconstructing the nipple and areola, improving symmetry of the breasts, and making any minor adjustments.

Does breast reconstruction cause cancer?
There is no evidence that breast reconstruction causes or contributes to the development of cancer.

How will my breast reconstruction look in 5 to 10 years? The long-term results of breast reconstruction are different for each woman and depend on the type of procedure you have, your weight, and whether you experience intervening infections or other breast problems.

Immediate Reconstruction: Yes or No?
Once you know you must undergo mastectomy, it is usually difficult to also have to think about reconstruction. This is the time to surround yourself with supportive individuals, be they family, friends, health care providers, or breast cancer support group members. It is also the time to educate yourself about reconstruction. This is a way to take charge of your health, to have some control over the direction your life is taking.

When it comes to the question of whether you are a candidate for immediate or delayed reconstruction, ask your breast and reconstruction surgeons to explain why they are recommending one or the other.

The primary factor that determines the best approach is whether the cancer has affected the lymph nodes and to what extent. Chemotherapy usually is not started until 2 or 3 weeks after mastectomy to allow for healing. If your surgeons believe you must begin chemotherapy immediately to get the best possible outcome, they may recommend delaying reconstruction.

Combining mastectomy and reconstruction adds days and occasionally weeks to the healing period, which would significantly delay chemotherapy and possibly have a negative impact on your prognosis.

If your surgeons say immediate reconstruction is an option for you, you must decide if it's best for you.

To help you make a decision, it may help to look at the pros and cons (outlined below) and to discuss your concerns with those close to you. The best candidates for immediate reconstruction are women with early breast cancer who are in good general health, women with small breasts, and those who need both breasts reconstructed. However, even if you are ready physically, you may not be mentally or emotionally prepared. In that case, it may be better to delay reconstruction.

Advantages and Disadvantages of Immediate Reconstruction

Avoiding an additional surgical procedure.
One less procedure means less chance of complications.
Less recovery time needed.
Costs less money
Less time to dwell on the cancer.
Less negative impact on body image.
Faster opportunity to get on with your life.

Less time to gather information to make an informed decision.
Surgical procedure is longer, which increases the chances of complications.
Possible dissatisfaction with the results
May delay mourning period for the missing breast

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This article is not designed as a substitute for personal medical advice but as a supplement to advice for those wishes to understand more about her condition.

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The reconstruction is possible immediately following breast removal. But in individuals with medical problems like high blood pressure obesity diabetes and also in individuals who smoke. The surgery is delayed as they are considered high risk candidates. Breast reconstruction usually takes multiple operations, which are spread out over weeks or months.

Risks involved:
Bleeding fluid collection, excessive sear tissue complications with anesthesia can occur but are relatively uncommon. Smokers should be advised that nicotine can delay healing, resulting in conspicuous sears and prolonged recovery.

In rare cases, due to infection, the implants may be removed and new implants inserted again after the infection clears.

Capsular contracture occurs if the scar around the implants begins to tighten and cause the breast to feel hard.

Reconstruction does not generally interfere with chemotherapy or radiation treatment should cancer reoccur.

Techniques:
There are many methods of breast reconstruction. The two most common are:

1. Tissue expander-breast implants: this is the most common techniques used in world wide. The surgeon inserts a tissue expander a temporary silastic implant, beneath the pectoralis major muscle of the chest wall and over weeks or months, inject a saline solution to slowly expand the over laying tissue. Once the expander has reached an acceptable size it may be removed and replaced with a more permanent implant. Reconstruction of the areola and nipple are performed in a separate operation after the skin has stretched to its final size.

2. Flap reconstruction: the second most common procedure is using tissue from other parts of patient's body, such as back, buttocks, thigh or abdomen.

The latissimus dor muscle flap: it is the donor tissue on the back. It is large flat muscle which can be used without loss of function. It can be moved into the breast defect, still attached to its blood supply under the armpit. This flap is usually used to recruit soft-tissue coverage over an underlying implant.

Abdominal flaps: the abdominal flap for breast reconstruction is the TRAM flap. The abdominal tissue between the umbilicus and the pubis is used. It requires advanced microsurgical technique and less common. It provides enough tissue to reconstruct large breasts. The contour of the lower abdomen is improved by this procedure. TRAM flap procedure may weaken the abdominal muscles, but are tolerated well in most patients to prevent muscle weakness and hernias; a piece of surgical mesh is placed over the defect and sutured in place.

3. Nipple and areola reconstruction:

Nipple areola graft: if the contralateral breast has not been constructed and the nipple and areolar are sufficiently large, tissue may be harvested and used to recreate the nipple-areolar complex on the reconstruction sensation in the nipple and an unpleasant cosmetic result at the donor site. Cosmetic result can be achieved using tattoos.
Local tissue flaps: a nipple may be created by raising a small flap in the target area and producing a raised mound of skin.

To create an areola, a circular incision may be made around the new nipple and sutured back again the nipple and areolar region may then be tattooed to produce a realistic color match with the contralateral breast.

Recovery:
Recovery from implant based reconstruction is faster than with lap-based reconstruction, but both take at least three to six weeks to recover and both require follow up surgeries in order to construct a new areola and nipple. The patients should avoid active sports, over head lifting and sexual activity during recovery period. TRAM flap patients can show abdominal muscle weakness but most patients resume normal activities after recovery.

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About Author

Both Annabel Cruz & Dave Stringham are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.

Annabel Cruz has sinced written about articles on various topics from Women, Breastfeeding and Breast Enlargements. Annabel Cruz is a researcher that studies Natural healing by combining both Western and Eastern ways. Feel free to use this article on your website or ezine as long as the following information about author/website is included. And we provide best puer. Annabel Cruz's top article generates over 14800 views. to your Favourites.

Dave Stringham has sinced written about articles on various topics from Tummy Tucks Before and After, Health and Breast Enlargements. Dave Stringham is the President of LookingYourBest.com an online resource for procedures. Learn more about. Dave Stringham's top article generates over 368000 views. to your Favourites.