One in nine women who live to age 85 will develop breast cancer. The rate of mastectomy has greatly increased over the past twenty years, leading to a great demand for breast restoration after mastectomy.
There are multiple methods of breast reconstruction, ranging from re-arrangement of remaining breast tissue in the case of partial mastectomy, use of abdominal or back tissue to re-build the breasts, or use of breast implants. The best approach depends on the clinical situation, and patient preference.
The most straight forward and aesthetically pleasing strategy is immediate reconstruction with implants at the time of mastectomy. In this case, the general surgeon and plastic surgeon work together to scoop out the breast tissue, leaving the skin, superficial fat and nipple/areola intact. A shaped implant is then placed to replace the breast tissue. This generally results in a post surgical breast that looks nearly completely unchanged. The scar is hidden in the fold under the breast. The surgical site is made numb with long acting numbing medicine that lasts for approximately three days. The patient can go home the same day, and post operative pain is manageable with a few pain pills. A drain is in place that remains for at least one week, and is removed in clinic. The aftercare for this procedure is nearly identical to that for breast augmentation.
If the mastectomy has been done by the general surgeon prior to being seen by the plastic surgeon, often the redundant skin and nipple have been removed. The reconstruction process is much more involved, requiring either the use of your own tissues, or an inflatable implant called a tissue expander to restore breast shape. Tissue expander reconstruction requires two trips to the operating room separated by 6 months. The first operation is to place the tissue expander, followed by a slow process of growing the breast shape by infusing water into the expander to produce a breast shape. Once the desired shape is achieved, the tissue expander is removed in the operating room and is replaced by a breast implant. Nipple reconstruction is a clinic based procedure that is carried out once the breast mound is complete.
Tissue based reconstruction is another option that is available that can achieve very nice results. It is particularly useful in patients that have undergone radiation, which makes the breast skin suboptimal for tissue expansion. Tissue based reconstructions are more demanding for the surgeon and patient, and are best performed by a hospital based practice where a doctor is constantly available to see you if there are challenges during your hospitalization. I will refer you to the appropriate providers if this approach is best for you.