BREAST RECONSTRUCTION

Breast reconstruction is performed to reconstruct the breast after breast cancer. Facing reconstruction surgery along with a diagnosis of cancer can be overwhelming. However, with today's technology and medical approaches there are options today that weren't available years ago. Breast reconstruction is often possible immediately following a mastectomy, so that the patient can combine surgeries and have the reconstruction underway. In this manner, the patient is spared the trauma of awakening without a breast. There are many questions to ask, and decisions to make. This section will assist with that process.

Some important facts about breast reconstruction:

• The reconstructive patient must have realistic expectations-the goal is to improve appearance, not attain perfection.
• Reconstruction at the same time as the mastectomy can be an emotional advantage for the patient.
• Some surgeons feel that it is advantageous to perform reconstructive surgery approximately three months after the mastectomy, to give the tissues time to heal and soften. However, most physicians feel that this is an antiquated view.
• Reconstruction of the areola and nipple, if desired, is usually performed in a separate surgery.
• Your surgeon may suggest completion of any chemotherapy or radiation therapies (if necessary) prior to any reconstructive surgery for locally advanced breast cancer.

PREPARING FOR SURGERY
You and your physician must make many important decisions - whether the reconstruction will be performed at the same time as or after the mastectomy, the technique to be used, if implants are to be placed, whether they will be used for both breasts, and the fill material, size, shape, and texture of the implants. Remember that different doctors use different techniques and usually recommend the one(s) in which they are trained and experienced. Educate yourself so that you can be a part of this decision-making process.

THE PROCEDURE
Many techniques are available. Which technique is used depends on the patient's desires, the physician's training and experience, the patient's health and anatomy, the amount of tissue available, and the other breast's appearance. The following are the most common reconstructive techniques:
Breast Implant

If there is sufficient tissue (skin), a silicone or saline implant may be placed beneath the pectoral muscle. Most often, a tissue expander is necessary prior to implant placement.

Tissue Expander
This balloon-like device with a reservoir is placed under the pectoral muscle during the original surgery. Over a period of a number of weeks, sterile saline is injected into the reservoir, gradually stretching the skin. Some expanders can be left in to serve as an implant; other expanders must be removed and replaced with an implant after the skin and muscle are expanded.

Tram Flap
A large flap of lower abdominal skin and fat, along with a part of one or both of the recti abdominus muscles, is either rotated through the abdomen or separated and reattached to the chest wall and shaped. The major advantage of this procedure is that there is no need for an implant because of the abundance of tissue available. The patient also benefits by getting a "tummy tuck." However, this is a major procedure, which can require four to six days in the hospital. This procedure is not recommended for patients who do not have excess abdominal fat.

Latissimus Dorsi Flap
A portion of this broad muscle in the back, along with overlying skin and fat, is rotated around the side to the chest wall and shaped. Since there is usually insufficient tissue to completely reconstruct the breast, an implant may be necessary.

Free-Flap Transfer
Tissue from the abdomen, buttocks, hips, or thighs, along with the blood vessels, is completely removed and transplanted to the chest wall. The blood vessels are joined to the blood vessels in the armpit.

Nipple and Areola
Reconstruction of the nipple and areola are usually performed in a separate surgery once the reconstructed breast has healed. The nipple can be more accurately positioned in this manner. Local tissue from the breast reconstruction, abdomen, and/or groin (labia) may be used. If desired, cosmetic tattooing can be performed later to match the color of the nipple to the other breast.

Anesthesia
Breast reconstruction is usually performed under general anesthesia. However, the type of anesthesia used is dependent on the procedure to be performed, the doctor's choice, and the patient's medical history or desires.

Length of Procedure
The breast reconstruction will vary tremendously depending on the type of procedure performed and the complexity.

Level of Pain/Discomfort
Generally with a breast reconstruction there is moderate pain and soreness for a week or two, which may be controlled with prescribed pain medications or Extra-Strength Tylenol.

PRE- AND POSTOPERATIVE INSTRUCTIONS
The following suggestions are intended to make you feel more comfortable and help you heal:

• Stop smoking, discontinue the use of alcohol, and stop taking vitamin E and any medications containing aspirin or ibuprofen (two weeks pre- and postoperative is usually recommended). Check with your doctor regarding any other medications (including homeopathic/herbal products) that you are currently taking.
• If you blow-dry your hair, it may be more comfortable to keep the dryer at a low angle for ten days to two weeks.
• Dressings - this procedure requires a supportive bra or dressing, which should be provided, to wear for four to six weeks after surgery. You may want to purchase a second garment to wear while you launder the other. Do not wear an underwire bra for six weeks.
• You must sleep on your back, with your upper body elevated, for at least the first week to ten days.
• Restrict upper-body activity for four to six weeks.

RECOVERY
The initial healing period for a breast reconstruction can take from one to two weeks, however recovery from a combined mastectomy and reconstruction or from a flap reconstruction could take up to six weeks. The normal sensation of your breast will be changed but some feeling could return over time. There is scarring with this procedure, but with proper care, and compliance with instructions, the scars should fade as well, over time. Remember that the goal of breast reconstruction surgery is to offer improvement.

RISKS / COMPLICATIONS
Although problems are unlikely, you need to be aware of what can happen and what action you should take. Most risks/complications will be avoided if you make an informed decision, choose a qualified physician, and follow your physician's instructions.
Complications that can occur with this surgery are bleeding, infection, hematoma (collection of blood under the skin) or scarring. If an implant is used a common complication is known as "capsular contracture". The body attempts to "wall off" the implant by forming a fibrous capsule around it. The thickness of the capsule formed varies from patient to patient and is influenced by heredity or the presence of postoperative hematoma or infection. Depending on the severity of the capsule, the physician may break it up manually or it may require removal and/or implant replacement.

STILL YOU…ONLY BETTER
Many women feel that the reconstructive surgery helps them with their self-esteem. After a diagnosis of cancer, for many-- lives are changed. Reconstruction surgery can help to put a bit of normalcy back into the lives of these courageous women.