What is breast reconstruction?

Breast reconstruction is the process of rebuilding a breast which is both natural-looking and -feeling through a series of surgical procedures.  This can involve implant-based or autologous (rearranging the patient’s own tissues) reconstructions.  The first phase of the reconstruction can be done at the time of the breast cancer removal (immediate reconstruction), or be performed in a delayed fashion due to patient preference or the need to receive certain cancer treatments prior to reconstructing the breast.  In either case, plastic surgeons attempt to provide a medical and psychological means of dealing with the after-effects of breast cancer surgery.  These factors should be the reasons a patient undergoes breast reconstruction, not due to pressures from family members or peers.  The goal of breast reconstruction is to help restore a patient’s physical appearance and her psychosocial well-being.

Breast reconstruction is the procedure performed in order to reconstruct the breast and create a normal appearance and symmetry.  Patients who have had malignant cancers may undergo mastectomy with possible chemo or radiation therapy thereby requiring reconstruction of either one or both breasts.  Breast reconstruction can be performed in one of three manners.  The simplest approach is associated with an implant placed either silicone or saline.  Drawbacks to implants include radiated breasts in which scar tissue can be very severe and will require removal of the implant.  Second method includes tissue being transferred on a pedicle to the breast such as from the back muscle or latissimus dorsi flap or the abdomen referred to as a TRAM flap.  These tissues are maintained to their blood supply directly to the native site and then are transferred on a pedicle to the breast in order to reshape it.  Third or lastly, free tissue transfer can be performed.  This includes removing skin and fatty tissue with the blood supply to the breast and using a microscope to reanastomose the blood supply of this free flap to the breast area.

Breast reconstruction surgery is a way to recreate the shape of a breast after part or all of the breast is removed (mastectomy) because of cancer.

A breast implant is a soft silicone shell filled with saline (salt water) or silicone gel. Silicone may create a more natural-looking breast, because its weight and texture is more like breast tissue. But saline is used most often, because it can be safely absorbed by the body if the implant leaks.

Breast reconstruction usually takes more than one surgery. Sometimes an implant is placed during the same surgery as mastectomy. The nipple and the brown area around it (areola) are created at a later time. But often the doctor will first place a balloon (tissue expander) beneath the chest muscle. Saline is added to the balloon every 1 to 2 weeks to help stretch the skin and muscle. This may take several months. When the right size is reached, the balloon is taken out and an implant is put in.

Implant surgery is done by a plastic surgeon. The breast surgeon who does your mastectomy can refer you to a plastic surgeon with special training in breast reconstruction.

You will meet with the plastic surgeon before your mastectomy to discuss the best procedure for you. The surgeon can show you pictures of other women who had implants after mastectomy. Ask to see both the best and worst results so you can get a better idea of what can happen. You can also ask to talk to women who have had the surgery.

Before having this surgery or any other surgery, you may want to see another surgeon to get a second opinion.