Because the consequences of cancer are as unique as the woman fighting the disease, the results of breast reconstruction can be unpredictable. Stay positive, but know that several surgeries may be necessary. Complete breast reconstruction often involves several stages of surgery, from the mastectomy until creation of the nipple-areola complex.
Breast Reconstruction Surgery
Women who have aggressive forms of breast cancer, or who are at high risk of developing the disease, sometimes choose to have a mastectomy, the surgical removal of one or both breasts. Some patients may then choose to have surgery to reconstruct their breasts to restore their form and shape. During this procedure, doctors can replace any skin, breast tissue or a nipple that they may have removed during the surgery. (If you still need radiation therapy after your mastectomy, your doctor may suggest you wait for reconstructive surgery until after you finish treatment.) Breast implants, filled with either silicone or saline, can be used to reshape your breast, or you can even use your own tissue, a procedure called flap surgery. Both breast implants and flap surgery are complex procedures, each with their own risks; they may require second surgeries to position the breasts correctly. Most insurance companies will cover this type of reconstructive surgery. Learn more about breast reconstruction with expert advice from Sharecare.
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Dr. Stuart A. Linder, MD , Plastic Surgery, answeredSee All 2 AnswersThe TRAM flap is known as the Transverse Rectus Abdominis Musculocutaneous Flap. The tissue from the lower abdomen as with a tummy tuck may be transferred to the breast either by a pedicle (still attached to the abdominal wall) or a "free-flap". A free-flap requires removal the tissue and transferring to the breast via microscopic anastomosis to vessels in the axillary region. TRAM flap patients require a reasonable amount of tissue under the umbilicus as with an abdominoplasty. They should also be non-smokers. Smoking may reduce the oxygenation and circulation of the pedicle which could lead to death or necrosis of the flap.
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Dr. Michael A. Howard, MD , Plastic Surgery, answered on behalf of NorthShore University HealthSystemI generally tell patients that the first two weeks will be somewhat difficult. But usually after about four weeks to six weeks recovery time, most patients will be back to their normal activity. -
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Menorah Medical Center answeredBreast cancer reconstructive surgery was first described in the Edwin Smith Surgical Papyrus, which dates back to 3000 B.C. Thankfully, things have changed dramatically since then. Breast cancer reconstructive surgery has gone from removing the entire breast, chest wall muscle and all the lymph nodes under the arm to saving the breast by removing only the tumor and only needing to remove one to three lymph nodes under the arm in most cases. Over the years, research has shown that such radical surgeries are not needed to achieve the same survival when combined with other treatment such as radiation. Additionally, newer techniques have allowed improved cosmetic outcomes with breast conservation, and in some cases saving the skin and/or nipple with mastectomy.
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Dr. Homayoun N. Sasson, MD , Plastic & Reconstructive Surgery, answered on behalf of Castle Connolly Top DoctorsSee All 4 AnswersThe timing of breast reconstruction following cancer surgery varies according to the stage and progression of the cancer, preferences of the woman and the surgeon and other treatments that might be necessary. Following are options for timing of breast reconstruction surgery:
- Immediate breast reconstruction is done at the same time as cancer resection, often requiring further revisional surgeries for better symmetry.
- Delayed breast reconstruction is usually done when interim treatments are indicated, such as adjuvant chemo, radiation or hormonal therapies.
- Delayed-immediate breast reconstruction is done at the same time as cancer surgery, but further definitive reconstruction is delayed until completion of interim treatments.
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See All 9 AnswersBreast reconstruction is a way to give women who have had a mastectomy a chance to have a normal appearing breast. There are several methods that sugeons use to reconstruct breasts. One is implantation of saline or silicone breast replacement implants under the skin. If there is not enough skin or tissue to do this a surgeon can sometimes take fat, muscle and skin from other areas and use them to make a natural looking breast so that the woman who has had breast cancer may lead as normal a life as possible after treatment for thier cancer. -
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Dr. Preya Ananthakrishnan, MD , Surgery, answered on behalf of Columbia University Department of SurgerySee All 2 AnswersMany breast cancer surgeons now perform oncoplastic surgery, which is a combination of oncologic procedures for tumor removal with plastic surgery techniques to maintain the shape of the breast. One key technique in this approach is the local advancement flap. With this technique, the surgeon removes the cancer, then rotates the remaining tissue to reconstruct the breast. This gives the woman an optimal appearance and leaves minimal indentations or defects, particularly after radiation. There are other more advanced oncoplastic techniques, including lumpectomy combined with breast reduction, which can give women the option of lumpectomy with immediate local reconstruction rather than mastectomy. In some cases, the surgeon may also reduce the size or alter the shape of the opposite breast in order to maintain a balanced appearance.
Women with DCIS (ductal carcinoma in situ), a noninvasive cancer, can also benefit from oncoplastic techniques. Because DCIS is distributed through the breast's ductal system, sometimes it can be difficult to excise. Removal of DCIS may require removal of a substantial amount of breast tissue, and some patients have traditionally had to undergo mastectomy. Now, the creative use of oncoplastic methods is allowing many women with DCIS to keep their breasts intact and with excellent results.
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Citrus Memorial Hospital answeredStaged breast reconstruction is a procedure for replacing removed breast tissue over time.
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Dr. Stuart A. Linder, MD , Plastic Surgery, answered
The major disadvantage of delaying your breast reconstruction may be the psychological impact of waking up from anesthesia with loss of a breast. The oncologist, general surgeon, and plastic surgeon, should be consulted with when determining the timing of safe breast reconstruction surgery. Cancers that require radiation therapy to the chest may require a Delay of placing any prosthetic device (permanent silicone implant, or tissue expander), due to high risk of scar tissue formation or poor healing due to devascularized tissue.
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If a woman doesn't have breast reconstruction at the time of her cancer treatment, she can still have it later. In this video, Dr. Heather Karu talks about why a woman may have delayed reconstruction and the options that can work best.