BREAST RECONSTRUCTION AFTER MASTECTOMY
by Daniel Sellers, MD
In this day of modern plastic surgical techniques, with hands and fingers being reattached, faces being rearranged bone-by-bone, extremities that would otherwise have been amputated just a few years ago being salvaged by modern microsurgical techniques——one would think that a woman who has lost a breast from cancer could expect a breast reconstruction that would be far better and more natural looking and feeling than she could have expected years ago. Well, such expectations are indeed justified, and indeed possible in today’s world of plastic surgery techniques. Breast reconstruction options are certainly more numerous now than several years ago, with possibilities of reconstructing a breast with a woman’s own tissues that retain a natural softness and can endure such cancer treatments as chemotherapy and radiation.
In general, there are three types of breast reconstructions: ones that utilize a silicone or saline filled implant to create the breast mound, ones that use a combination of locally transferred flaps of muscle and/or skin plus an implant, and ones that utilize only tissue transferred from a woman’s own body. As to the first technique, the reconstruction is often staged, with the placement of a special “tissue expander” first to enlarge the pocket for subsequent placement of a permanent implant. This tissue expander can be placed at the same time as the mastectomy, thus decreasing the total number of surgeries required for the reconstruction and hastening its completion. In the combination technique, an appropriate sized pocket for the implant is created by replacing the skin and subcutaneous tissue removed during the mastectomy by transferring a muscle-skin “flap” from the back (which leaves a scar in the bra strap line) or abdomen (TRAM), then the implant is placed into this pocket.
Many women will be best served by creating a breast mound using only their own tissues. The most common location to transfer this tissue from is the lower abdomen. In fact, this is the same tissue that would otherwise be discarded in a “tummy-tuck” operation. This tissue is soft, pliable, and has a natural feel and consistency. Yes, in this reconstruction the woman gets a modified tummy-tuck as part of the surgery. This tissue retains its blood supply from above, through the rectus muscle, or can be transferred by use of microsurgical means using vessels from the groin area, or a combination of both blood supplies. Other potential locations from which to transfer tissue to build the breast mound include the buttock, the outer thigh, or the inner thigh.
Finally, the breast reconstruction is completed by reconstructing the nipple and areola. This step is usually delayed until the reconstructed breast has settled into its final position so that placement of the nipple onto the mound can be most accurately done. It should be reemphasized that breast reconstruction initiated at the time of mastectomy often gives a nicer final result than reconstructions delayed. Part of this, however, depends upon the type of reconstruction chosen, and the adjuvant cancer treatments to be received.
With all of the options available, and with Federal Law requiring insurance companies to pay for breast reconstruction after mastectomy (including modification of the remaining breast to match, if necessary), any woman who is facing a mastectomy, or who has undergone this disfiguring procedure, should take hope, and contact Dr. Sellers discuss her options BEFORE her mastectomy, if possible.
