Mastectomy is the surgical removal of all or some of the breast. It is done to treat, or prevent, breast cancer. Following mastectomy, many women opt for breast reconstruction surgery. This plastic surgery procedure attempts to return the breast to its former shape, size, and appearance.
Lumpectomy is another type of cancer-removal surgery. It spares more of the breast. It may also be followed by breast reconstruction.
There are two main types of breast reconstruction.
Reconstruction with implants replaces the breast tissue with an implant filled with saline or silicone.
Reconstruction with flap surgery uses tissue from your abdomen, back, or buttocks to reconstruct the breast.
There are pros and cons to each procedure.
Reconstructing the breast with an implant is somewhat easier than rebuilding the breast with living tissue. Using your own tissue for reconstruction also carries a greater risk of certain complications.
Unlike an implant, the flap tissue is alive and needs nourishment from your blood supply. There is a risk of tissue death. There is an additional risk of permanent damage to the area from which the tissue was removed. For example, it could cause an abdominal wall hernia. A hernia occurs where the muscles are damaged and organs bulge out of their proper place. You could also lose sensation at the tissue donor site.
Breast implants are disc-shaped silicone shells. They can be filled with sterile salt water (saline) or silicone gel. They are inserted under the skin or muscles of the chest. Once in place, they provide a similar shape to that of a natural breast. However, the sensations you experience in your breast will be different. It may not move in the same way as your other breast.
People are worried about the possible side effects from leaking silicone gel. Some silicone-filled implants have leaked in the past. Today, saline-filled implants are more popular. Few gel-filled implants are still in use. However the outside of the implant is still made from a silicone polymer.
One-stage Immediate Breast Reconstruction
With this option, the plastic surgeon begins reconstruction as soon as the damaged breast tissue has been removed. Ordinarily, a general surgeon performs the mastectomy. Then a plastic surgeon inserts the implant(s) while the patient remains under anesthesia. This technique takes fewer doctor visits to complete. It has been gaining in popularity.
Two-stage Delayed Reconstruction
More commonly, implants are placed using two-stage delayed reconstruction. During an initial surgery, a plastic surgeon will implant a balloon-like device called a tissue expander. At regular times after the surgery, the doctor will inject saline solution into the expander. Injections can take place over several weeks. This allows the patient’s skin to stretch gradually. In time the expander is replaced by the permanent breast implant. This takes a second surgery.
In some cases, the expander remains in place as the final implant.
Reconstruction must be tailored to the individual. No two breast reconstructions will be exactly alike. The goal is to make a “new” breast that is as close to the original breast as possible.
Sometimes, the nipple and aureola are spared during breast-cancer surgery. The aureola is the dark skin surrounding the nipple. If they must be removed, an artificial nipple and aureola can be made. There are different ways to do this. Some surgeons use tattoos to simulate a natural-looking nipple and aureola.
Any surgical procedure involves risk.
The risk of infection may last up to six months after implant surgery. Patients may be instructed to take antibiotics to prevent infections after surgery.
Other potential complications include:
- scar tissue forming around the implant
- leaking or burst implants
- implants that do not stay in place
- swelling in the upper chest or arms (lymphedema)
Chemotherapy and/or radiation treatments may affect healing from breast reconstruction surgery, especially when administered after surgery. According to the Mayo Clinic, women who need radiation treatments may do better with flap reconstruction than an implant (Mayo Clinic, 2010).