Breast reconstruction may be performed to correct congenital abnormalities, but it is most often done after a mastectomy or extensive lumpectomy. Reconstruction doesn’t restore full sensation or function to the breast. However, it can offer significant improvement in appearance. According to statistics compiled by the American Society of Plastic Surgeons, over 93,000 women had this procedure in 2010. It is becoming more common over time, with an increase of 18 percent in the last 10 years. This may indicate that the newer techniques used for today’s reconstructions are more appealing to patients than older methods.
Although this procedure is not necessary to restore physical health, it is considered more than simply cosmetic. Reconstructive surgery helps many patients feel like their lives are getting back to normal after cancer treatment. This can be a real and lasting benefit from an emotional and psychological standpoint. Insurance carriers are required by law to offer coverage for this plastic surgery as a medically necessary procedure. However, this does not mean all women can or should pursue reconstruction.
Why Do Women Seek Breast Reconstruction?
Women who have lost one or both breasts to cancer often feel that their body is no longer under their control. They may have a sense that they are damaged, incomplete, or even undesirable after their mastectomy. They often feel very self conscious about their appearance and this feeling may or may not fade over time. In these cases, having a reconstructed breast may be more appealing than the idea of wearing a prosthetic to fill out an empty bra cup or simply getting used to having a missing breast.
Who is a Good Candidate for Breast Reconstruction?
Patients who have had all cancerous tissue successfully removed from their breast and who are not undergoing radiation are typically the best candidates for this procedure. Radiation can cause significant changes in skin texture and elasticity and may also interfere with healing. So, it is usually inadvisable to pursue reconstruction until the process of radiation treatment is complete.
Patients who are in good health (other than the presence of cancer) and who do not smoke are often candidates for a reconstruction using their own tissue. This donor tissue may be taken from areas such as the lower abdomen or upper back. Having a body weight that is not too low or too high makes this option more accessible. Women without sufficient tissue available for this type of reconstruction may still be able to have implants inserted to rebuild their breasts.
Breast Reconstruction Procedure Choices
There are several different methods available for reconstruction after a mastectomy. The best outcomes are usually associated with immediate reconstruction, but delayed reconstruction may also work for some patients.
Autologous Tissue Flap (Grafting) — This approach involves removing skin, fat, and muscle from a donor site on the body and grafting this tissue onto the chest to create a new breast. The donor tissue is usually taken from the lower abdomen as part of a tummy tuck procedure. The upper back and the buttocks are other areas that may be considered for donor tissue. This is a complex procedure that will affect the appearance of both the donor site and the grafting site. However, the texture of the reconstructed breasts will be closer to natural than the affect achieved by implants.
Breast Implants — Patients who don’t want to have additional scars or risk complications from surgery on other areas of their body may choose to have implants used in their reconstruction. Skin may still need to be grafted from other areas of the body in some cases. In others, a tissue expander may be placed under the pectoral muscle. It is inflated over time to expend the overlying tissue and skin and create enough room for a regular implant placement. Implants are not guaranteed to last a lifetime and may need to be replaced in the future if they rupture. With both tissue flap and implant procedures, the nipple and areola are usually reconstructed using available skin that is tattooed to look pink or brown.
SSM (Skin-Sparing Mastectomy) — Women who will not be treated with radiation after surgery may be candidates for a skin-sparing mastectomy. This technique preserves some or all of the existing breast skin and results in minimal scarring. Occasionally, the areola and nipple can be spared as well if they are free of cancerous cells. This approach provides the most natural reconstruction outcome, but it is not an option available to all patients. You should discuss this with your oncologist and plastic surgeon prior to scheduling your mastectomy. An SSM may be used in conjunction with a flap procedure or with implants to create the desired breast size. Data collected so far on patient outcomes indicates that there is no added risk for recurrence of cancer with this method compared to a traditional mastectomy.
Potential Complications of Breast Reconstruction
This type of procedure can be very complex and requires more skill than almost any other breast surgery. Besides the risks associated with all major surgeries, breast reconstruction also carries the potential for:
- Poor wound healing including the failure of grafted tissue to survive
- Extensive scarring including puckering that distorts the breast skin
- Results that look and feel unnatural
- Significant asymmetry
- Complications from breast implants (including capsular contracture)
- Complications at the site where donor tissue was harvested
- The need for repeated surgeries to achieve a satisfactory outcome — or failure to achieve the desired outcome even with multiple operations
It is very important for you to find a board certified plastic surgeon who specializes in reconstructive breast procedures. Since this operation should be covered by your medical insurance, you will need to check your policy to see if your choice is restricted to a specific network of providers.