A New Start

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Breast cancer continues to impact women and their families at an alarming rate.
Over 46 thousand women will get breast cancer this year. There are
over 1.7 million women alive with a history of breast cancer. Being
a survivor is in itself a source of pride, but these women may still
face significant questions relating not only to their physical health,
but their sense of emotional well-being. Among the most pressing issues
for women who have had mastectomies is breast reconstruction. AboutPlasticSurgery.com,
an Internet resource for women interested in implant advances, reports
that over 30 percent of the inquiries it receives concern the use
of implants in breast cancer reconstruction. These women don’t simply
want to stay alive; they want to live.

Right or wrong, the female breast can have a serious impact on a
woman’s self-esteem. Mastectomy involves emotional loss as well as
physical loss. The goal of breast reconstruction, either at the time
of the mastectomy or delayed, is to replace not just the breast but
any self-esteem or sense of femininity the patient may feel she has
lost. There are different approaches to reconstruction that vary depending
on the type of mastectomy, the condition of the breast skin, and the
patient’s preferences.

When there is enough skin and it is loose and thick enough, an implant
can be placed beneath the muscle. More commonly, a tissue expander
(a balloon-like device) is placed beneath the muscle and filled with
saline solution over several weeks. This stretched skin can then accommodate
an implant.

When there is not enough skin, or when a patient prefers her own
soft and supple tissue, a flap is used. This consists not only of
skin, but also the fatty tissue underneath it and the muscle and blood
vessels that sustain it. The abdominal tissue, with one side of the
rectus muscle, is a common donor area. It is either tunneled through
the upper abdomen or detached from and reattached to its blood vessels.
This essentially provides the result of a tummy-tuck and the aesthetic
result of the breast is usually excellent. Occasional problems include
lower abdominal pooching or hernias, but usually the patient is able
to do sit-ups without any special difficulties.

Another frequent donor site is the broad muscle on the back with
its overlying skin and fat. This tissue is tunneled through the armpit
and sutured into the breast area. Often, an implant is placed underneath
to provide adequate size while retaining the tactile benefits of the
patient’s own tissue. The scar in the back is not as well-hidden as
in the abdominal donor area.

The scars fade gradually and are usually quite acceptable. The recently-developed
“skin-sparing mastectomy” removes only the nipple-areola complex,
preserving other breast skin and limiting breast-scarring tremendously.
The nipple and areola are reconstructed under local anesthesia at
a later date. This is a short and simple procedure. Most patients
are released from the hospital in 2-5 days but should avoid overactivity.