Modern surgical technology makes it possible to construct a natural-looking breast after mastectomy (breast removal) for cancer or other diseases. The procedure is commonly begun and sometimes completed immediately following mastectomy, so that the patient wakes with a new breast mound. Alternatively, reconstruction may begin years after mastectomy. There are several ways to reconstruct the breast, both with and without implants; your surgeon(s) should work together with you in deciding which is the best for you. Breast reconstruction does not affect the recurrence of cancer, does not cause any other diseases, and does not affect chemotherapy or radiation treatment.
The most common technique combines skin expansion with implant insertion. First, the surgeon inserts a balloon expander beneath the skin and chest muscle where the reconstructed breast will be located. A saline (salt water) solution is then injected into the expander through a tiny valve beneath the skin over a few weeks or months, eventually filling it and stretching the skin. The expander may then be left in place or replaced with a permanent implant. A final procedure reconstructs the nipple and areola (dark area of skin around the nipple). Some patients do not require tissue expansion and begin with the implant.
Another, more complicated type of implant reconstruction involves the creation of a skin flap using tissue from other parts of the body. If the flap is not large enough to serve as the new breast by itself, an implant is then inserted beneath it. Tissue for the flap consists of skin, fat and muscle from the back, abdomen or buttocks and may either be surgically removed and reattached (free flap, requiring a microvascular surgeon) or remain connected to its original blood supply and "tunneled" through the body to the chest (pedicled flap). Advantages over implant insertion are a more natural look and feel for the breast and abdomen, and elimination of any risks associated with silicone implants; disadvantages are scars at the breast and donor-tissue site, and longer recovery.
Both implant insertion and tissue flap surgery are followed by nipple and areola reconstruction. The reconstructed breast will probably look and feel different from the natural breast. Further surgery may be desired to adjust the natural breast to better match the reconstructed one, although a perfect correspondence in size, shape and height is unlikely.
Most patients are tired and sore for a week or two, and recovery can take up to six weeks, but you will be released from the hospital in two to five days. Stitches are taken out in a week to ten days. A surgical drain may be left in place to prevent a build-up of fluid in the reconstructed breast; this will be removed after a week or two.
The reconstructed breast will be numb following surgery, but it is possible that some sensation will return as time passes. Scars will fade, but not disappear. Periodic mammograms with a radiologist trained to examine breasts with implants are recommended.
Breast reconstruction has not been proven to affect the recurrence of cancer or other diseases, chemotherapy or radiation treatment.
Nevertheless, in addition to the complications possible from any surgical procedure (bleeding, fluid collection, excessive scar tissue, or difficulties with anesthesia), there are some risks inherent in breast reconstruction, including infection around the implant, if an implant is used, and capsular contracture, when the scar (capsule) around the implant tightens, causing the breast to feel hard. Treatment for capsular contracture varies from "scoring" the scar tissue to removing or replacing the implant. Some patients may need time to come to terms emotionally with their new breasts.