Surgical Procedures - Breast Surgery

BREAST RECONSTRUCTION (RECONSTRUCTION MAMMAPLASTY)

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Surgical procedures to restore the size and shape of breasts after mastectomy.

Each year, more than 55,000 women who have been stricken with breast cancer turn to reconstructive surgery to restore their body images. This can be accomplished in several ways.

'FLAP' RECONSTRUCTION

Today more and more women are choosing 'autologous' procedures - those that use the body's own tissues for reconstruction so that the resulting breasts both feel and look more natural. This is known as 'flap' reconstruction. Hurlingham Clinic Breast Reconstruction 'Flap' Reconstruction

Flap surgery is far more complex than other methods of breast reconstruction. During the procedure, the surgeon partially detaches a flap of skin, muscle, and fat from the patient's abdomen or back, and then rotates it, tunnelling it underneath the skin to the mastectomy site - making sure that enough of the arteries and veins that channel blood through the flap continue to do so. The surgeon then forms the flap into a mound that matches the healthy breast as closely as possible and sutures it into position. If both breasts have been removed, a bilateral procedure using two flaps can be carried out.

In the most common type of flap reconstruction, the TRAM (Transverse Rectus Abdominus Myocutaneous) procedure, a piece of skin, fat and/or muscle is moved from the abdomen and used to rebuild a breast. This eliminates the need for an artificial implant and, since the 'donor' tissue comes from the abdomen, women undergoing a TRAM flap procedure effectively have their waistlines reduced at the same time.

In a more complex variation of this procedure, requiring a highly skilled and highly trained plastic surgeon, tissue is cut completely away from the abdomen or buttocks. Using microsurgical techniques, the surgeon then reattaches the blood vessels on the flap to blood vessels on the chest wall. He can then shape the tissues as before to simulate a normal breast.

In both these flap procedures, the scars surrounding the reconstructed breast heal in about two months. At this point the surgeon may go on to create a nipple and an areola using the flap skin, and later he may tattoo the areola to give an even more natural appearance.

RIGHT FOR YOU?

The operations are lengthy and complex but, for many women today the benefits far outweigh the drawbacks. These can include: scarring on the chest and at the 'donor' site; possible muscle weakness or even hernia at the donor site; and a long recovery period. Hurlingham Clinic Breast Reconstruction

Good general health is a first essential. Smoking, obesity and diabetes are all reasons why a patient may not be considered suitable. All of them can lead to circulatory problems that hinder recovery.

Naturally not everyone who wants an autologous tissue transplant is a suitable patient. For those women who do qualify, the surgery can be performed immediately following mastectomy or at a later date, depending on the preferences of patient and surgeon.

IMPLANTS AND 'TISSUE EXPANSION'

A simpler and more common way to reconstruct breasts following mastectomy involves the insertion of breast implants filled with saline or silicone gel, often in conjunction with a procedure called tissue expansion. Tissue expansion produces improved results for many women, particularly those who, after mastectomy, are left with chest skin that is too tight and taut to accommodate an implant of sufficient size to restore body symmetry. This procedure is now being used more widely since general surgeons are performing less radical mastectomies these days and are also recommending less radiation treatment following the operation.

WHAT HAPPENS?

Women who have tissue expansion as part of breast reconstruction undergo several procedures. First, a tissue expander is placed beneath the skin, usually at the time of mastectomy. This has three parts: a saline bag, a self-sealing valve, and a tube that connects the two parts. For a period of weeks or months your surgeon will use the self-sealing valve to fill the tissue expander gradually with saline solution until a sufficient amount of extra tissue has been created. The expander is then normally removed and a permanent saline or silicone gel implant is inserted, although in some cases the expander can be left in place as the permanent implant.

Finally the nipple and areola (the surrounding pigmented skin) may be reconstructed, usually about three months after the permanent implant is in place. Sometimes, the opposite breast will then need to be lifted, reduced, or enlarged to achieve symmetry.

How Will You Feel AFTER SURGERY

The initial surgery to implant the expander causes most people only temporary discomfort, which can be controlled with medication. When tissue is expanded gradually, there may be slight discomfort each time the saline solution is injected.

Is It Right For You?

Your age, the amount and thickness of your chest skin, and any tissue changes resulting from radiation therapy will all affect your surgeon's view. He will also discuss with you the possible risks involved in using tissue expansion and inserting breast implants. For example, in rare cases, the device used to expand tissue may rupture and leak. Remember, however, that the saline solution with which the expander is filled can be readily absorbed into your system and the expander can also be replaced easily if necessary. The permanent implants may also leak and rupture, although this has not been found to cause problems. In addition, the natural scar tissue that the body forms around the implant may harden and contract (capsular contracture) which can make the reconstructed breast feel hard. In most cases, however, such problems can be corrected with relative ease.

Finally, your expectations will be a factor in post-mastectomy reconstruction of any kind. While these operations can improve your appearance and renew your self-confidence, they will not result in perfection. Talk openly with your plastic surgeon about how you expect to look and feel after surgery to be sure your expectations and what the surgery can accomplish are one and the same.

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