The breast reconstruction helps to restore a breast to near normal shape, appearance and size. This is usually done after a mastectomy, and involves several plastic surgery techniques. It helps to restore a breast lost due to cancer, or other conditions, hence, a physically and emotionally rewarding procedure for women. The reconstructed breast will not have the normal sensation and feel. It also leaves a visible scar behind, both at the donor site as well as the recipient site.
Preparation
A complete medical evaluation is done before breast reconstruction and medications are prescribed according to the requirement. The patients should stop smoking well in advance to the surgery and also should avoid taking aspirin and other drugs that can increase bleeding. Your surgeon will discuss in detail regarding the procedure adopted, anaesthesia and also on what is to be done on the day of surgery.
Patient status
The breast reconstruction procedure may be done in an accredited office-based surgical centre, outpatient/ambulatory surgical centre or a hospital.
Anaesthesia
The entire process is done under general anaesthesia.
Procedure
Flap technique- A flap is the muscle, fat and skin taken from some other part of the woman’s body (donor site). This flap either creates or covers the breast mound. This type of breast reconstruction technique is used in cases where a mastectomy or radiation therapy has left insufficient tissue on the chest wall to cover and support the breast implant.
There are different types of flaps.
- TRAM flap- donor muscle, fat and skin from abdomen
- Latissimus dorsi flap- Donor muscle, fat and skin from the back
These flaps may either remain attached to the original blood supply and be tunnelled up through the chest wall. In some cases it may be completely detached and reconstructs complete breast mound.
DIEP or SGAP flap technique is yet another breast reconstruction procedure. In this instead of muscle, tissue from abdomen or buttock is transported to the chest.
Tissue expansion - Though tissue expansion is a lengthy breast reconstruction procedure it allows an easy recovery. It involves the stretching of healthy skin to provide coverage for a breast implant. In this an expander is placed below the skin and the device is slowly filled through an internal valve to expand the skin. It may require several office visits over a period of 4-6 months. If the implant is not designed to serve as a permanent implant, a second surgical procedure is needed to replace it.
Implants - Saline and silicone implants can be an addition or alternative to flap technique. The reconstruction with implant alone may require tissue expansion.
Several other plastic surgery techniques including grafting are involved in the creation of nipples and areola.
After surgery
The patient should wear a support bra over gauze bandages. A small drainage tube collects the excess fluid from the incision. It takes several weeks for the incision to heal and the swelling to minimize.
Risks
The potential risks includes bleeding, infection, poor healing of incisions, the risk of anaesthesia, partial or complete loss of flap, loss of sensation at the donor site and reconstruction site, implant rupture and breast firmness.