Removal of even a portion of a woman’s breast can lead to a request for breast reconstruction.
Fortunately, treatment for cancer of the breast no longer requires extensive mutilating operations. This is a result of better understanding, increased awareness, earlier detection, and advances in adjuvant therapies. There is also a new awareness among cancer surgeons who recognize the necessity of treating the whole patient, not just her cancerous breast.
Breast reconstruction may involve a comparable reduction of the other breast, replacing missing volume with a small breast implant, recreating an entirely new breast mound, or a combination of procedures.
Women who require a so-called lumpectomy to treat their cancer generally are left with mild to moderate asymmetry. In many cases the asymmetry can be reduced by placement of an implant similar to one used in augmentation mammoplasty. The procedure is very similar to that of an augmentation except that it is done on only one side.
Women who require a mastectomy are left with more significant asymmetry and there are many reconstructive options to consider.
One of the simplest reconstruction alternatives involves a staged procedure involving the placement a tissue expander beneath the chest wall muscle. The tissue expander may be inserted either at the time of the mastectomy or at some point after. In the weeks that follow, the expander is slowly inflated with a saline solution. With each expansion the skin and muscles of the chest wall stretch, creating a pocket that will eventually hold the permanent prosthesis. Once the desired pocket size is achieved, a second operation is performed. At the second operation, the tissue expander is removed and a permanent prosthesis is placed.
Many women stop at this point but others go on to request reconstruction of the nipple-areola complex. Again, there are many alternatives to reconstruction ranging from simple tattooing to tissue grafting.
Depending on the size of a woman’s breasts and the degree of sagging (ptosis), she may require a procedure on the opposite breast to reduce asymmetry. Because each case is unique, treatment options are tailored to the individual.
The first person to discuss reconstruction will most likely be your cancer surgeon, not a plastic surgeon. It is appropriate to discuss your reconstruction option before any cancer operation is performed. If this is not a comfortable thing for you to do, or if you have already had your operation, there is no time limit on discussing your options for reconstruction afterward.
