While breast reconstruction after mastectomy isn’t medically required, most women find that it can help restore the look and feel of breasts, making them more comfortable about their looks. There are a number of options and techniques available, with the best choice for any given patient depending in part on the extent of tissue removal during mastectomy and radiation therapy.
In most cases, breast reconstruction is completed at a later date, after the mastectomy and tissue expansion. Less commonly, breast reconstruction with implants can be done at the same time as the mastectomy.
After a mastectomy and before reconstruction surgery, a tissue expansion procedure is used to allow the body to ‘grow’ enough skin for use in the reconstruction process. Typically, a silicone balloon expander is inserted under the skin and gradually filled with saline or carbon dioxide during multiple office visits over a two- to six-month period. This causes the skin to gradually stretch and grow. The expander can be filled even while the patient undergoes chemotherapy or radiation therapy.
Breast reconstruction is done using saline or silicone breast implants or natural tissue flaps (using skin and fat from other parts of the body including the abdomen, back, thighs, or buttocks).
Tissue Flap Reconstruction
The most common method of breast reconstruction uses the patient’s own tissue to rebuild the shape of the breast after mastectomy and/or radiation therapy. There are a number of types of tissue reconstruction surgeries, depending on which part of the body is used for the donor tissue. Many of these procedures require the skills of highly trained plastic surgeons.
Tissue flap reconstruction occurs after tissue expansion is complete, and usually requires a hospital stay of three to four nights. Recovery takes four to six weeks.
Reconstruction with Implants
Another option is to use permanent implants for breast reconstruction. In this outpatient procedure, the surgeon removes the tissue expander and replaces it with a permanent silicone or saline implant. Reconstruction with implants requires a shorter recovery period than tissue flap reconstruction, and leaves fewer scars.
Immediate Breast Reconstruction with Implants
In some cases, where a mastectomy leaves enough tissue on the chest wall to cover and support an implant, a saline or silicone implant may be inserted at the time of mastectomy. Typically this option is available to women who have moderate-sized breasts or excess natural breast skin. Direct implant insertion is done by a plastic surgeon immediately after a breast surgeon has performed the mastectomy.