If you or someone close to you has been diagnosed with breast cancer, or has undergone mastectomy, it is important to understand that there are several surgical options available for breast reconstruction. Many patients may be unaware of the options available to them, and what treatments they are entitled to. Numerous studies have shown higher reported quality of life and psychosocial well-being in patients who have undergone reconstruction versus those who have had unilateral or bilateral mastectomy without reconstruction. The restoration of a natural breast shape is a patient right, and should be considered by all women who undergo mastectomy, and are medically well enough to undergo reconstruction.
Breast reconstruction encompasses several types of procedures designed to restore the shape and contour of the breast after mastectomy, as well as to reconstruct the nipple and areola complex. In general, reconstructive procedures can be divided into two categories: autologous and implant-based. Autologous reconstruction refers to procedures that use a patient’s own tissue to reconstruct the breast mound. This can be accomplished by one of several methods, most commonly by using tissue from the abdomen, buttock, or back. In some procedures tissue is rotated from the abdomen or back, but as microsurgical techniques have evolved, free tissue transfer has allowed more distant tissue to be used for reconstruction. Further refinements have resulted in the increased popularity of free flaps and perforator flaps, in which tissue can be used for reconstruction based on a single artery and vein, often without having to remove muscle tissue at all.
Implant-based reconstruction typically involves the placement of tissue expanders, which are unfilled temporary implants, which help to create a breast pocket and are serially filled through the skin to expand the tissue over time. Outpatient surgery is then performed to exchange the expanders for permanent implants, at which time reshaping can be done if necessary. In some patients, permanent implants can be placed immediately after mastectomy, eliminating the need for tissue expansion. This type of reconstruction has the advantage of not placing additional incisions or donor sites on the body, and generally requires shorter surgical times. Nipple and areola reconstruction is typically performed after breast shape has been accomplished by either method, and is usually a smaller outpatient procedure.
Since the passage of the Women’s Health and Cancer Rights Act in 1998, and additional legislation in 2001, all breast and nipple reconstructive procedures (as well as procedures on the opposite breast for symmetry) have been mandated to be covered by health insurance. While this legislation has been important in protecting patients’ rights, many patients are unaware that they may undergo reconstruction, even if it is several years after having a mastectomy.
For more information on breast reconstruction, visit our website, where you can read more about reconstruction, and visit our 3-D animation gallery to watch videos of how common breast reconstructive procedures are performed. Call our office to schedule your consultation, and Dr. Ridha will help you select which option will best help restore your natural breast shape and appearance .