Breast Reconstruction Surgery
A breast reconstruction surgery is a medical cosmetic procedure that aims to rebuild lost breast tissue. It is performed on patients of both sexes although it is more commonly performed on women, particularly those who have undergone a mastectomy due to cancer. The operation involves the use of the patient’s own tissues or prosthetic materials (i.e. breast implants) to reconstruct the breast. It may also include the reconstruction of a new nipple-areola complex. Breast reconstruction can be performed immediately after a mastectomy and it usually requires multiple follow-up operations. These follow-up mini-surgeries have an interval of a couple of weeks to a few months.
Patient Type
As with any surgical operation, breast reconstruction is not recommended for patients who are obese, diabetic or smokers. These patients are at high-risk for complications. The surgeon may opt to delay the procedure to decrease these risks since studies show no significant differences exist in the results between immediate and delayed reconstruction. In fact, there may be a slightly higher risk of infection if the surgery is performed immediately after the mastectomy. However, immediate reconstruction is said to provide the patient with some psychological benefits. Patients who are undergoing radiation treatment as part of their cancer treatment must have delayed reconstruction due to high risk of complications.
Price
The cost of a reconstruction surgery ranges from $5000 to a whopping $50,000. Reconstruction using implants costs higher than reconstruction with tissue flaps. Since the procedure is mostly done for medical reasons, it is usually covered by insurance. Immediate and delayed reconstruction operations are both paid for by the insurance company including all the related procedures that the patient might need over time. Such related procedures include, but are not limited to, refinement of the reconstructed breasts and correction of the asymmetry between the breasts.
Techniques
A number of breast reconstruction techniques exist but the two most frequently used are the breast implant and flap reconstruction techniques.
The expander-implant technique is the most commonly used method worldwide. It involves the insertion of a tissue expander (AKA temporary implant) beneath the muscle of the chest wall. In the following weeks, saline solution will be injected into the implant little by little to allow the overlaying tissue to stretch and expand.Once the expanders reach the desired size, the surgeon will remove and replace them with more permanent implants. Reconstruction of the nipple-areola complex is done in a separate operation after the tissues have adjusted to their final size.
The second most popular technique of breast reconstruction is the flap reconstruction method. It requires the use of the patient’s own tissues to rebuild the breast. The term “flap” pertains to a portion of tissue gathered from a donor site and transferred to the receiver site. The parts of the body where the tissues can be harvested include the abdomen, thighs, buttocks and back. The flap may be left attached to its source (pedicle flap) or be completely disconnected from it (free flap). The types of flap often used in breast reconstruction include the transverse rectus abdominis myocutaneous (TRAM) flap, latissimus dorsi flap and deep inferior epigastric perforator (DIEP) flap. The other less commonly used types are the superficial inferior epigastric artery (SIEA) flap,superior/inferior gluteal artery perforator (sGAP/iGAP) flap, transverse upper gracilis (TUG) flap and profunda artery perforator (PAP) flap.
The second most popular technique of breast reconstruction is the flap reconstruction method. It requires the use of the patient’s own tissues to rebuild the breast. The term “flap” pertains to a portion of tissue gathered from a donor site and transferred to the receiver site. The parts of the body where the tissues can be harvested include the abdomen, thighs, buttocks and back. The flap may be left attached to its source (pedicle flap) or be completely disconnected from it (free flap). The types of flap often used in breast reconstruction include the transverse rectus abdominis myocutaneous (TRAM) flap, latissimus dorsi flap and deep inferior epigastric perforator (DIEP) flap. The other less commonly used types are the superficial inferior epigastric artery (SIEA) flap, superior/inferior gluteal artery perforator (sGAP/iGAP) flap, transverse upper gracilis (TUG) flap and the profunda artery perforator (PAP) flap.
Risks
A reconstruction surgery involving implants carries the same risks and complications as an augmentation surgery using the same prostheses. It produces a higher rate of capsular contracture and the possible need for revisional surgeries. Capsular contracture pertains to the hardening of a scar around the implant. For reconstruction involving tissue flaps, bleeding and formation of blood clots are the most common complications.
Recovery
Breast reconstruction using tissue flaps are complex and invasive so they require a longer recovery time. But in general, activities that require physical exertion must be avoided for at least four weeks. Most patients can resume normal activities eight weeks following the operation. After week eight, the majority of the complications have subsided and patients will start to see improvements on their reconstructed breasts.
Finding the Right Doctor
It’s important for a patient to find a surgeon they are comfortable discussing the procedure with at all times. Patients should ask the doctor about his experience performing reconstruction surgeries and also make sure he is a certified member of the American Society of Plastic Surgeons.