Breast Reconstruction: An Overview of Possibilities
26 Dec 2015
A mastectomy is a life-altering surgery that affects both a woman’s body and often her sense of sexuality. Fortunately, the mastectomy doesn’t need to be the end of the story. One option you will be given as you work through your own comfort with your new (or future) body is breast reconstruction.
If you have been recently diagnosed and are considering breast reconstruction, talk with your surgeon as soon as possible. Breast reconstruction can affect the method your breast surgeon uses during the mastectomy. However, it is never too late to look into breast reconstruction, and if you have undergone a mastectomy, even years ago, there are still plenty of reconstruction options available for you today.
Most breast reconstruction services are available as either delayed procedures or immediate procedures. Delayed procedures are done on a different date than your mastectomy while immediate (simultaneous) procedures are done during your mastectomy. Additionally, there is a staged reconstruction option that uses a tissue expander to stretch the skin and create room for your final implants. They can also stay inside the chest wall as “space holders” until the woman is ready for her final reconstruction. This is often the best option if you are undergoing radiation therapy following your mastectomy, because radiation can cause the final reconstructed breasts to change in appearance.
Breast Reconstruction Options
There are a couple different types of breast reconstruction that are chosen based on each individual woman’s specific situation and preferences for surgery.
Types and Styles
Breast implants are normally made with silicone or saline. Both types are made from a solid shell of silicone, so the difference lies with the filling of each shell. While silicone implants are made up of silicone gel, saline ones use a saltwater solution. If a saline implant leaks, the solution is expelled and absorbed and the implant deflates. Silicone implants do not collapse immediately if they break. Instead, the implant will slowly deflate, as the silicones leaks out. While silicone implants look and feel more natural than saline implants, some women are uncomfortable with the thought of a silicone leak. At this time, medical studies have not shown any negative health conditions from the use of silicone in the implant.
Beyond the two filling types, you can select from several styles: gummy bear, round, smooth, and textured. Gummy bear implants are form-stable and retain their shape even if the shell is broken; however, they may rotate once in place, resulting in an unusual appearance. One advantage of the gummy bear implants is that the filling is a thicker, “gummy” substance, making leakage less likely in the event of a rupture. Round and smooth implants may also move once in place, but they are more uniform in shape so the movement is less noticeable. Smooth implants, specifically, allow for more natural movement. Finally, textured implants prevent movement by sticking the implants to scar tissue that is purposely developed by the surgeon.
Reconstruction with implants is one of the least invasive breast reconstruction methods and allows for shorter surgery times and hospital stays. Recovery is faster and there are fewer scars that result from the procedure. Additionally, breast implants are surgically removable, so you have the option of removing or altering them at a later date to match your changing body and lifestyle.
Breast implants do not look or feel as natural as autologous reconstruction in general, though silicone implants do have a more natural feel than saline ones. They also need to be replaced over time, with replacements required on average every 10 years. However, replacements may be required sooner than that if the implant deflates or bursts. Beyond that, having breast implants can affect routine mammograms by requiring more x-rays to be taken.
Autologous “Flap” Reconstruction
Natural flap reconstruction procedures use tissue and skin from other areas of the body to create a more natural reconstructed breast than implants. Most flap procedures use tissue from either the abdomen (TRAM and DIEP flap), back (LD flap), thigh (TUG flap) or buttocks (GAP flap).
Tissue flap reconstruction procedures are typically done in one of two ways: pedicle or free flap surgery. Free flap procedures involve surgeons cutting the blood vessels and tissue from a given area of the body and attaching them to the chest. Pedicle flap procedures cut and attach only tissue. TUG, GAP, and DIEP flaps are usually free flap procedures while LD flaps are pedicle procedures and TRAM flaps can be either one.
Another type of autologous reconstruction is fat grafting. This technique gently removes fat cells from other areas of the body using liposuction and places it in the breast area. Fat grafting the entire breast is a newer reconstruction option compared to the usual tissue flap procedures; however, it had been previously used for fixing small problems in an already reconstructed breast. Fat grafting does not involve major surgery, but some reconstructed breasts may lose volume if the body reabsorbs some of the added fat.
Unlike breast implants, flap reconstructions do not require any replacement or repeated procedure unless there is a specific complication with the initial procedure. Certain procedures, like TRAM flaps, may result in less pain and faster healing, and the use of natural tissue makes it easier for the surgeon to match the reconstructed breast to a natural one. Further, the procedure typically has added cosmetic benefits, such as a “tummy tuck.”
The surgery is much more invasive and normally results in more scarring and longer surgery times. Recovery time overlaps with implant recovery times, but is, on average, longer. Additionally, some flap reconstruction procedures take muscle from certain areas to assist with blood flow to the flap tissue. This can result in weakness in the surgical area and forced limitations on physical activities.
Nipple and Areola Reconstruction
Some women are eligible for areola-sparing and nipple-sparing mastectomies, which remove the breast tissue while leaving the nipple or areola. However, if this is not option, you can still choose to have nipple and areola reconstruction. There are several different ways women can have their nipple and areolas reconstructed, including intradermal tattooing, tissue flaps, and cartilage and skin grafts, and there are regularly new options being made available. Regardless of the actual technique(s) used, every effort is made to ensure the reconstructed nipple matches the real nipple in projection, location, shape, and size.
Tissue is most often used to reconstruct nipples and areolas and it involves taking tissue from various areas on the body and placing it where the nipple should be. Tattooing the newly constructed nipple is then often used to add the areola and get the right color and depth. You can also opt for a purely tattooed reconstruction that involves tattooing the nipple and areola entirely. There are currently 2D and 3D tattooing options in many locations. Additionally, you may prefer tattooing a different image in place of where the nipple and areola would be as a way of leaving a meaningful message.
One of the newer additions to breast reconstruction is the use of tissue matrixes, or Acellular Dermal Matrix (ADM). Tissue matrixes are often created from donated human or animal skin cells, and they have been used for such things as treating burn patients and abdominal wall reconstructions for more than 20 years. Most often used in addition to breast implants and tissue expanders, tissue matrixes are a great option for women seeking a more realistic reconstructed breast, but either have a low BMI that makes taking tissue from the thighs, abdomen, or buttocks difficult or are concerned about limiting their athletic abilities following the procedure.
There are currently a number of different tissue matrixes available on the market, including FlexHD, Neoform, and AlloDerm. Each brand offers a slightly different product in terms of the how the actual matrix is made and stored, but they all offer similar benefits.
Discussing all of your options with your doctor can help you navigate and understand the benefits and drawbacks to each category and determine which type of breast reconstruction is right for you and whether or not you plan on having your nipple reconstructed. Some individuals can opt for a combination of more than one method, depending on their needs.
In most cases, there is no rush in getting either type of reconstruction, and breast reconstruction is not a requirement for anyone. New methods of tissue support and reconstruction are regularly examined to find new ways of helping women who have dealt with breast cancer reclaim their bodies following a mastectomy.
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