Breast Reconstruction Options After a Mastectomy | I'm Taking Charge
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Breast Reconstruction Options After a Mastectomy

Breast Reconstruction Options After a Mastectomy 2018-05-29T02:38:48+00:00

Let’s start here: you have choices regarding breast reconstruction. You didn’t have a choice about whether you got breast cancer or inherited a faulty BRCA gene. But you DO have choices about what breast reconstruction option you want.

Note: We’re going to devote this space to talk about breast reconstruction after a mastectomy, but we also have information on breast reconstruction after a lumpectomy.

A mastectomy is a life-altering surgery: you lose a body part, an erogenous zone, and your feminine curves. Breast reconstruction cannot give you your original breasts back, nor can it recreate the erogenous sensitivity of your old breasts. It can, however, recreate those beautiful curves that you have always known.

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Going Flat

Before we go any further, some of you need to know that going flat is a real option. Maybe every breast cancer survivor you know has reconstructed. Maybe your doctor referred you so quickly to a plastic surgeon that the thought of going flat hasn’t occurred to you. Maybe you just want to see what going flat looks like.

We don’t know your story, but breast reconstruction is a deeply personal choice. It may be incredibly empowering to reclaim something that breast cancer stole. On the other hand, it could feel like pushing your body to fit inside society’s standards.

We don’t know what you will feel, but if you’re craving the option to envision going flat, go to Rebecca Pine’s reflections on going flat. She has a beautiful photography project showing breast cancer survivors’ strength and femininity, with and without breast reconstruction.

It is tragic when we hear in interviews with women how nobody ever mentioned that they could go flat. For this reason, we hereby give you permission to consider going flat as one breast reconstruction option.

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Using Your Natural Skin (and Maybe Nipples Too!)

You also can have breast reconstruction. It’s equally tragic when a woman is not told of all her breast reconstruction options… or told too late. Certain breast reconstruction options exist only at the time of her mastectomy. We talk more about breast reconstruction timing here. Talking about breast reconstruction early on may change what type of mastectomy you have.

Depending on the location and size of your tumor, your breast surgeon might be able to safely save the skin of your breast at the time of your mastectomy. You can avoid months of pain caused by stretching your skin to create space for breast reconstruction. Think: no new stretch marks and no new skin grafts. It also means dramatically less scarring. We call this a skin-sparing mastectomy.

Sometimes the surgeon can even save your entire nipple in a nipple-sparing mastectomy. Fewer women are eligible for this type of mastectomy, as the nipple has the potential of holding breast cancer cells. However, for the women who do qualify, it can have a beautiful aesthetic result and fewer future reconstructive procedures.

Read more about Nipple-Sparing and Skin-Sparing Mastectomies.

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Using Your Own Tissue

Your plastic surgeon can take muscle and fat from somewhere else on your body (such as your tummy or buttocks) to rebuild your breast mounds. This is called autologous breast reconstruction. When possible, the entire site is rebuilt with only the tissue and skin from your own body. The results often have the most natural look and feel.

Still, while it sounds wonderful for everything to be “natural” with no foreign bodies, there are truly both pros and cons to this method.

One consideration is that you’ll have two surgical sites instead of one. For example, if tissue is taken from your buttocks, both your buttocks and chest will need to heal. This may mean a longer and more complicated healing process (at least initially). Flaps taken from the belly, such as the TRAM flap, may have a significant risk of hernias.

Autologous reconstruction will probably also mean some loss of muscle tone at the donor site. That’s why many athletes are leery of autologous breast reconstruction.

That being said, microsurgery has taken autologous reconstruction to a new potential, with better results and fewer complications. Certain microsurgery procedures, such as the DIEP flap, may even include sensory nerve repair (called microneurorrhaphy). Learn more about this new and exciting possibility at Terri Coutee’s DiepCJourney.

Ask your plastic surgeon about the following microsurgery options:

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Rebuilding a Breast Mound with Implants

Putting a foreign object in your body might not be appeal, but breast implants have a lot of exciting advantages you might not know about. For one thing, if your goal is to get back to normal as quickly as possible, implant-based breast reconstructions tend to have the quickest recovery time. If you have immediate breast reconstruction, you may even wake up from your mastectomy with your new breast mounds already there. This can be a huge relief! You’re also not taking tissue from somewhere else on your body, which means athletes don’t have to worry about their muscle tone.

However, most implants do eventually require replacement, which means an additional surgery at some point. One reason for replacement is that the implant develops a leak. If using a silicone implant, you may not even know there’s been a rupture, as the silicone holds together very well. Only trace amounts will leak out at a time. This can be an advantage as you don’t have to worry about a sudden deflation. On the other hand, you may not feel comfortable with the idea of trace silicone leaking out while you’re unaware (the FDA has declared silicone implants to be safe). Silicone implants also tend to be softer to the touch and to feel more natural.

If you use implants with a saline water solution, they will be harder to the touch. In the event of a rupture, they will deflate rapidly. This could leave you with a very awkward appearance until you are able to get it repaired. However, saline is natural to your body.  With saline implants, you don’t have to worry about silicone or any unhealthy chemicals leaking into your bloodstream.

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Using Tissue Expanders to Create Space

Sometimes a woman does not have enough skin and tissue to build a breast mound under them. That’s why tissue expanders are a frequent part of the breast reconstruction process.

Traditionally, the plastic surgeon would place an empty (or nearly empty) tissue expander in the woman’s chest in an initial surgery. Then, in weekly visits to the surgeon’s office, the surgeon would inject saline solution to stretch the skin and chest wall.

Today there is also the option of tissue expanders using compressed carbon dioxide. The woman expands these tissue expanders at home using a wireless device, similar to a remote control. Women report this option to be less painful.

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Rebuilding a Nipple and Areola

After getting through breast reconstruction, some women decide to forego nipple and areola reconstruction. However, others are left uncomfortable with the “blank” look of nipple-less breasts. Again, this is a deeply personal decision.

One of the most common options is to have a breast tattoo. Some women opt for a tattoo that looks remarkably like a nipple, but others go for images of flowers or symbols of strength and survival. These tattoos can cover up scars and become a reminder of beauty coming out of pain.

An option that we’ve only heard of being done by one tattoo artist is the microdermal nipple implant.

Surgical options can also recreate a nipple with the surrounding skin. A tattoo would then form the areola.

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How to Make the Choice?

Talk with your plastic surgeon. Then talk with another. If necessary, talk with a third. Choosing a plastic surgeon with experience in the type of breast reconstruction you’re interested in is critical.

Read all you can about your breast reconstruction options and then present your questions to each plastic surgeon you meet with.

Ultimately, you will make the choice for your breast reconstruction type together with a plastic surgeon you trust. That’s why it’s important that you choose a plastic surgeon you trust.

Browse our categories and articles below as you seek to understand more on the types of breast reconstruction available to you.

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