Breast reconstruction is a surgery that can be done either immediately after a mastectomy while you are under anaesthesia, or at a later date if you are not emotionally or medically fit to undergo a second surgery, or if you need to undergo radiation therapy after your mastectomy for breast cancer.
As breast reconstruction is a major surgery that involves more than one procedure, women need to be fully aware about what is involved. Moreover, women have many options like use of implants and flap procedures during breast reconstruction surgery.
Implants and tissue flaps
If implants are used, the skin is stretched using a special tissue expander after which a silicone gel or saline implant is inserted. The tissue expander is periodically filled with additional saline to reach the desired volume for a few weekly sessions. While these sessions are rather painful, the final results are well worth the pain.
In case of the tissue flap procedure, your tissue is removed from your back or abdomen and is used to create a breast mound for reconstructing your breast. If abdominal tissue is used, it is called a TRAM flap, the acronym for transverse rectus abdominis muscle. In case back tissue is used, it is called a latissimus dorsi flap. It is very important that these procedures are performed by a plastic surgeon with sufficient experience in this type of surgery.
Tattoo the nipple
If required, the areola (dark area surrounding the nipple) can be reconstructed using tissue from the back or abdominal flap and tattooed to resemble the colour of your nipple. In rare cases, your surgeon may also attach the nipple from your original breast. This step is resorted to only if your surgeon is sure that the tissue is free from cancer.
You should however remember that while breast reconstruction can help improve your breast appearance, the lack of nerve connections may make your nipple not rise or flatten in response to touch or temperature. Breast reconstruction usually has no effect on chemotherapy and if radiation therapy is required, your surgeon may delay the reconstruction. While complications are not common, they include bleeding, scarring and infections.
You can opt to wear breast prosthesis if you do not want to undergo a breast reconstruction after a mastectomy or a wide local excision. The prosthesis is made using silicone gel which fits into your bra cup, and may feel cold and heavy at first. These sensations however go away with time.