Reconstructive Procedures » Breast Reconstruction
Mastectomy is a traumatic experience for any woman. Breast reconstruction is an alternative for women of any age providing your health is good enough for you to tolerate a general anesthetic.There are two basic ways of reconstructing a breast or both breasts - prosthetic implants or using your own tissue. Your surgeon will discuss with you the risks and benefits of implants versus using your own tissue to reconstruct your breast(s).
Prosthetic implants usually consist of silicone shell implants enclosing saline (salt water) or silicone. Dr. Tumi prefers to use silicone implants. The implants are usually placed underneath the muscle of the chest wall. Although implant surgery is usually more simple and shorter than using your own tissue, the complication rate of implant surgery and the need to operate again at a later date is higher with implants. Implants have a higher rate of complications if you have had radiation to the chest skin.
Implants placed under the skin are more convenient than prostheses placed in your brassiere. However, the body's reaction to these can be a capsule or envelope surrounding the implant making the breast hard and tender. In addition, implants do not have the same natural feel as would transplanting your own tissue.
After mastectomy, the skin envelope may not be large enough to allow for an implant and skin expansion may be required before the "permanent" implant is inserted. Tissue expansion is done by inserting an expandable silicone "balloon" which is inflated with salt water weekly by your surgeon. When enough skin is available the implant can be inserted.
Using your own tissue is called autologous reconstruction. Autologous reconstruction involves transferring soft tissues (skin, fat) from other areas of the body. Because of the frequent excess tissues and because of the convenient anatomy skin from the lower belly is often a preferred area for harvesting autologous tissues for breast reconstruction (TRAM flap reconstruction). Less commonly, other areas can also be harvested, i.e. buttock, thigh or back. Complications of using your own tissue include the small chance that the transplanted tissue does not survive. There are other complications associated with the four hour surgery including hernia if the tissue is taken from the abdomen.
It is important to understand that a "normal" breast will never be obtained with a breast reconstruction operation and realistic expectations are in order. However, patient satisfaction is generally high.
Please also see the ASPS site, www.breastreconstruction.ca and www.plasticsurgery.ca for further information about breast reconstruction.
