It’s hard to think of any “good news” when it comes to breast cancer and mastectomy. Yet, for many women, finding out that breast reconstruction is a very viable option that can be performed immediately after surgery or at a later time, is very good news indeed.
When is it appropriate to begin learning about, talking about, and asking about breast reconstruction? As soon as a woman is diagnosed with breast cancer. This way the patient can become more knowledgeable and her physician can more clearly understand her needs and begin partnering with a plastic surgeon. Many women opt to have the reconstruction performed at the time of the mastectomy (minimizing the trauma or emotions they may go through of losing their breast), so the sooner your breast physician can speak with your plastic surgeon, the better.
About the Procedure
There are three types of breast reconstruction: Breast Reconstruction with implants, with tissue grafts and with what is known as a TRAM flap (from part of your abdomen muscles and tissue.). The type of reconstruction really depends on three things: the woman’s health and body type, personal choice, and doctor recommendation. It should be noted that immediate reconstruction is only recommended for those women who have no cancer remaining after the mastectomy.
When having a breast reconstructed with an implant, the process can begin immediately, but will take up to six months to complete. The first phase is implanting an expander, a device that is like an implant but that will eventually be replaced (though there are expanders that can also act as implants, eliminating the need to have the expander removed). The expander’s role is to slowly create space in the chest wall for the implant. A saline solution is inserted into the expander and more is added over the next few months.
The second Breast Reconstruction method is the Autologous Reconstruction. This method uses skin, muscle and tissue from the back, belly or thigh region to rebuild the breast. This procedure doesn’t work well with thin patients because they may not have enough tissue in these regions to “donate.” However, for women who are physically able, Autologous Reconstruction gives them natural feeling breasts and they do not run the risk of implant leaking or complications.
A sub-type of the Autologous Reconstruction is the TRAM Flap procedure. The name TRAM comes from Transverse Rectus Abdominus Muscle, the muscle that makes up the lower part of the abdomen. There are many benefits of the TRAM Flap method. One, for women who have a “belly,” the TRAM flap works as both Breast Reconstruction as well as a Tummy tuck. Second, the skin, muscle and tissues can often remain “connected” to blood supply, minimizing complications that come from separating tissue entirely from the body and then reattaching. The skin and tissue of the belly can easily mimic the “feel” of a real breast, but the woman will not have the same physical sensation she had before the mastectomy.
A drawback from the TRAM Flap procedure is for women who only had one breast removed and years later need to have the other breast removed as well. The TRAM Flap reconstruction will not be available for the second reconstruction. However, for women who have a double mastectomy, a single TRAM Flap operation can work for recreating both breasts.
Risks and Complications
Healing from Breast Reconstruction surgery will depend not only on the individual, but on the procedure that was performed as well. For women who opt for Autologous or TRAM Flap Reconstruction, not only will they be healing form the reconstruction, but their “donor” site will be healing as well. The patient will need several weeks off from work and a couple months before they can return to all activities. Your physician will give you post-op instructions that will help you feel better and heal more quickly. But the most important thing is to give yourself the time and the care it takes to heal.