Breast reconstruction after mastectomy
Published October 28, 2009, by:
Fadi Nukta, MD
The diagnosis of breast cancer is one of the most stressful news a woman can get. Breast cancer is the most common cancer in women. The routine use of mammograms is increasing the rate of detection. The expanding public knowledge of reconstruction options is leading more patients to opt for undergoing breast reconstruction after mastectomy.
There are two major methods of breast reconstruction after mastectomy (resection of the breast). One involves the use of autologous tissue (patient’s own tissue) and the other is prosthetic reconstruction (implant reconstruction).
Autologous reconstruction uses the patient’s own tissue to create a new breast. Several donor sites are utilized. The skin of the lower abdomen can be transferred with the abdominis rectus muscle and used to reconstruct a new breast. Similarly, the skin on the back with the latissimus dorsi muscle can be used as well. Other less commonly used tissue are those of the buttocks and the inner thighs.
The advantages of autologous reconstruction are that: the reconstruction is, by nature, more resistant to infection, does not involve the use of implants, and therefore, does not carry the risk of implant rupture or capsular contracture.
The major disadvantages of autologous reconstruction are that: it involves performing an operation on another part of the body, the operations are complicated with relatively extended hospital stay, and there may be more pain and longer recovery.
On the other hand, prosthetic reconstruction involves the use of breast implants to reconstruct the breast. It usually requires at least two operations — one to insert a tissue expander to stretch the skin after the mastectomy and the second to place the permanent implant. Implants can be filled with either saline (saltwater) or silicone.
The advantages of implant reconstruction are that: it does not involve the use of another part of the body, the operations are usually simpler technically with a shorter hospital stay, and there is less pain and a shorter recovery time.
The disadvantages of implants reconstructions are that: they are more prone to infection early after surgery, are at risk of rupture 10 percent within 10 years, which requires change of the implant, and capsular contracture caused by dense scar tissue around the implant. This can lead to contour deformities.
Choosing the best method for reconstruction depends on several factors, including patient preferences and surgeon’s experience, and other factors. For example, smoking and the need for radiation therapy usually makes autologous reconstruction more appropriate.
Large numbers of patients choose to also undergo nipple and areola (the dark skin around the nipple) reconstruction. This is usually done at a later stage.
For best results, it is very important for you to have at least two discussions with your surgeon. These discussions should be tailored to your case and what would work best for you.
