You may have had or are about to have a mastectomy, either because you’ve been diagnosed with breast cancer or are at very high risk of developing it in the future. If so, your doctor may have told you about options to rebuild your breast or breasts — a surgery called breast reconstruction. Typically, breast reconstruction takes place during or soon after mastectomy, and in some cases, lumpectomy. Breast reconstruction also can be done many months or even years after mastectomy or lumpectomy. During reconstruction, a plastic surgeon creates a breast shape using an artificial implant (implant reconstruction), a flap of tissue from another place on your body (autologous reconstruction), or both.
Whatever your age, relationship status, sexual activity, or orientation, you can't predict how you will react to losing a breast. It’s normal to feel anxious, uncertain, sad, and mournful about giving up a part of your body that was one of the hallmarks of becoming a woman: a significant part of your sexuality, what made you look good in clothes, how you might have fed your babies. No one can ever take that away from you. Moving forward, you now have the opportunity to determine what you want to have happen next. But first you must do some careful thinking and delving into your feelings in order to figure out what is best for you. In this section, we’ll talk you through each of the reconstruction options, what’s involved, and any risks, as well as alternatives to reconstruction.
When reconstructing a breast with implants, a surgeon will insert silicone or saline implants underneath the skin or muscle, in the place of the previous breast tissue.
For most people, this is a two stage procedure. During the first stage, a surgeon places a tissue expander underneath the remaining breast skin, or pectoralis muscles. The expander serves as a temporary saline implant that gradually stretches the remaining tissue.
After the person has fully healed following surgery, a surgeon will inject sterile saline or salt water through the skin into the tissue expander on a weekly basis. This balloon gradually grows, stretching the overlaying skin and muscle until the breast reaches a size with which the person is comfortable.
When the chest tissues heal and the surgeon has added enough saline to the tissue expander in preparation for the implants, they will perform the second procedure to insert the implants.
The surgeon removes the tissue expanders and replaces them with either a silicone or saline implant. They will usually reopen the original scar. This often means that the procedure leaves no new scars on the chest.
In some cases, a surgeon may place a permanent saline or silicone implant at the time of the mastectomy, without use of a tissue expander.
Breast Reconstruction with Skin Flap
With skin flap surgery, the surgeon takes tissue from another part of the body and moves it to the chest to rebuild the breast.
The surgeon usually removes this tissue from the abdomen. However, it may come from other places on the body, including the buttock, back, or thigh.
Skin flap surgery highly complex, as it involves transferring tissue from one area of the body to another. Two methods are available for this surgery:
free flap surgery
pedicle flap surgery
In free flap surgery, a surgeon completely removes the tissue and the blood vessels that provide it with circulation for placement in the breast.
They stitch the blood vessels into other blood vessels in the chest at the intended site of placement. These blood vessels are very small, so the surgeon will use a microscope to sew them together in a procedure called microsurgery.
In pedicle flap surgery, a surgeon will not entirely remove the transplanted tissue from its blood vessels. Instead, the tissue remains attached to the body, and the surgeon usually rotates this into the chest to form the breast.
A surgeon usually uses tissue from the abdomen or back for pedicle flap surgery.