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BREAST
RECONSTRUCTION
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reconstruction is performed to reconstruct the breast after breast
cancer. Facing reconstruction surgery along with a diagnosis of
cancer can be overwhelming. However, with todays technology and
medical approaches there are options today that werent available
years ago. Breast reconstruction is often possible immediately
following a mastectomy, so that the patient can combine surgeries
and have the reconstruction underway. In this manner, the patient is
spared the trauma of awakening without a breast. There are many
questions to ask, and decisions to make. This section will assist
with that process.
Some
important facts about breast reconstruction:
- The
reconstructive patient must have realistic expectationsthe
goal is to improve appearance, not attain perfection.
- Reconstruction
at the same time as the mastectomy can be an emotional advantage
for the patient.
- Some
surgeons feel that it is advantageous to perform reconstructive
surgery approximately three months after the mastectomy, to give
the tissues time to heal and soften. However, most physicians
feel that this is an antiquated view.
- Reconstruction
of the areola and nipple, if desired, is usually performed in a
separate surgery.
- Your
surgeon may suggest completion of any chemotherapy or radiation
therapies (if necessary) prior to any reconstructive surgery for
locally advanced breast cancer.
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How
Can I Prepare for Surgery?
How
is the Procedure Done?
What
Can I Expect Pre- and Postoperatively?
Tell
Me About Recovery
What
Kind of Risks / Complications Are There?
Still
You
Only Better!
PREPARING
FOR SURGERY
You and your physician must make many important decisions
whether the reconstruction will be performed at the same time as or
after the mastectomy, the technique to be used, if implants are to
be placed, whether they will be used for both breasts, and the fill
material, size, shape, and texture of the implants. Remember that
different doctors use different techniques and usually recommend the
one(s) in which they are trained and experienced. Educate yourself
so that you can be a part of this decision-making process.
THE
PROCEDURE
Many
techniques are available. Which technique is used depends on the
patients desires, the physicians training and experience, the
patients health and anatomy, the amount of tissue available, and
the other breasts appearance. The following are the most common
reconstructive techniques:
Breast
Implant
If there is
sufficient tissue (skin), a silicone or saline implant may be
placed beneath the pectoral muscle. Most often, a tissue expander
is necessary prior to implant placement.
Tissue
Expander
This
balloon-like device with a reservoir is placed under the pectoral
muscle during the original surgery. Over a period of a number of
weeks, sterile saline is injected into the reservoir, gradually
stretching the skin. Some expanders can be left in to serve as an
implant; other expanders must be removed and replaced with an
implant after the skin and muscle are expanded.
Tram Flap
A large flap of lower abdominal skin and fat, along with a
part of one or both of the recti abdominus muscles, is either
rotated through the abdomen or separated and reattached to the
chest wall and shaped. The major advantage of this procedure is
that there is no need for an implant because of the abundance of
tissue available. The patient also benefits by getting a
"tummy tuck." However, this is a major procedure, which
can require four to six days in the hospital. This procedure is
not recommended for patients who do not have excess abdominal fat.
Latissimus
Dorsi Flap
A portion
of this broad muscle in the back, along with overlying skin and
fat, is rotated around the side to the chest wall and shaped.
Since there is usually insufficient tissue to completely
reconstruct the breast, an implant may be necessary.
Free-Flap
Transfer
Tissue
from the abdomen, buttocks, hips, or thighs, along with the blood
vessels, is completely removed and transplanted to the chest wall.
The blood vessels are joined to the blood vessels in the armpit.
Nipple
and Areola
Reconstruction
of the nipple and areola are usually performed in a separate
surgery once the reconstructed breast has healed. The nipple can
be more accurately positioned in this manner. Local tissue from
the breast reconstruction, abdomen, and/or groin (labia) may be
used. If desired, cosmetic tattooing can be performed later to
match the color of the nipple to the other breast.
Anesthesia
Breast
reconstruction is usually performed under general anesthesia.
However, the type of anesthesia used is dependent on the procedure
to be performed, the doctors choice, and the patients medical
history or desires.
Length of
Procedure
The breast
reconstruction will vary tremendously depending on the type of
procedure performed and the complexity.
Level of
Pain/Discomfort
Generally
with a breast reconstruction there is moderate pain and soreness for
a week or two, which may be controlled with prescribed pain
medications or Extra-Strength Tylenol.
PRE-
AND POSTOPERATIVE INSTRUCTIONS
The following
suggestions are intended to make you feel more comfortable and help
you heal:
- Stop
smoking, discontinue the use of alcohol, and stop taking vitamin
E and any medications containing aspirin or ibuprofen (two weeks
pre- and postoperative is usually recommended). Check with your
doctor regarding any other medications (including
homeopathic/herbal products) that you are currently taking.
- If you
blow-dry your hair, it may be more comfortable to keep the dryer
at a low angle for ten days to two weeks.
- Dressings
this procedure requires a supportive bra or dressing, which
should be provided, to wear for four to six weeks after surgery.
You may want to purchase a second garment to wear while you
launder the other. Do not wear an underwire bra for six weeks.
- You must
sleep on your back, with your upper body elevated, for at least
the first week to ten days.
- Restrict
upper-body activity for four to six weeks.
RECOVERY
The initial
healing period for a breast reconstruction can take from one to two
weeks, however recovery from a combined mastectomy and
reconstruction or from a flap reconstruction could take up to six
weeks. The normal sensation of your breast will be changed but some
feeling could return over time. There is scarring with this
procedure, but with proper care, and compliance with instructions,
the scars should fade as well, over time. Remember that the goal of
breast reconstruction surgery is to offer improvement.
RISKS
/ COMPLICATIONS
Although
problems are unlikely, you need to be aware of what can happen and
what action you should take. Most risks/complications will be
avoided if you make an informed decision, choose a qualified
physician, and follow your physicians instructions.
Complications
that can occur with this surgery are bleeding, infection, hematoma
(collection of blood under the skin) or scarring. If an implant is
used a common complication is known as "capsular contracture".
The body attempts to "wall off" the implant by forming a
fibrous capsule around it. The thickness of the capsule formed
varies from patient to patient and is influenced by heredity or the
presence of postoperative hematoma or infection. Depending on the
severity of the capsule, the physician may break it up manually or
it may require removal and/or implant replacement.
STILL
YOU
ONLY BETTER
Many women feel
that the reconstructive surgery helps them with their self-esteem.
After a diagnosis of cancer, for many-- lives are changed.
Reconstruction surgery can help to put a bit of normalcy back into
the lives of these courageous women.
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