Breast Reconstruction (Rejuvenation) after breast cancer surgery

Reconstruction after surgery for breast cancer is an option; it is not required. While some survivors choose to have reconstruction performed at the same time as the mastectomy, others prefer to wait, wear a breast prosthesis, or wear nothing at all. As you consider your options, remember that the choice is completely yours.

The goal of breast reconstruction is to create a breast mound that matches the other breast and to provide symmetry when a woman is wearing a bra.

The procedure can be performed at the same time as the mastectomy or any later time.

The advantages of immediate reconstruction include:

• Waking up from surgery with a breast
• Combining the mastectomy and reconstruction into one surgery

The advantages of waiting include:

• Having additional time to choose the best option for you
• Minimizing the chances of infection if undergoing chemotherapy
• Not having to coordinate the schedules of two doctors

Plastic surgeons, medical doctors who perform reconstruction, can use an implant or the patient’s own tissue for reconstructing the breast. The types of breast cancer reconstruction follow.

Note: It’s recommended that breast cancer survivors don’t use breast enhancement pills and supplements, which are intended to help women in general with natural breast enhancement, since they usually contain estrogen mimicking compounds.

Artificial Surgical Implants

Permanent tissue expanders

Implants filled with saline or silicone gel

Synthetic implants can be filled with saline or silicone gel. Before the implant is inserted, a temporary expander, an elastic bag with a tube and valve attached, is surgically inserted behind the pectoral muscle. The expander is regularly filled with saline during a three-to-six-month period. This process gradually stretches the skin to the desired size. The expander is then removed and replaced with an implant.

Advantages to getting implants

• Shorter operation and recovery time
• No additional scarring
• Less expensive then other methods

Disadvantages to getting implants

• Capsular contracture, the most common problem, where scar tissue forms around the implant and squeezes it, making the breast feel hard and sometimes painful. Removal or replacement may be necessary.
• Increasing chance of rupture
• Emotional/financial costs of replacement
• Difficulty in detecting cancer on a mammogram

Flap Procedures Using Your Own (Autologous) Tissue

Reconstruction using your own tissue has the most natural appearance and avoids placing foreign materials in your body. The downside of this procedure includes the pain that may result at the donor and/or transplant sites, the higher cost and the longer time for surgery and recovery.

Perforator procedures use skin and fat only

• Deep inferior epigastric perforator (DIEP) flap
  DIEP flap uses the abdominal skin and fat along with tiny blood vessels that are taken through the muscle, which is then left in place. This procedure creates a tummy tuck at the same time.. The flap forms a soft, living tissue breast mound when the blood vessels are reattached at the mastectomy site.
• Superficial inferior epigastric artery (SIEA) flap
  This procedure uses the same tissue as the DIEP flap, but the abdominal wall and muscles are not disturbed.
• Superior gluteal artery perforator (S-GAP) flap
  This is a good alternative for women who lack sufficient tissue for the DIEP flap, whose abdominal flap has already been used, or whose abdominal scarring prevents use of the tissue. The S-GAP uses skin, fat and blood vessels from the upper buttock. The flap forms a soft, living tissue breast mound when the blood vessels are reattached at the mastectomy site.
• Inferior gluteal artery perforator (I-GAP) flap
  The I-GAP is similar to the S-GAP except the tissue used to form the breast mound is taken from the lower buttock.

Nonperforator procedures use skin, fat and muscle

• Transverse rectus abdominis myocutaneous (TRAM) flap
  The skin, fat, blood vessels and part of a muscle are tunneled from the abdomen to the chest and shaped into a breast, creating a tummy tuck at the same time
• Free TRAM flap
  This procedure is similar to the TRAM except the tissue taken from the abdomen is cut from the blood supply and reattached at the chest.
• Atissimus dorsi (LAT) flap
  The fat, skin, muscle and blood vessels are tunneled from the upper back to the chest to create a breast mound. A synthetic implant is used to augment the reconstruction, if needed to match the size of the remaining breast.

Nipple/Areola Reconstruction

Nipple and areola reconstruction take place after the breast reconstruction heals. The nipple is reconstructed using local tissue on the breast and occurs eight to twelve weeks after breast reconstruction.

The areola is tattooed around the nipple about six weeks after the nipple reconstruction. Some women and men choose to have breast reconstruction, but not nipple and areola reconstruction. Reconstruction of breast, nipple, and areola are all optional.

References

1. https://www.amoena.com/us-en/breast-forms/
2. https://renaissance.stonybrookmedicine.edu/surgery/blog/faqs-about-nipple-reconstruction
3. http://www.brightfuturesforfamilies.org/wp-content/uploads/2019/03/fall_2004.pdf
4. https://diepcjourney.com/2018/05/23/nipple-reconstruction-after-mastectomy/
5. http://www.brightfuturesforfamilies.org/1103/best-breast-enhancement-pills/