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Breast Reconstruction
Health Guide
If You Are Considering Breast Reconstruction

Reconstruction of a breast that has been removed due to cancer or other disease is one of the most rewarding surgical procedures available today. New medical techniques and devices have made it possible for surgeons to create a breast that can come close in form and appearance to matching a natural breast. Frequently, reconstruction is possible immediately following breast removal (mastectomy), so the patient wakes up with a breast mound already in place, having been spared the experience of seeing herself with no breast at all. But bear in mind, post-mastectomy breast reconstruction is not a simple procedure. There are often many options to consider as you and your doctor explore what's best for you. This brochure will give you a basic understanding of the procedure - when it's appropriate, how it's done, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your surgeon if there is anything you don't understand about the procedure.

The Best Candidates for Breast Reconstruction

Most mastectomy patients are medically appropriate for reconstruction, many at the same time that the breast is removed. The best candidates, however, are women whose cancer, as far as can be determined, seems to have been eliminated by mastectomy.

Still, there are legitimate reasons to wait. Many women aren't comfortable weighing all the options while they're struggling to cope with a diagnosis of cancer. Others simply don't want to have any more surgery than is absolutely necessary. Some patients may be advised by their surgeons to wait, particularly if the breast is being rebuilt in a more complicated procedure using flaps of skin and underlying tissue. Women with other health conditions, such as obesity, high blood pressure, or smoking may also be advised to wait.
In any case, being informed of your reconstruction options before surgery can help you prepare for mastectomy with a more positive outlook for the future.

All Surgery Carries Some Uncertainty and Risk

Virtually any woman who must lose her breast to cancer can have it rebuilt through reconstructive surgery. But there are risks associated with any surgery and specific complications associated with this procedure.

In general, the usual problems of surgery, such as bleeding, fluid collection, excessive scar tissue, or difficulties with anaesthesia, can occur although they're relatively uncommon. And, as with any surgery, smokers should be advised that nicotine can delay healing, resulting in conspicuous scars and prolonged recovery. Occasionally, these complications are severe enough to require a second opinion.

If an implant is used, there is a remote possibility that an infection will develop, usually within the first two weeks following surgery. In some cases, the implant may need to be removed for several months until the infection clears. A new implant can later be inserted.

The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or "scoring" of the scar tissue, or perhaps removal or replacement of the implant.

Reconstruction has no known effect on the recurrence of disease in the breast, nor does it generally interfere with chemotherapy or radiation treatment, should cancer recur. Your surgeon may recommend continuation of or periodic mammograms on both the reconstructed and the remaining normal breast. If your reconstruction involves an implant, be sure to go to a radiology centre where technicians are experienced in the special techniques requires to get a reliable x-ray of a breast reconstructed with an implant.
Women who postpone reconstruction may go tTypes of Implants

If your surgeon recommends the use of an implant, you'll want to discuss what type of implant should be used. A breast implant is a silicone shell filled with either silicone gel or a salt-water solution known as saline. There are now also implants filled with soya bean oil.

Because of concerns that there is insufficient information demonstrating the safety of silicone gel-filled breast implants, the Food & Drug Administration has determined that new gel-filled implants should be available only to women participating in approved studies. This currently includes women who already have tissue expanders (see below under Skin Expansion), who choose immediate reconstruction after mastectomy, or who already have a gel-filled implant and need it replaced for medical reasons. Eventually, all patients with appropriate medical indications may have similar access to silicone gel-filled implants.

The alternative saline-filled implant, a silicone shell filled with salt water, continues to be available on an unrestricted basis, pending further FDA review.

As more information becomes available, the FDA guidelines may change. Be sure to discuss current options with your surgeon (Above guidelines are current as of July 1992).
The Surgery

While there are many options available in postmastectomy reconstruction, you and your surgeon should discuss the one that's best for you.

Skin expansion: The most common technique combines skin expansion and the subsequent insertion of an implant.

Following mastectomy, your surgeon will insert a balloon expander beneath your skin and chest muscle. Through a tiny valve mechanism buried beneath the skin, he or she will periodically inject saline-water solution to gradually fill the expander over several weeks or months. After the skin over the breast area has stretched enough, the expander may be removed in a second operation and a more permanent implant will be inserted. Some expanders are designed to be left in place as the final implant. The nipple and the dark skin surrounding it, called the areola, are reconstructed in a subsequent procedure. (For more information on tissue expansion, ask your surgeon for a brochure on this subject.)

Some patients do not require preliminary tissue expansion before receiving an implant. For these women, the surgeon will proceed with inserting an implant as the first step.

Flap reconstruction: An alternative approach to implant reconstruction involves creation of a skin flap using tissue taken from other parts of the body, such as the back, abdomen, or buttocks.

In one type of flap surgery, the tissue remains attached to its original site, retaining its blood supply. The flap, consisting of the skin, fat and muscle with its blood supply, are tunnelled beneath the skin to the chest, creating a pocket for an implant or, in some cases creating the breast mound itself, without need for an implant.

Another flap technique uses tissue that is surgically removed from the abdomen, thighs or buttocks and then transplanted to the chest by reconnecting the blood vessels to new ones in that region. This procedure requires the sklls of a reconstructive surgeon who is experienced in microvascular surgery as well.

Regardless of whether the tissue is tunnelled beneath the skin on a pedicle or transplanted to the chest as a microvascular flap, this type of surgery is more complex than skin expansion. Scars will be left at both the tissue donor site and at the reconstructed breast, and recovery will take longer than with an implant. On the other hand, when the breast is reconstructed entirely with your own tissue, the results are generally more natural and there are no concerns about the silicone implant. In some cases, you may have the added benefit of an improved abdominal contour.

Follow up procedure: Most breast reconstruction involves a series of procedures that occur over time. Usually, tLink to St Marks Breast Centre Online

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