Rochester General Hospital
Breast Reconstruction Surgery
What is breast reconstruction surgery?
With advances in breast reconstruction surgery, about one-third of women undergoing breast removal have their breast(s) rebuilt. Even though medical, surgical, and radiation therapy treatments for breast cancer have increased the number of breast-sparing procedures available, nearly one-third of breast cancer patients still require a mastectomy (removal of the breast or breasts). In addition, other women have their breast(s) removed due to other diseases.
Breast reconstruction surgery involves creating a breast mound that comes as close as possible to the form and appearance of the natural breast.
The goal of reconstructive surgery is to create a breast mound that matches the opposite breast and to achieve symmetry. If both breasts have been removed, the goal of breast reconstructive surgery is to create both breast mounds approximately the size of the patient’s natural breasts.
What are the criteria for breast reconstruction surgery?
In general, all women undergoing a mastectomy are candidates for immediate or delayed breast reconstruction. However, there are criteria for selecting the best candidates for the procedure, including the following:
- the size and location of the cancer, as this helps to determine the amount of skin and tissue to be removed in the mastectomy (a primary factor when making recommendations for reconstruction)
- whether tissue has been damaged by radiation therapy or aging, and is not sufficiently healthy to withstand surgery
Other considerations include the following:
- potential for complications
- patient’s desires
- the amount of tissue removed from the breast
- the health of the tissue at the planned operation site
- whether radiation therapy is part of treatment
- the patient’s general health and physique
- past medical history
- co-existing illnesses
- other risk factors such as cardiac disease, diabetes, smoking, and obesity
When is breast reconstruction surgery performed?
The patient is usually educated and counseled in breast reconstructive possibilities prior to mastectomy, so that she can make the decision for or against reconstruction before going into surgery. Based on the personal medical history of each patient, a recommendation will be made for either of the following:
immediate reconstruction - reconstructive surgery performed at the same time as mastectomy.
delayed reconstruction - a second operation (to reconstruct missing breast tissue) is performed after recovery from the mastectomy is complete. If chemotherapy is part of the treatment protocol, the surgeon may recommend delayed reconstruction.
What are the different types of breast reconstruction surgery?
The two most effective approaches available for both monolateral (one breast) and bilateral (both breasts) reconstruction include the following:
- expander/implant reconstruction - the use of an expander to create a breast mound, followed by the placement of a permanently filled breast implant.
- autologous tissue reconstruction - the use of the patient’s own tissues to reconstruct a new breast mound. The common technique is the TRAM (transverse rectus abdominous muscle) flap. A TRAM flap involves removing an area of fat, skin, and muscle from the abdomen and stitching it in place to the mastectomy wound.
About the procedure:
Although each procedure varies, generally, breast reconstructive surgeries follow this process:
- Location options may include:
- outpatient surgery center
- hospital outpatient
- hospital inpatient
Possible complications associated with breast reconstructive surgery:
Possible complications that may be associated with breast reconstruction may include, but are not limited to, the following:
- bleeding
- fluid collection
- infection
- excessive scar tissue
- anesthesia problems
The most common complication of breast reconstruction surgery is capsular contracture, which occurs if the scar or capsule around the implant begins to tighten. Occasionally, this (and other) complications are severe enough to require a second operation.
The Silicone-Implant Controversy
A controversy about the safety of silicone gel implants still exists. Many women prefer them to saline-filled implants because the silicone feels more like breast tissue and shifts with body movement more naturally. If a leak occurs in a saline implant, the saline is absorbed into the body and is harmless. But, there is a question whether silicone leaks can trigger certain connective tissue and autoimmune conditions.
In 1992, the US Food and Drug Administration (FDA) restricted the use of silicone implants for further study. Studies completed thus far have failed to show an increased risk of autoimmune disease among women with silicone implants, and several organizations, including the American Cancer Society, have petitioned the FDA, to ease the restrictions.
