Breast Reconstruction
Reconstruction opens a world of possibilities after a mastectomy
The goal at Clinique K is to give patients immediate access to Dr. Karl Schwarz and his staff, providing the framework and support needed to make a well-informed, personalized decision on their breast reconstruction. The clinic and its surgeons function outside of the public system. This allows Dr. Schwarz and his associates to utilize state of the art products and techniques, and offer personalized care and greater flexibility with no waiting list.Modern breast cancer care should be delivered by a multidisciplinary team, including breast surgeons, oncologists, geneticists, plastic surgeons, nurses, and therapists. While breast reconstruction after mastectomy or partial mastectomy has been historically overlooked, it has become an integral part of breast cancer treatment. The combination of increased awareness, new techniques and improved aesthetic outcomes are making breast reconstruction a popular choice among women affected by breast cancer.
Choosing the breast reconstruction that is right for you may seem overwhelming. The lack of concise, easy to understand information on breast reconstruction can create a lot of stress and anxiety. However, a consultation with a plastic surgeon (specialized in breast reconstruction) as soon as you are diagnosed with breast cancer is an important first step, and may alleviate some of the angst associated with understanding and learning about all of your options.
Breast reconstruction options can vary based on your body type, the nature of the tumor, and its treatment. A plastic surgeon, working with breast surgeons and oncologists, can help you decide whether breast reconstruction with an implant or autologous reconstruction (using your own body’s tissues to create a breast) is best for you.
Immediate Vs. Delayed Reconstruction
Breast reconstruction can either be performed immediately, during the same surgery as the mastectomy, or in a delayed fashion, months or years after the mastectomy.The biggest advantage of having it done immediately is psychological. It has been shown in multiple studies that waking up with a breast shape after mastectomy surgery, and never having to live without a breast, is beneficial. Additionally, if you know that you want a breast reconstruction, having an immediate reconstruction can save you from an additional surgery and recovery time, shortening the treatment and healing process significantly.
Delayed breast reconstruction is preferred in two scenarios. One in which the patient is not psychologically prepared, and the other in which more aggressive cancer treatments are needed prior to reconstruction. No matter the reason, if a woman is not ready to undergo breast reconstruction at the time of her mastectomy, a delayed reconstruction can be performed. This can be done several months or years after the cancer is removed.
Implant Vs. Autologous Reconstruction
There are essentially two types of breast reconstruction: Implant-based and autologous reconstruction. Implant-based reconstruction involves the creation of a new breast using a breast implant, either silicone or saline (salt water) filled. With this technique, the size and type of implant determines the final size and shape of the breast.Autologous reconstruction involves the use of your own body’s tissues to create a new breast. The tissue can be taken from your lower abdomen, back, buttocks, or inner thighs, depending on your body type.
There are pros and cons to both types of breast reconstruction and discussing them in detail with your plastic surgeon will help you make the best decision for you.
Two-Stage Vs. Direct-to-Implant Reconstruction
Traditionally, implant-based breast reconstruction has been performed using a two-stage approach. The first stage involves placing a tissue expander under the skin (and sometimes covering it with the chest muscle), either at the same time of the mastectomy or in a delayed fashion. A tissue expander is a temporary implant-like device that is filled with saline at the time of placement as well as during subsequent postoperative visits. The goal of the tissue expander is to stretch the patient’s chest skin so that several months later it can be replaced with a permanent breast implant (a procedure referred to as the “second stage”).The biggest advantage of this two-stage approach is that small-breasted women who wish to have reconstructed breasts larger than their natural size are able to. Additionally, this technique allows the patient to choose the final size during the expansion period by living with the expanders at different sizes, as they are filled over time.
Direct-to-implant reconstruction is the latest alternative to the two-stage approach, and involves a single surgery. The technique involves reconstructing the breast immediately with a permanent implant, eliminating the need for a tissue expander or second surgery. This is done by using a biologic product called an ADM (Acellular Dermal Matrix) to cover and support the implant (instead of the muscle) under the skin. The obvious advantage is that, in most cases, it allows for the patient to have their mastectomy and final reconstruction in only one procedure. The direct-to implant approach continues to increase in popularity among patients due to its efficiency and excellent aesthetic outcomes.
Recovery After Breast Reconstruction Surgery
Reconstruction using implants is usually an outpatient procedure, while flap-based reconstruction may require a couple of days of inpatient post-operative care. Additionally, if reconstruction is performed at the same time as the mastectomy, an overnight stay may be necessary.The nurse at Clinique K will give you a list of dos and don’ts prior to going home, as well as a set of medications to help you recover well and in comfort. We recommend you have someone to look after you for the first few days following surgery.
The recovery timeline is as follows: surgical dressing removed after one week, the ability to resume moderate exercise after two weeks, swelling and bruising should subside after three to six weeks, and final results will be achieved after one year when incisions heal, and implant/tissue settles.
It is also important to note that breast reconstruction does not affect the recurrence of cancer and, if timed properly, does not affect chemotherapy or radiation treatment.
Types of Mastectomy
The importance of the mastectomy is often overlooked when discussing breast reconstruction. The primary and most important role of a mastectomy is to remove the breast cancer. However, the quality and/or type of mastectomy can have a significant effect on the aesthetic result of a breast reconstruction. Therefore, it’s important to discuss the following mastectomy options if you are considering immediate breast reconstruction.Skin-Sparing Mastectomy
A skin-sparing mastectomy is performed by removing the breast with the entire nipple and areola, leaving behind as much skin as possible. The technique was developed to facilitate immediate breast reconstruction, where the remaining skin is used to cover either the implant or flap tissue. The development of the skin-sparing mastectomy has led to less visible scars and improved breast shape.Nipple-Sparing Mastectomy
A nipple-sparing mastectomy is used to describe a mastectomy which preserves the nipple/areola complex, along with the entire breast skin. In effect, the only component removed is the glandular and fatty tissue of the breast. Leaving the nipple and entire skin envelope behind for an immediate reconstruction can produce some of the most natural-looking breasts. As a result, nipple-sparing mastectomy has become the procedure of choice in prophylactic mastectomy patients. In select cancer patients where the tumor is small and located away from the nipple, nipple-sparing mastectomy can also be performed safely.Skin-Reducing Mastectomy
A skin-reducing mastectomy is most often performed in women with large or sagging breasts who wish to undergo immediate reconstruction. In these cases, there is simply too much breast skin. Techniques to reduce the breast skin envelope and reconstruct immediately are now referred to as skin-reducing mastectomies. Refinements in this technique have led to less visible scars and improved cosmetic results.Prophylactic Mastectomy
Prophylactic mastectomy refers to mastectomies performed for preventive reasons, in patients who do not yet have breast cancer. The popularity of prophylactic mastectomy has grown as a result of the discovery of the BRCA-1 and BRCA-2 genes. Patients who carry these genes have a significantly higher risk of developing breast cancer in their lifetime. The BRCA genes are used in combination with modern risk-assessment tools that strongly weigh a woman’s family history of breast cancer. Together, they help to identify patients at “high risk” of developing breast and even ovarian cancer.Patients with a significant family history of breast or ovarian cancer are usually sent to a geneticist for counseling. With additional help from a breast surgeon and plastic surgeon, you can decide whether or not prophylactic mastectomy and breast reconstruction is the right decision for you.
Some of the best cosmetic results in breast reconstruction are achieved in prophylactic mastectomy patients. The biggest advantages include not having to contend with a tumor during the mastectomies and being able to spare the patient’s nipples, leading to very natural results. The plastic surgeon can perform the reconstruction at the same time as the mastectomy, so that the patient wakes up from the procedure with breasts. This has made the decision of undergoing prophylactic mastectomy and reconstruction much easier for women considered “high risk.”
Types of Breast Reconstruction Performed at Clinique K
• Expander to Implant• Direct to Implant
• Latissimus Dorsi Flap
• TRAM Flap
• DIEP Flap
• TUG Flap
• GAP Flap
