Breast Reconstruction

The procedure works to surgically rebuild the appearance of breasts and is specially designed for women who’ve had a mastectomy performed as a treatment for breast cancer. It can be carried out right after a mastectomy, so the patient is able to immediately have a reconstructed breast in place. Reconstruction involves restoring breast contour, as well as the nipple and areola if required. There are various approaches to breast reconstruction, such as:

-   Implants: In this approach, implants made of silicone or saline will be inserted just below the skin or muscle to replace the breast tissue that was formerly present. This procedure often involves two stages:

o   First stage: A tissue expander is placed just below the breast skin that is still present, or the pectoralis muscles. This acts as an impermanent implant that works to progressively stretch whatever tissue still remains after mastectomy. After the patient has undergone the complete healing process post-surgery, sterile saline (salt water) will be injected into the expander every week. This causes it to enlarge, which forces the overlapping skin and muscle to stretch until the breast grows to a size that the patient is comfortable with.

o   Second stage: Once all tissues have healed and sufficient saline has been injected into the expander, the surgeon will finally move on to the second stage which involves the insertion of the implants. The expander will be removed and replaced with a saline or silicone implant, which typically involves reopening the scar that was originally present. As such, no new scars will be left on the chest. There are certain instances where the tissue expander is not inserted at all and instead, a saline or silicone implant is placed permanently in conjunction with mastectomy.

-   Skin flap surgery: This is a highly complex surgical procedure wherein the breast is rebuilt from tissue that is taken from a different area of the body (usually the abdomen) and transferred to the chest. Apart from the abdomen, the tissue can also be taken from the back, thighs, or buttocks. There are two approaches to skin flap surgery:

o   Free flap surgery: In this approach, the tissue, as well as the blood vessels providing its circulation, are completely removed to be transferred to the breast. The tissue’s blood vessels are stitched into the chest’s blood vessels at the surgical site. As these structures are very tiny, a microscope will be used for stitching in a process known as microsurgery.

o Pedicle flap surgery: Compared to its free flap counterpart, pedicle flap surgery does not involve the complete removal of the tissue and its blood vessels. In this approach, the tissue will still be attached to the body (usually the abdomen or back) but will now be rotated into the chest to aid in breast formation. It takes about one to five hours for this procedure to be completed, in addition to mastectomy. The patient will typically be under general anesthesia for the actual operation, while only local anesthesia is required for any follow-up sessions.