Breast Reconstruction Surgery for Women
Undergoing a mastectomy as a result of breast cancer treatment may leave you with a mixture of emotions: the relief of the removal of cancer but also the devastation of losing one or both breasts. Breast reconstruction may be an option you have considered to restore feelings of self-confidence and complete recovery. Board-certified plastic surgeon Dr. Franckle has performed numerous breast reconstructive surgeries to help women who have undergone a mastectomy find a renewed confidence in their bodies.
What is Breast Reconstruction Surgery?
Breast reconstruction surgery rebuilds one or both breasts that were lost to a mastectomy. It is not considered cosmetic surgery since it restores natural appearance and function of the breasts. There are two general types of breast reconstruction: breast reconstruction with your own tissue or breast reconstruction with tissue expanders and implants. The most suitable method(s) for your situation will be discussed with you during your consultation with Dr. Franckle.
Who is the Best Candidate for Breast Reconstruction?
Depending on your situation, breast reconstruction can take place during or after a mastectomy. Most candidates for reconstructive surgery have recently undergone a mastectomy of one or both breasts and wish to restore the shape and volume of their breasts. Determining your candidacy for breast reconstruction surgery mainly depends on your overall health, smoking history, breast cancer treatment, and the shape and size of your body. It is also vital to consult with your primary doctor when making this decision.
Breast Reconstruction with Natural Tissue
If you choose to have breast reconstruction without implants, then you may opt for either DIEP Flap/Free Flap or Latissimus Flap/Pedicle Flap Breast Reconstruction. Both procedures use your own natural tissue and fat to reconstruct more natural looking breasts. Reconstruction with natural tissue may be necessary if you have lost breast tissue and skin following a mastectomy or subcutaneous mastectomy.
During the DIEP Flap/Free Flap Breast Reconstruction procedure, a flap of lower abdominal fat, muscle, and skin is shifted to the missing breast tissue. This flap of skin and lower abdominal muscle is referred to as a TRAM flap (transverse rectus abdominis myocutaneous), and it is formed into a natural looking breast. The abdominal area is closed like a Tummy Tuck and leaves a horizontal scar as well as a scar around the belly button. An attempt is made to create a “normal” breast and mound shape at the first operation, but smaller, subsequent procedures may be necessary. Nipple/areola construction is typically performed at a later date.
Latissimus Flap/Pedicle Flap Breast Reconstruction takes tissue from the outer back instead of the abdomen. In this procedure, a flap of skin and muscle is elevated from the upper, outer back and rotated to the breast area. Usually, but not always, an implant or tissue expander is placed under the flap to provide the correct volume and shape to the reconstructed breast. Nipple/areolar reconstruction is often performed after the healing of the flap to ensure the best possible position. In cases where the reconstruction is performed at the same time as a skin-sparing mastectomy, excellent results with a near-perfect match may be attained. In cases where larger amounts of skin are lost or in cases of delayed breast reconstruction, the Latissimus flap primarily replaces the skin defect. Although breast reconstruction with natural tissue is initially more complicated than implants, breasts reconstructed from body tissue age more naturally and often don’t require frequent maintenance.
Breast Reconstruction with Implants
Breast reconstruction using implants is a less invasive option than reconstruction with natural tissue. Numerous implant options can be used for breast reconstruction, such as silicone or saline implants. During the procedure, tissue expanders are placed beneath the skin to extend it and create space for the breast implant. The implants are then inserted through different incisions that are dependent upon the kind of implant used. The incisions can be hidden in the crease beneath the breast, around the areola, or under the arm. This surgery is an outpatient procedure and lasts between one to two hours. The patient will then be fitted with bandages and an elastic bra once all the incisions have been closed.
What is Recovery like after Breast Reconstruction?
Your recovery process greatly depends on the type of procedure chosen. DIEP/Flap Free Flap and Latissimus Flap/Pedicle Flap Breast Reconstruction are both major procedures using the body’s own skin and muscle tissue and therefore require up to two or three days of hospitalization. Ambulation will begin the day after DIEP/Flap Free Flap surgery and patients will be reasonably comfortable after seven to ten days. Complete recovery usually takes about six weeks, while the abdominal donor site causes the most discomfort during healing. Recovery for a Latissimus Flap/Pedicle Procedure takes about four weeks. Discomfort in the back incision site and reconstruction site will be present for several weeks, and stitches will be removed within a month.
Since reconstruction with implants is an outpatient procedure, patients do not require hospitalization after surgery. Patients are encouraged to rest for up to two weeks after the procedure. Regular activities may resume two to four weeks after surgery, while a full recovery normally takes four to five months.
Is Breast Reconstruction Covered by Insurance?
Fortunately, breast reconstruction surgery following a mastectomy must be covered by insurance under Federal law. New Jersey state law also requires insurance to cover reconstructive breast surgery, including coverage to achieve and restore symmetry and provide benefits for prostheses [17B:26-2.1a.]. Our staff will discuss insurance options with you before surgery to ensure you are given maximum coverage.
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