Breast Reconstruction Health Article

Definition

Breast reconstruction is a series of surgical procedures performed to recreate a breast. Reconstructions are commonly done after one or both breasts are removed as a treatment for breast cancer. Also, a breast may need to be refashioned for other reasons, such as trauma or abnormalities that occur during breast development.

Purpose

Many authorities consider reconstruction an integral part of the therapy for breast cancer. A breast that appears natural offers a sense of wholeness and normalcy, which can aid in the psychological recovery from breast cancer. It eliminates the need for an external prosthesis (false breast), which many women find physically uncomfortable as well as inconvenient.

Precautions

Not all women are good candidates for breast reconstruction. Overall poor physical health, or specific problems such as cigarette smoking, obesity, high blood pressure, or diabetes, will increase the chance of complications. Also, a difficult and/or prolonged recovery period or failure of the reconstruction may be a result. A woman's physical ability to cope with major surgery and recuperation also need to be considered.

Description

Breast reconstruction is done in two stages, with the ultimate goal of creating a breast which looks and feels as natural as possible. It is important to remember that while a good result may mimic a normal breast closely, there will inevitably be scars and loss of sensation. The reconstructed breast cannot be exactly like the original.

The first step is to form a structure called a breast mound. This can be accomplished using artificial materials called breast implants, or by using tissues from other parts of the woman's body. The second step involves creating a balance between the newly constructed breast and the breast on the opposite side. The nipple and areolar complex (darker area around the nipple) are recreated. This is usually done several months after the mound is created, to allow swelling to go down. Other procedures may be necessary, such as lifting the opposite breast (mastopexy), or making it larger or smaller to match the reconstructed breast.

Timing, immediate or delayed reconstruction

While immediate reconstruction (IR) is not recommended for women with breast cancer who need to under-go other, more important treatments, breast reconstruction can be done almost anytime. It even can be done during the same procedure as the mastectomy, or it can be delayed. There are psychological benefits to IR. The ability to return to normal activities and routines is often enhanced when reconstruction follows immediately after mastectomy. A better appearance may result from IR. There is less skin removal, often resulting in a shorter scar. The surgeon is better able to preserve the normal boundaries of the breast, so it is easier to match the opposite breast more closely.

The cost of IR is generally lower than the cost of delayed reconstruction (DR). There is one fewer operation and hospital stay. Surgeon's fees may be lower for a combined procedure than for two separate surgeries.

There are disadvantages of IR as well. The surgery itself is longer, causing more time under anesthesia. Post-operative pain and recovery time will be greater than for mastectomy alone.

Other authorities contend that delayed reconstruction (DR) offers different physical and psychological advantages. The initial mastectomy procedure alone takes less time, and has a shorter recovery period and less pain than mastectomy and IR. The patient has more time to adjust to her diagnosis and recover from additional therapy. She is better able to research her options, and to formulate realistic goals for reconstruction. Some reconstructive surgery requires blood transfusions. With DR, the patient can donate her own blood ahead of time (autologous transfusion), and/or arrange to have family and friends donate blood for her use (directed donation).

The psychological stress of living without a breast is a disadvantage of DR. The extra procedure DR entails results in higher costs. Although initial recovery is faster, an additional recuperation period is required after the delayed operation.