Breast Reconstruction Health Article

Normal results

A normal result of breast reconstruction depends on the woman's goals and expectations. It will not be the same as the breast it replaces. In general, the reconstructed breast should be similar in size and shape to the opposite breast, but will have less sensation and be less mobile than a natural breast. A reconstruction using an implant will usually be firmer and rounder than the other breast. It may feel cooler to the touch, depending on the amount of tissue over it. Scars are unavoidable, but should be as inconspicuous as possible.

Morbidity and mortality rates

Normal scar formation should be expected. With any silicone prosthesis, a capsule usually forms around it. However, in some instances a mild form of capsular contraction may develop. Mild ridges that can be felt under the skin categorize this condition. If the capsule contracts, as occasionally occurs, it results in a hardening of the breast. There is no way to predict who will excessively scar. Other risks include infection, excessive bleeding, problems associated with anesthesia, rupturing of the implant, and leakage. There have been a total of 120,000 reports of ruptured silicone implants. Approximately 50,000 reports of breakage have been received for saline implants.

Deaths associated with breast reconstruction are extremely rare. Most post-surgical mortality has been attributed to anesthesia errors or overdoses of pain medications.

Alternatives

Alternatives to breast reconstruction surgery include using external breast forms that fit into brassiere cups or are attached to the skin of the chest. Creams that allege to increase breast size usually produce no noticeable results. The use of creams containing hormones can lead to long-term hormonal imbalances. Reputable experts do not generally recommend these preparations for breast enlargement.

BOOKS

Ball, Adrian S., and Peter M. Arnstein. Handbook of Breast Surgery. London: Edward Arnold, 1999.

Berger, Karen J., and John Bostwick. A Woman's Decision: Breast Care, Treatment & Reconstruction, 3rd edition. St. Louis: Quality Medical Publshers, 1998.

Bostwick, John. Plastic and Reconstructive Breast Surgery, 2nd edition. St. Louis: Quality Medical Publishers, 1999.

Engler, Alan M. BodySculpture: Plastic Surgery of the Body for Men and Women, 2nd edition. London: Hudson Pub., 2000.

PERIODICALS

Colville, R. J., N. R. McLean, C. A. Mallen, and L. McLean. "The Impact of Breast Augmentation on the Breast-screening Programme." British Journal of Plastic Surgery, 55, no. 7 (2002): 592–593.

Hudson, D. A. "Submuscle Saline Breast Augmentation: Are We Making Sense in the New Millenium?" Aesthetic and Plastic Surgery 26, no. 4 (2002): 287–290.

Jejurikar, S. S., J. M. Rovak, W. M. Kuzon Jr, K. C. Chung, S. V. Kotsis, and P. S. Cederna. "Evaluation of Plastic Surgery Information on the Internet." Annals of Plastic Surgery 49, no. 5 (2002): 460–465.

Smith, M., and K. Kent. "Breast Concerns and Lifestyles of Women." Clinics in Obstetrics and Gynecology 45, no. 4 (2002): 1129–1139.

ORGANIZATIONS

American Board of Plastic Surgery. Seven Penn Center, Suite 400, 1635 Market Street, Philadelphia, PA 19103-2204. (215) 587-9322. <http://www.abplsurg.org/>.

American College of Plastic and Reconstructive Surgery. <http://www.breast-implant.org>.

American College of Surgeons. 633 North Saint Claire Street, Chicago, IL 60611. (312) 202-5000. <http://www.facs.org/>.

American Society for Aesthetic Plastic Surgery. 11081 Winners Circle, Los Alamitos, CA 90720. (800) 364-2147 or (562) 799-2356. <http://www.surgery.org/>.

American Society of Plastic Surgeons. 444 E. Algonquin Rd., Arlington Heights, IL 60005. (888) 475-2784. <http://www.plasticsurgery.org/>.

OTHER

American Society of Cosmetic Breast Surgery. Information about Breast Surgery. [cited February 24, 2003] <http://www.breast-implant.org>.

National Library of Medicine. Breast Implants. [cited February 24, 2003] <http://www.nlm.nih.gov/medlineplus/breastimplantsbreastreconstruction.htm>.

Public Broadcasting System Breast Implants on Trial. [cited February 24, 2003] <http://www.pbs.org/wgbh/pages/frontline/implants/cron.html>.

U.S. Food and Drug Administration. Breast Implants. [cited February 24, 2003] <http://www.fda.gov/cdrh/breastimplants/labeling/mentor_patient_labeling_5900.htm>.

L. Fleming Fallon, Jr., MD, DrPH

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

Breast reconstruction is normally performed by a surgeon with advanced training in plastic and reconstructive procedures. It is commonly, but not exclusively, performed as an outpatient procedure.

QUESTIONS TO ASK THE DOCTOR

• What will be the resulting appearance?
• Is the surgeon board certified in plastic and reconstructive surgery?
• How many procedures has the surgeon performed?
• What is the surgeon's complication rate?