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Patient Educ.(11) Reconstruction




If it is necessary for you to undergo a mastectomy, you should be aware of breast reconstruction. Breast reconstruction recreates the breast shape after the natural breast has been removed. The goal of reconstruction is to provide symmetry (evenness) of the breasts when you are wearing a bra, so you will feel more comfortable about your appearance in most types of clothing.

Some women have reconstruction at the same time as their mastectomy; others have it done several months or even years later. In most cases, a woman who has had a mastectomy can have her breast reconstructed.

Reconstruction is a very personal decision and some women feel it is not necessary. After a mastectomy, many women prefer to wear an artificial breast form, called a prosthesis, inside their bras. Others opt to make no attempt to alter their appearance. Reconstruction is a choice that can have a significant impact on your lifestyle. For this reason, it is a choice you do not need to make immediately or without help.

Both a general surgeon and a plastic surgeon can help you decide whether to have breast reconstruction.

Thanks to recent advances in plastic surgery techniques, a mastectomy need not have the same physical and emotional consequences as it did in the past. Women of all ages who have had a mastectomy are finding that breast reconstruction can be a step toward restoring their bodies and former lifestyles. Emotionally it helps to restore their female identity.

Plastic surgeons have been developing methods of breast reconstruction since the late nineteenth century. Until the late 1960’s, however, the standard surgical procedure was very complex and the results were often disappointing. Few women chose to have reconstruction.

Two medical advances have made reconstruction more popular in recent years: 1) Creation of saline implants, and 2) Development of ways to transfer skin and muscle to the chest area from other areas of the body.

Reconstruction of the entire breast, including the nipple and areola (the dark-colored skin around the nipple), is a procedure that may require two or more operations over a six to 12 month period. A hospital stay of several days is usual for each operation in the process.

Several types of implants are used in reconstruction. Generally, they are soft, fluid-filled sacs, available in various sizes. The surgeon chooses the size and shape that will best match the patient’s opposite breast.

Breast reconstruction is a personalized procedure. There are three major types:

1) "Simple" breast reconstruction,

2) "Latissimus dorsi" reconstruction, and

3) "Rectus abdominus" reconstruction.

Your plastic surgeon will recommend the best procedure for you after considering the type of mastectomy performed, your postop treatment, your skin and muscle condition, your breast size, and other factors.

In breast reconstruction complications may arise if a woman’s body reacts unfavorably to a foreign substance—the implant. In about twenty-five percent of patients, the body’s response creates a problem known as "capsular contracture" where the body develops a firm, fibrous capsule around the implant to protect itself. The capsule may become very thick, creating a spherical "baseball" appearance and possibly causing discomfort. Sometimes a contracture softens, as it is absorbed by the body, and improves. Frequently, the surgeon can manipulate it to split the capsule, and the implant then assumes its normal size and shape. Contractures may need to be released surgically.

Women who are considering reconstructive breast surgery should be aware that mastectomy and reconstruction incisions are permanent, although the degree of scarring varies among individuals. As with any other type of plastic surgery, it is difficult to predict the overall result. Also, you should realize reconstruction will not restore the sensation of the breast lost after a mastectomy.

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