Weighing the Benefits and Risks of Breast Reconstruction Surgery After Mastectomy
Breast cancer is no longer the death sentence it was decades ago. Improved medical interventions result in more survivors – even with the most aggressive forms of cancer. While women are concerned for their health, they may also be concerned about restoring the appearance of their breasts, leading them to consider breast reconstruction – a procedure performed after a mastectomy to restore the breast to its original size and shape. While it has risks, new methods provide women with greater and safer options to regain their previous shape.
Breast reconstruction is performed either immediately after a mastectomy or months later. Immediate reconstruction is done during or soon after the mastectomy. This procedure is offered to women who don’t require chemotherapy. This procedure leads to better results because there is no damage to chest tissue. However, women who have immediate reconstruction has a higher risk of necrosis (cell death) of chest tissue, which requires additional surgery and may lead to deformed breasts. Women who require radiation treatment may have delayed reconstruction after treatment is complete. A tissue expander is used to stretch the skin to prepare it for the implant during the final procedure.
The next step is determining the best surgical procedure. Breast reconstruction is completed with either implants or tissue flap procedures. Implants (sacs filled with either saline, silicone gel, or an alternative material) can be used to rebuild the breast’s size and shape. While a reasonable option, implants must be replaced periodically (every 10-15 years), and they may interfere with mammograms. Alternatively, tissue flap procedures use the woman’s body tissue and muscle from other body parts to rebuild the breast. Common tissue flap site are the abdomen and upper back; in rarer cases, thigh and buttocks tissues may also be used. Unlike implants, tissue behaves and feels like other body tissues – they expand and shrink due to weight changes. However, abdominal hernias and muscle weakness may occur. This procedure is also not recommended for smokers, diabetics or women with circulation problems because healthy blood vessels are necessary to supply the breasts with blood.
Nipple and areola reconstruction, the final step, is performed about 3-4 months after breast reconstruction. With this procedure, small amounts of tissue and skin are removed from the reconstructed breast then shaped and placed at the nipple site. The areola can be created with skin grafts from the groin or abdomen, or tattooed around the nipple. Infections, bleeding and scarring may occur, but this risk is fairly low.
All benefits and risks must be considered before making a decision about this surgery. Women should consult licensed surgeons and technologists, and ensure that they are good candidates for the procedures.