Breast Reconstruction in Breast Cancer Patients

Many women who undergo surgery due to breast cancer seek ways to reconstruct their breasts after cancer treatment. Breast reconstruction or restoration after cancer treatment allows women to regain the natural shape and appearance of their breasts.

What is Meant by Breast Reconstruction or Restoration?

Breast reconstruction, also known as breast restoration, is a type of cosmetic surgery performed after a mastectomy or lumpectomy. This surgery aims to maintain the natural appearance of the breasts and is available for women who need to have their breast tissue partially or completely removed due to breast cancer.

In breast reconstruction, the surgeon can create a new breast with a natural form and appearance using various methods, including the use of implants or tissue techniques. Although this procedure is often referred to as breast prosthesis after cancer, there are multiple methods available for reconstruction.

Women who undergo a mastectomy as part of their breast cancer treatment and have one or both breasts removed may choose to undergo breast reconstruction to regain the natural shape of their breasts.

Reasons for Breast Reconstruction After Cancer

Choosing to undergo breast reconstruction after cancer can be for various reasons, including:

  • Improved self-image and body confidence
  • Permanent restoration of breast appearance
  • Enhanced appearance of the breasts under clothing
  • Elimination of the need for external breast prostheses under a bra
  • Symmetrical appearance of the breasts when wearing a bra or swimsuit

Breast reconstruction, as the name suggests, is a procedure for breast cancer patients who have undergone mastectomy or the removal of the affected breast as part of their treatment.

Breast reconstruction involves replacing one or both breasts with a natural shape, appearance, symmetry, and appropriate size in individuals who have undergone unilateral or bilateral mastectomy.

Additionally, those who have had a lumpectomy might have an unsatisfactory breast appearance or congenital anomalies in breast development, necessitating reconstruction.

With breast reconstruction after cancer, patients can largely regain the natural appearance of their breasts. However, it is important to note that a reconstructed breast only resembles the appearance of a breast and cannot function naturally, such as in breastfeeding.

Types of Breast Reconstruction Methods

Individuals who have undergone a mastectomy for breast cancer treatment have several options for breast reconstruction. Before deciding on the most suitable method, the medical team considers various factors, such as the patient’s health status and personal preferences. Generally, the methods for breast reconstruction after cancer include:

  • Breast implant insertion
  • Tissue techniques
  • Oncoplastic reconstruction
  • Nipple reconstruction

Each method can be performed using various techniques. None of these breast reconstruction methods can be deemed the absolute best for all cases. The most appropriate method for each person is determined individually based on clinical judgment after examination and preoperative consultation.

Breast Reconstruction Using Tissue Flap

One method of breast reconstruction involves using the body’s natural tissues. In this process, natural muscle or fat tissue is taken from other parts of the body, such as the abdomen, sides, or buttocks. The advantage of this method over implants is that the reconstructed breasts have a form closer to natural breast tissue.

Sometimes, fat tissues can be used as a supplement to breast reconstruction with implants. However, the flap method requires a longer recovery period, creates an additional scar in a location other than the breasts, and is not recommended for smokers or people with diabetes. The most common types of flaps (tissue replacements) include:

  • SGAP Flap: Uses fat tissue from the buttocks (not the muscle).
  • IGAP Flap: Utilizes tissue from the buttocks for breast reconstruction after cancer.
  • Latissimus Dorsi Flap: A muscle in the back that is not essential for function.
  • PAP Flap: Uses tissue from the inner and back thigh for breast reconstruction.
  • TRAM Flap: Involves using skin, fat, blood vessels, and muscle from the lower abdomen.
  • TUG Flap: Utilizes tissue from the inner thigh, similar to the PAP method, leading to muscle and tissue grafting.
  • DIEP Flap: In this technique, the surgeon uses skin, fat, and blood vessels from the abdomen. This method is recommended for individuals who have not had multiple abdominal surgeries, have good skin quality in the abdominal area, and have sufficient fat and skin volume in the abdomen for breast reconstruction.

Nipple and Areola Reconstruction After Breast Surgery

During mastectomy surgery for breast cancer treatment, the nipple is usually removed along with the rest of the breast tissue. However, nipple-sparing mastectomy is possible for some patients.

Nipple and areola reconstruction typically takes place three to four months after the initial breast reconstruction surgery to allow adequate healing time. Skin or tissue from other parts of the body is sometimes used to create the areola and nipple tissue. Techniques such as tattooing can be employed to achieve a natural color and appearance.

In some cases, a combination of these methods is used to achieve successful and natural-looking breast reconstruction after cancer. Modern plastic surgery techniques have significantly improved the ability to restore the natural appearance of reconstructed breasts.

Breast Reconstruction Using Implants / Breast Prosthesis After Cancer

Breast implant insertion is a common and widely used method by many surgeons for breast reconstruction. This method is feasible if the mastectomy or breast radiation therapy has left sufficient tissue in the chest wall to cover the breast implant.

In implant-based breast reconstruction, surgeons use silicone or saline implants. In some cases, a combination of flap and implant techniques may be used to shape the breast.

The techniques and methods of breast reconstruction after cancer using implants include:

  • Immediate placement of a breast tissue expander
  • Immediate breast reconstruction with a prosthesis
  • Delayed breast reconstruction using a tissue expander
  • Immediate breast reconstruction using the latissimus dorsi muscle with a prosthesis

Breast Reconstruction After Lumpectomy with Oncoplastic Technique

Many women who undergo breast-conserving surgeries like lumpectomy for breast cancer treatment do not need breast reconstruction. However, some patients may experience deformed and misshapen breasts after breast cancer surgery. For example, this can occur when a large tumor is removed from a small breast.

To address this issue, some surgeons combine breast cancer surgery techniques with plastic surgery techniques, known as oncoplasty. The goal of oncoplasty is to restore the natural appearance of the breasts during breast cancer surgery (lumpectomy or mastectomy). This technique helps individuals who have lost part of their breast during lumpectomy to achieve the desired shape by reducing or lifting the breast, thereby correcting the deformity.

These patients are suitable candidates for various breast reconstruction methods after cancer to reshape the breasts, including:

  • Fat grafting
  • Breast lift
  • Scar revision
  • Partial tissue flap
  • Use of smaller implants

To achieve better results, a combination of the above methods may be used. Additionally, it is important to note that this surgery (oncoplasty) has similar results and potential complications as breast cancer surgery without breast reconstruction and does not impose any additional complications on the patient.

The Experience of Breast Reconstruction After Cancer

Mastectomy, or the surgical removal of a breast, is a procedure that even breast surgeons find challenging because the importance of the breast to women cannot be overlooked. The absence of a breast can lead to long-term depression for patients. This highlights the significance and role of breast reconstruction surgery after mastectomy. The best breast surgeons will certainly recommend this procedure to their patients. However, this surgery is complex and requires years of experience and up-to-date knowledge in breast surgery. It is essential to choose the best breast surgeon in Tehran or your own city for this procedure.

Considerations When Choosing a Breast Reconstruction Method

If you have decided on breast implant surgery after mastectomy or using tissue techniques, there are still many factors to discuss with your doctor before making a final decision. Some considerations include:

  • Breast size
  • Size and location of the cancerous lump
  • Recovery time
  • Whether to reconstruct one or both breasts
  • The impact of breast reconstruction surgery on other parts of the body
  • The method used in breast cancer surgery (lumpectomy or mastectomy)
  • Willingness to undergo one or multiple surgeries after the main breast reconstruction surgery
  • Need for additional treatments besides surgery (radiation and chemotherapy)
  • Availability of tissue (e.g., thin women may not have enough extra fat tissue for breast reconstruction)
  • General health status (including factors that may affect your health, such as smoking or specific medications)

Your surgeon will discuss the various options available for breast reconstruction with you after reviewing your medical history and general health status. It is best to communicate your personal preferences and concerns clearly with your doctor.

Preparing for Breast Reconstruction Surgery

Your specialist breast cosmetic surgeon will discuss the guidelines you need to follow before the breast reconstruction surgery. Some of these instructions include:

  • Avoid eating and drinking several hours before the surgery.
  • Try to quit smoking at least six weeks before the surgery.
  • Avoid taking blood-thinning medications like aspirin and warfarin.
  • Refrain from self-medicating with vitamins, dietary supplements, and herbal medicines.

Bring a companion to the hospital who can support you during the hospital stay and take you home after your recovery period.

Postoperative Care and Recovery After Breast Reconstruction Surgery

  • Here are some guidelines to follow during the recovery period:
  • Avoid smoking in the days and weeks following surgery.
  • Obtain and wear a special postoperative bra for six months.
  • Continuously use medical-grade bras for six months after surgery.
  • Surgical scars may take about one to two years to fully heal.
  • Gradually start light stretching and exercises according to your doctor’s instructions in the days following surgery.
  • Swelling at the surgical site may last for six to eight weeks. Be patient and endure the postoperative pain and inflammation.
  • Drains are usually used to remove blood and serous fluid post-surgery. Avoid full showers while the drain is in place. The drain will be removed by your surgeon once the discharge is no longer bloody and less than 20-30 cc per day.
  • Patients can resume daily activities and engage in light exercises like walking. Perform specific postoperative exercises, avoid sleeping on the operated side, and refrain from heavy activities with the affected arm.

Potential Complications of Breast Reconstruction Surgery

Every surgery, whether cosmetic or therapeutic, carries its own risks and complications, and breast reconstruction is no exception. It is important to note that many of the complications mentioned below occur very rarely. These complications include:

  • Fatigue
  • Bleeding
  • Infection at the surgical site
  • Blood clots or hematoma
  • Issues related to anesthesia
  • Interstitial fluid accumulation, inflammation, and swelling in the surgical area

Potential problems following breast reconstruction surgery may include:

  • Necrosis or death of breast tissue, skin, or fat cells
  • Loss of or changes in nipple sensitivity
  • Displacement, leakage, or rupture of the implant
  • Breast asymmetry

One rare complication of using implants in breast reconstruction or mammoplasty is a type of cancer called anaplastic large cell lymphoma (ALCL), which is not a form of breast cancer. ALCL can occur eight to ten years after implant placement, especially if the implant’s surface hardens over time. Regular tests prescribed by your doctor can help reduce the risk of developing lymphoma.

Recovery After Breast Reconstruction Surgery

Patients are likely to feel fatigued and weak for one to two weeks following breast reconstruction surgery. This period may be longer for those who have undergone tissue flap procedures. The length of hospital stay depends on the type of surgery performed for breast reconstruction after cancer.

Special drains are used to remove excess fluids from the surgical site and are typically removed by the doctor in the days following surgery.

Most patients can return to their normal lives six to eight weeks after breast reconstruction surgery. Recovery time is shorter for those who have had implants compared to those who have undergone tissue flap procedures.

Cost of Breast Reconstruction Surgery After Cancer

The cost of breast reconstruction surgery can vary significantly based on several factors we’ve discussed, including the choice of surgical method, preoperative preparations, the reason for reconstruction, the use of breast implants, and the medical facility selected. These factors can influence the total cost of breast reconstruction surgery and oncoplastic surgery. An approximate estimate of the cost can be provided at the end of the preoperative consultation with Dr. Farhad moussazadeh.

Choosing the Best Breast Reconstruction Surgeon

As mentioned, breast reconstruction surgery can be performed either several months after mastectomy or simultaneously with breast cancer surgery. To determine the best timing for breast reconstruction and achieve satisfactory results, we recommend consulting with the best breast reconstruction surgeon. Selecting a surgeon who specializes in both cosmetic and therapeutic breast surgeries ensures a comprehensive evaluation of all aspects related to the choice of reconstruction method.

Dr. Farhad moussazadeh, an internist and breast surgery fellowship holder from Canada, with over fifteen years of experience in various cosmetic and therapeutic breast surgeries, is one of the best breast reconstruction surgeons in Tehran. He is ready to provide any necessary consultations to patients.

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