I’ve had a mastectomy and am wondering if reconstruction is right for me.
– Dr. Sébastien Nguyen, plastic surgeon specializing in breast reconstruction and cosmetic breast surgery at Hôpital Saint-Sacrement, explains.
First, it’s important to understand that there are three breast reconstruction techniques:
- Prosthetic breast reconstruction, also known as the allogenic method. This technique involves the insertion of a temporary implant (tissue expander) behind the woman’s large pectoral muscle, which helps stretch the patient’s skin. Once the skin has been sufficiently stretched the expansion prosthesis is removed and replaced by a permanent silicone or saline implant. This type of reconstruction is normally done in two distinct steps. In some cases, it is possible to insert the permanent implant in a single operation. The nipple and areola are reconstructed later under local anesthesia.Dr. Nguyen uses silicone implants in 99.9% of cases in his practice. According to him a silicone implant is less palpable to the touch and less obvious, visually, than a saline implant. As a result, the reconstructed breast looks and feels more natural.
- Flap reconstruction, using tissue from the patient’s body or autogenic method. When using this technique, tissue from the patient’s body (usually from the belly or back and sometimes from the buttocks or thighs) is relocated to the chest to be shaped into a breast. This surgery is more complex, takes longer, requires a longer convalescence period than implant surgery, and leaves more visible scars. On the other hand, it generally results in a more natural-looking reconstructed breast and has the advantage of adjusting itself to the changes in the patients’ weight.
- A combination of the two techniques. Consists in using the patient’s tissues in combination with an implant.
Making a Choice
A woman may well decide not to proceed with reconstruction and opt instead for an external prosthesis (breastform) inserted in her bra. If she does choose to go ahead with surgery, it is important that she be well informed and discuss all possible options available after a mastectomy, in order to make an informed decision.
The breast reconstruction procedure most frequently performed by plastic surgeons in America is the prosthetic type: the procedure itself is simpler to perform and is also easier for the patient (less morbid) as it is less painful, leaves fewer scars and requires a shorter recovery period.
Here is what you and your doctor should consider when weighing your options:
- age. Flap reconstruction is more suitable for young, healthy women. As the woman’s body changes with time, a breast reconstructed with her own tissues will adapt to these changes;
- illnesses. If a woman has health problems such as diabetes, hypertension or respiratory issues, implants are generally recommended since the surgery takes less time to perform and requires a shorter recovery period;
- physical examination. In order to use the woman’s own tissues for reconstruction, a woman must have enough accessible tissue (folds). The flap-reconstruction option often rules itself out when the patient has no excess weight;
- time available for recovery. Although recovery time can vary from patient to patient, implant surgery usually requires a shorter recovery period;
- the patient’s expectations. Unrealistic expectations may be a reason for advising against breast reconstruction;
- physiological state.
Note: prosthetic reconstruction may be contraindicated for certain women where radiotherapy caused hardening of the skin on the affected breast, resulting in lack of elasticity that would make this type of reconstruction risky or even impossible.
For some women breast reconstruction is not recommended, notably in the following instances:
- in cases of very advanced cancer, with a poor prognosis for survival. At times, simple techniques may be offered to young patients to mitigate psychological trauma caused by the loss of a breast;
- in cases where the patient has a major pre-existing condition, such as a heart condition;
- when the woman is a smoker, as there is a risk of major complications, particularly in terms of recovery and post-operative infection;
- when the woman is very obese, as her physical condition would not allow her to get through such a long and complex operation.
Drawbacks of Breast Reconstruction
Surgery is never risk-free. Certain complications such as infection, bleeding or delayed healing can occur as they can with any procedure.
Risks related directly to breast prosthesis:
- undergoing future surgery: implants have an average life span of 15 to 20 years, following which they may need to be replaced if problems arise;
- inflammation may occur, causing calcification (capsular contracture), which leads to hardening of the breast.
Risks related directly to flaps:
- major complications such as the loss of a flap (necrosis), thrombophlebitis or (very rarely) pulmonary embolism.