Although lumpectomies are being performed with greater frequency today, for some cases, a mastectomy is the preferred operation. A mastectomy removes the entire breast. In practically all cases, the breast can be reconstructed surgically. The size and shape of a reconstructed breast will match the other breast, and the nipple and areola can be reconstructed to produce a normal-looking, cosmetically pleasing breast.
The type of breast reconstruction surgery necessary depends on the mastectomy procedure and the patient’s wishes. In many mastectomies, the skin and nipple can be preserved, simplifying the reconstructive procedure. Breast reconstruction options should be discussed with the surgeon before undergoing a mastectomy. In many cases, the breast reconstruction can be performed immediately after the mastectomy, during the same surgical procedure. If radiation therapy to the surgical site is being considered, it may be wiser to delay reconstruction until after the radiation therapy is completed. Irradiating the newly reconstructed breast can cause damage and delay healing.
There are a number of different types of breast reconstruction surgery. The simplest type is to place an implant into the breast to replace the tissue that has been removed. If the skin is being preserved during the mastectomy, the implant can be placed during the same surgical procedure. Implants are sacs of silicone or saline. Some of the silicone implants available today have the same texture, shape, and consistency of natural breast tissue.
If there isn’t sufficient healthy skin to rebuild the breast immediately, a two-stage reconstruction can be done. An expandable implant will be placed at the time of the mastectomy, and over the next two or three months it will be slowly inflated, stretching the skin out. When sufficient skin has grown, the final implant can be placed.
Flap procedures use tissue and skin donated from a different part of the body to rebuild the breast. These procedures are more complicated than implant placement. The donor site is subjected to surgery and may experience scarring and complications. The most common flap procedures are called TRAM and DIEP. These two procedures take tissue from the belly area to rebuild the breast.
TRAM flaps remove muscle from the belly, which on occasion may lead to abdominal weakness and hernias. DIEP flaps essentially involve performing a tummy tuck, removing only excess skin and fatty tissue from the belly and moving it to build the breast. Flap procedures are more painful and have longer recovery times than implant procedures, but the result is usually more natural in appearance.
Although skin and nipple-sparing mastectomies preserve the nipple, often the nerves are cut or damaged, leaving the nipple with no sensation. Sometimes the blood supply to the preserved nipple is insufficient and it withers away later. If the original nipple cannot be preserved, women can opt to have a new one rebuilt after the reconstructive surgery heals, or they can opt to have a realistic tattoo placed to mimic a nipple and areola in appearance.
At the John Bull Center for Cosmetic Surgery and Laser Medispa, we work with each patient individually to determine the safest and most effective treatment for her needs. Our medical team – led by Dr. John Bull – will work with you every step of the way to ensure you get the best possible results. Contact The John Bull Center in Naperville today to schedule your consultation.