John Bull, Jr., MD, FACS, believes breast reconstruction is one of the most rewarding procedures he performs for his patients. New medical techniques and devices have made it possible for Dr. Bull to create a breast that can come close in form and appearance to matching a natural breast. Frequently, Dr. Bull can provide his breast reconstruction patients with this surgery immediately following breast removal (mastectomy). As a result, the mastectomy / breast reconstruction patient wakes up with a breast mound already in place, having been spared the experience of seeing herself with no breast at all.
Dr. Bull discusses breast reconstruction in Naperville and Chicago performed at The John Bull Center for Cosmetic Surgery and Laser Medispa.
But bear in mind, post-mastectomy breast reconstruction is not a simple procedure. There are often many options to consider as you and Dr. Bull explore which would be best for you. The information presented here will not answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask Dr. Bull if there is anything you don’t understand about the procedure.
Are you a candidate for breast reconstruction?
Most mastectomy patients are appropriate for reconstruction; many are able to have reconstruction at the same time that the breast is removed. The best candidates, however, are women whose cancer, as far as can be determined, seems to have been eliminated by mastectomy.
There are legitimate reasons to wait. Many women aren’t comfortable weighing all the options while they’re struggling to cope with a diagnosis of cancer. Others simply don’t want to have any more surgery than is absolutely necessary. Some patients may be advised by their surgeons to wait, particularly if the breast is being rebuilt in a more complicated procedure using flaps of skin and underlying tissue.
Women with other health conditions, such as obesity, high blood pressure, or smoking, may also be advised to wait.
In any case, being informed of your reconstruction options before surgery can help you prepare for a mastectomy with a more positive outlook for the future.
Are there risks with reconstruction?
Virtually any woman who must lose her breast to cancer can have it rebuilt through reconstructive surgery. But there are risks associated with any surgery. As the procedures vary significantly please ask Dr. Bull to explain the risks of your specific procedure.
In general, the usual risks of surgery, such as bleeding, fluid collection, excessive scar tissue, or difficulties with anesthesia, can occur although these are uncommon. As with any surgery, smokers have a higher rate of complications and a higher rate of multiple complications, which can delay healing, resulting in conspicuous scars and prolonged recovery. Occasionally, these complications are severe enough to require a second operation.
Reconstruction has no known effect on the recurrence of disease in the breast, nor does it generally interfere with chemotherapy or radiation treatment, if this is necessary.
Women who postpone reconstruction may go through a period of emotional readjustment. Just as it took time to get used to the loss of a breast, a woman may feel anxious and confused as she begins to think of the reconstructed breast as her own.
Preparing for the Surgery
As soon as you have been diagnosed with cancer, you can begin talking about reconstruction. The best plan is for your breast surgeon and Dr. Bull to work together to develop a strategy that will put you in the best possible condition for reconstruction.
After evaluating you and discussing your goals, Dr. Bull will explain which options are most appropriate for you. Be sure to discuss your expectations frankly with Dr. Bull. Usually, the reconstruction is done in stages. First the breast mound is reconstructed depending on the technique used, the nipple and areola are made at a second operation at least three months later to allow the tissues to heal and settle into a natural position. Post-mastectomy reconstruction can improve your appearance and renew your self-confidence; but please remember the desired result is improvement, not perfection.
Dr. Bull will explain the anesthesia required but usually this is general anesthesia for the reconstruction of the breast mound. In most cases, health insurance policies will cover most or all of the cost of post-mastectomy reconstruction.
While there are many options available in post-mastectomy reconstruction, you and Dr. Bull will choose the one that’s best for you.
Skin expansion. The most common technique combines skin expansion and with a second operation, insertion of an implant. Following mastectomy, Dr. Bull will insert a balloon expander beneath your skin and chest muscle. Through a tiny valve mechanism buried beneath the skin, he will periodically inject a salt-water solution to gradually fill the expander over several weeks or months. After the skin over the breast area has stretched enough, the expander may be removed in a second operation and a more permanent implant will be inserted. Some expanders are designed to be left in place as the final implant but can only be used in certain cases. The nipple and the dark skin surrounding it, called the areola, are reconstructed in a subsequent procedure.
Some patients do not require preliminary tissue expansion before receiving an implant. For these women, Dr. Bull will proceed with inserting an implant as the first step.
Flap reconstruction. An alternative approach to implant reconstruction involves creation of a skin flap using tissue taken from other parts of the body, such as the back, abdomen, or buttocks.
In the most common type of flap surgery, the tissue remains attached to its original site, retaining its blood supply. The flap, consisting of the skin, fat, and muscle with its blood supply, are tunneled beneath the skin to the chest, creating a pocket for an implant or, in some cases, creating the breast mound itself, without an implant.
Another flap technique uses tissue that is surgically removed from the abdomen, thighs, or buttocks and then transplanted to the chest by reconnecting the blood vessels to new ones in that region.
This type of reconstruction is more complex than skin expansion. Scars will be left at both the tissue donor site and at the reconstructed breast, and recovery will take longer than with an implant. On the other hand, when the breast is reconstructed entirely with your own tissue, the results are generally more natural. In some cases, you may have the added benefit of an improved abdominal contour if it is possible to use your abdominal tissue for the reconstruction.
Follow-up procedures. Most breast reconstruction involves a series of procedures that occur over time. Usually, the initial reconstructive operation is the most complex. Follow-up surgery may be required to replace a tissue expander with an implant or to reconstruct the nipple and the areola. In many cases, Dr. Bull will recommend an additional operation to enlarge, reduce, or lift the natural breast to match the reconstructed breast.
Getting back to normal
You are likely to feel tired and sore for a week or two after reconstruction. Your discomfort can be controlled by medications prescribed by Dr. Bull or your breast surgeon.
Depending on which procedure, you will be released from the hospital in one to five days. Many reconstruction options require a surgical drain to remove excess fluids from surgical sites immediately following the operation, but these are removed within the first week or two after surgery. Usually the stitches are placed under the skin and tapes cover the incisions for up to two weeks to help the incisions heal.
It may take you up to six weeks to recover from a combined mastectomy and reconstruction or from a flap reconstruction alone. If implants are used without flaps and reconstruction is done apart from the mastectomy, your recovery time may be less.
Reconstruction cannot restore normal sensation to your breast, but in time, some feeling may return. Most scars will fade substantially over time, though it may take as long as one to two years. The scars however, never disappear entirely.
Follow Dr. Bull’s advice on when to begin stretching exercises and normal activities as this varies depending on the exact procedure performed.
Your new look
Chances are your reconstructed breast may feel more firm and look rounder or flatter than your natural breast. It may not have the same contour as your breast before mastectomy, nor will it exactly match your opposite breast. But these differences will be apparent only to you. For most mastectomy patients, breast reconstruction dramatically improves their appearance and quality of life following surgery.