While taken for granted, reconstruction after mastectomy was not performed in this country until 1980. Dr. Fisher co-authored one of the first articles on “Immediate Breast Reconstruction after Mastectomy” in 1980. Breast Reconstruction also includes procedures for lack of development of the breast or after implant failure. Reconstructive methods, including total muscle coverage are most useful for implant revisions.
Reconstruction of a breast that has been removed due to cancer or other disease is one of the most rewarding surgical procedures available today. New medical techniques and devices have made it possible to create a breast that can come close in form and appearance to matching a natural breast. Frequently, reconstruction is possible immediately following breast removal (mastectomy) so the patient wakes up with a breast mound already in place, having been spared the experience of seeing herself with no breast at all.
But bear in mind, post-mastectomy breast reconstruction is not a simple procedure. There are often many options to consider what is best for you.
If Dr. Fisher recommends the use of an implant, he will discuss what type of implant should be used.
Skin expansion. The most common technique combines skin expansion and subsequent insertion of an implant. Following mastectomy, Dr. Fisher 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. 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. Fisher 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 one 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 need for 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. Regardless of whether the tissue is tunneled beneath the skin on a pedicle or transplanted to the chest as a microvascular flap, this type of surgery 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 and there are no concerns about a silicone implant. In some cases, you may have the added benefit of a improved abdominal contour.
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. Dr. Fisher may recommend an additional operation to enlarge, reduce or lift the natural breast to match the reconstructed breast.
After the surgery, you are likely to feel tired and sore for a week or two after reconstruction. Most of your discomfort can be controlled by medication prescribed by Dr. Fisher.
Depending on the extent of your surgery, you will probably be released from the hospital in two 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. Most stitches are removed in a week to 10 days.
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, but they will never disappear entirely.