Generally about the treatment
Reconstruction of a breast, which has been removed due to cancer or a different disease, is a surgical procedure that women left with only one breast are very grateful for having done.
With a breast reconstruction, the symmetry of the body is restored, along with a changed self-image and increased confidence. Furthermore, it will no longer be necessary to wear an external breast prosthesis.
The purpose of breast reconstruction is to create a duplicate of the breast, making it look as much as the other breast as possible. This imitation can be done by the help of a breast implant/breast prosthesis, the patient's own tissue, or both.
Please be aware that a breast reconstruction will not be able to recreate the functions of the breast. The breast will also feel and look different than the healthy breast. Fortunately, new medical techniques and research has made it possible to create a very good cosmetic result.
You can have breast reconstruction done solely of the lost breast, but some women have to, or prefer to have a cosmetic operation of the healthy breast as well, due to a wish for symmetry, shape and/or size.
Cosmetic breast surgery that can be done to the healthy breast include breast reduction, breast lift, or insertion of silicone or salt water implant.
The procedure
There are several methods for breast reconstruction. Here are the different procedures:
The implant method
The breast prosthesis/breast implant, which can be made from salt water or silicone, is inserted, often through the scar left from the previous operation. The implant is placed under the breast muscle.This method can only be used, if the healthy breast is small, or if you are willing to accept that the healthy breast will be made smaller later on through surgery, in order to obtain symmetry.
The expansion method
This method is used, if you wish for insertion of an implant, and if there are problems achieving the sufficient breast volume with the help of the breast implant method alone, in which case a prosthesis of adjustable size (an expansion prosthesis) is inserted. Here, there will be a choice of an implant with an adjustable salt water chamber, or as a combination of a silicone implant and a salt water chamber.The implant itself is placed underneath the breast muscle, and can be drained or filled through a valve. After the surgery, the prosthesis will be filled with salt water about once a week, in order for the patient's skin and muscle to slowly expand and adjust to the changes.
The flap technique
Breast reconstruction can also be done using your own skin, fat, and muscle tissue - a so-called flap. The flap can either be taken from the back, stomach, buttock, or from the side of the body, underneath the armpit. The operation has the purpose of moving a tissue flap from either of the areas mentioned to the breast in order to make the breast reconstruction possible.The tissue flap will often make the use of an expansion prosthesis unnecessary. The flap technique is more extensive and takes longer to perform than the other methods.
Once the breast volume has been recreated by the help of one of the methods described above, and once the scars have healed, and the tissue has settled, a nipple and areola (the dark area surrounding the nipple) can be created. The actual nipple is constructed from the skin layers found in the area. Then the nipple and areola is tattooed in order to achieve the same colour as the healthy breast.
Anaesthesia
A breast reduction often requires several operations. The first operation, where the breast volume is created, is usually done under general anaesthesia and under hospitalisation for 2-5 days. With the flap technique one should count on 5-10 days at the hospital.
Follow-up operations (such as reconstruction of the nipple) can be performed under local anaesthesia, combined with soothing medicine, and is most commonly done on an outpatient basis.
Side-effects
Temporary swelling around the scars, contusion (bruising), changes of sensation, discomfort and pain. Tiredness and soreness for 1-2 weeks or more.
With the flap operation method, an additional scar will be left in the area where the skin is taken from.
Risk of complications
There is a risk of infections, bleeding, and impacts of the anaesthesia. There is also a risk of poor healing, which can result in big and unsightly scars.
When a breast implant is used, there is a risk of tissue reaction around the implant, as well as tissue death. The implant could burst causing the need for new surgery, although this is very rare. There is also a risk of capsular contraction, which shows in form of different degrees of firmness and discomfort. Special techniques must be used for a mammogram. The implant may shift over time.
Regardless of the surgical method, there is a risk of a poor cosmetic result, such as asymmetry of both breasts and nipples.
It will be necessary for 1 out of 4 women to have one or two minor operations several months after the surgery in order to adjust the shape and placement of the reconstructed breast, loosen the inner scar (capsule tightening) or merely to adjust unsightly looking scars.
There is a risk of side effects from the anaesthetic used, along with bleeding, poor wound healing, a poor cosmetic result, and blood accumulation.
No form of surgery is risk free, although severe complications are very rare.
Healing and recovery
Work may be resumed after 3-4 weeks. With the flap technique: 4-8 weeks. As a general rule, the patient should restrain from heavy lifting as well as strenuous exercise and sex for up to 4-8 weeks.
The scars will slowly become less apparent with time, but note that they will never go away completely.