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Dr. Placik's Breast Reconstruction Information

Old 04-24-2012, 08:08 PM
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Dr. Placik's Breast Reconstruction Information

Info courtesy of Dr. Otto Placik
(Original article is located here.)

Breast reconstruction is a surgical procedure, or series of procedures, performed to reconstruct the breast after its removal for cancer or premalignant breast disease. The operation is designed to reconstruct the missing breast mound, the nipple, and areola, and may even include prophylactic (preventive) removal and rebuilding of the opposite breast. Reduction, reshaping, or even enlargement of the remaining breast may also be done in order to give symmetry and comfort.

Due to recent advances in plastic surgery techniques, a mastectomy need not have the same physical and emotional consequences that it did in the past. Women of all ages who have had all or part of a breast removed are finding that breast reconstruction can be a step toward restoring their bodies and their lifestyles. Reconstruction can help the mastectomy patient feel and look better in clothes, help her regain a positive self image and contribute to a better mental attitude.

Surprisingly, many women are still unaware that a breast can be reconstructed after surgery. Almost any woman who has had a mastectomy can have her breast reconstructed. But reconstruction isn't for everyone. Some women prefer to wear breast forms (prostheses) rather than having additional surgery. The important thing is that you have a choice.

The decision to undergo breast reconstruction and the timing of the procedure(s) should be made by you and your doctors. Prior to initial treatment, you may wish to consult with the various medical professionals who form your support team including your oncologist, general surgeon and plastic surgeon, so that they can plan a coordinated approach to surgical treatment and reconstruction. The better informed you are about your options, the greater chance you have of regaining physical and emotional stability.

Timing of breast reconstruction is very important. With many patients it can be started at the time of the mastectomy. Other women choose to wait for a short time after mastectomy in order to better cope with the new problems they face. During this time, the benefits of reconstruction can be carefully considered.

Complications are relatively infrequent but potential difficulties should be discussed at the time of consultation with your plastic surgeon. You need to fully understand what will be done.

The type of mastectomy will determined the complexity and number of operative stages required to reconstruct the breast. In general, more satisfactory reconstruction results can be achieved for women who have had modified radical or simpler forms of mastectomy in which the pectoral muscle, the large fan-shaped muscle that lies behind the breast, is saved. Preservation of this muscle allows the surgeon to perform a more natural appearing reconstruction.

There are basically four types of mastectomy:
  1. The radical or Halsted mastectomy is the removal of the breast, pectoral muscle and contents of the axilla (underarm) in a single block of tissue.
  2. The modified radical mastectomy includes the removal of the breast, nipple, areola and contents of the axilla, but leaves the pectoral muscle intact.
  3. The simple (or total) mastectomy is the removal of the breast, nipple and areola.
  4. Prophylactic mastectomy is considered a preventive measure for women who are at high risk for breast cancer. Those who have had a previous mastectomy on the opposite side are often candidates. The operation may consist of a simple mastectomy or a subcutaneous mastectomy, which preserves the nipple and areola.
The breast implant (prosthesis) is an important part of many reconstructive procedures. There are several types, each with its own benefit depending on the type of reconstruction needed, including: 1) silicone gel; 2) implants inflated with saline solution; 3) a biphasic implant, which is a combination of the first two; 4) silastic textured implants; and 5) tissue expanders. The implants are generally well-tolerated by the body. Careful consideration is given to the size of the implant, which should correspond to your body size and configuration, the size of the remaining breast, your personal goal, and the factors and limitations of the mastectomy site. The use and present status of breast implants will be discussed at the time of your consultation.
More extensive procedures involving the transfer of additional tissue and muscle from the back or abdominal areas may be required in some situations. They may or may not require the use of an implant.

Nipple areolar reconstruction may be done in a variety of ways. These structures can often be formed from the skin of the newly reconstructed breast or from "grafts" removed from other parts of the body. The doctor will discuss this with you as well.

Recovery time naturally will relate to the extent of the required surgical procedure and will be discussed at the time of your consultation.
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