The myriad decisions women face after receiving a breast cancer diagnosis are intensely personal. Finding out about breast reconstruction should begin when you are first diagnosed, so you do not make decisions that may limit your future options. In 2009, 86,424 breast reconstruction procedures were performed according to the American Society of Plastic Surgeons, but surprisingly, many women are not properly informed about all of their reconstructive options at the time of diagnosis. “This is an important conversation that should take place when a woman is diagnosed so she is informed about choices that can improve her quality of life,” says Susan Downey, M.D., F.A.C.S., a Los Angeles plastic surgeon. “Choosing the most advanced procedures available in breast reconstruction can help women restore their bodies and return to their lives much more quickly.”
Breast reconstruction takes on a variety of forms. It may be performed immediately after a mastectomy, or it can be delayed for weeks or even years. Immediate reconstruction can involve the placement of an implant or tissue expander that will eventually be replaced by an implant. The advantages are that the process will begin at the time of your breast removal which is cost effective, however, the initial operation and recovery may be longer. If your skin is very tight you may need tissue expansion prior to reconstruction. A balloon expander may be placed under the skin and chest muscle, to be gradually filled with salt-water to stretch the skin. The process takes several weeks to months, at which point either the expander will be left in, or a permanent implant will be placed, and the nipple areola can be reconstructed. If there is adequate skin available, a single stage reconstruction may be done where a silicone gel implant or one with a silicone elastomer shell filled with saline is permanently placed in the breast at the time of mastectomy. The silicone gel used for breast implants has a thicker consistency so it acts more like a cohesive unit than a liquid and implants come in round or contoured shapes with a smooth or textured surface. Your breasts can be reconstructed using an implant, your own tissue or a combination of both. Commonly performed procedures using your own tissue from the torso area to create a skin flap include the TRAM flap (transverse rectus abdominus muscle) flap taken from the abdomen, and Latissimus Dorsi flap (taken from the upper back) reconstruction that involve reconnecting blood vessels contained in the tissue to the grafting site. The advantage of this surgery is that your own skin is used, but it is more complex and involves considerable scarring and recovery, since there are two surgical sites to heal. If only one breast is affected, cosmetic work on the opposite breast may be done at the same time so your breasts appear symmetrical. “The ultimate goal of breast reconstruction surgery is to restore symmetry by creating symmetrical breasts that strongly resemble your natural breasts,” says New York Plastic Surgeon Carlin Vickery, M.D. “I often perform Hybrid breast reconstructions, which are customized surgeries that combine elements of flap procedures, such as DIEP or Deep Inferior Epigastric Perforator Flap taken from the abdomen, to harvest enough tissue to rebuild the breast flap. A saline or silicone gel implant is then placed under the breast tissue to add the necessary volume.”
When performed by an experienced plastic surgeon, your breasts can be beautifully restored so that you can fully return to your life with barely any signs of treatment. In most cases Federal law mandates that insurers cover reconstructive breast surgery for women who have undergone a mastectomy, including for procedures to achieve symmetry on the opposite side of the breast.
Wendy Lewis is the Founder and Editor in Chief of BeautyintheBag.com
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