Mastectomy(removal of the breast) for cancer is the most common reason that women come seeking breast reconstruction, but other problems such as severe post radiation changes or congenital(inherited defects)deformities can also lead the patient to seek reconstruction.

Recent advances in reconstructive techniques have opened a whole host of options to the patient seeking breast reconstruction. Surgeons can often create a breast that closely approximates the form, feel, and appearance of a normal breast. The use of artificial materials such as implantable breast prostheses, tissue expansion techniques, and the transplantation of the patient’s own tissue either by pedicled flaps or by the free flap technique all serve as part of the plastic surgeon’s tools. The surgeon must examine the patient and discuss the various options to choose the technique which will best serve each patient. Often a combination of techniques may be chosen to produce the best result.

The patient and the plastic surgeon may also discuss other options such as immediate reconstruction versus delayed reconstruction. Many factors enter into the decisions about the timing of surgery and the choice of surgical procedure. There is no single best answer and the patient and surgeon must explore the options carefully. There are risks as well as advantages to each choice. If the patient remains uncertain at the end of the consultation it is usually best to delay reconstruction. Some patients will remain satisfied with the use of an external prosthesis to provide symmetry in clothing.

WHO SHOULD HAVE BREAST RECONSTRUCTION SURGERY?

Although many breast cancers can now be treated by “lumpectomy” there are still a number of women who will be advised by their cancer surgeon to undergo mastectomy. The reasons for this usually are related to the size of the tumor when first discovered, and to the risk of multiple tumors in a breast due to the type of tumor present. There are several different types of breast cancer and individual factors such as age and general health may affect the type of treatment recommended by the cancer surgeon. When the recommendation is for removal of all of the breast tissue the patient may ask the cancer surgeon about the possibility of reconstruction if the surgeon does not mention the possibility. Most patients who undergo mastectomy are candidates for some type of reconstruction if they so desire. Patients who fail to develop a normal breast due to childhood injury or congenital defects are candidates for reconstruction, often during mid to late puberty.

WHY RECONSTRUCT THE BREAST?

Some would argue that the only real function of the breast is to provide milk for the newborn. Since there is no reconstructive technique capable of meeting this criteria there are those who would argue that breast reconstruction is cosmetic. A second and very important function of the breast is to provide a normal appearance of symmetry. Although none of our paired features are perfectly symmetrical we expect to see in others and to feel and see in ourselves an overall sense of visual balance. When this is lacking the eye is immediately alerted. Patients who seek breast reconstruction after experiencing loss of the breast often cite a feeling of asymmetry or a lack of “wholeness”. Each patient’s motivation may be different but there goal is to restore a symmetrical appearance and feel which for some women cannot be obtained with an external prosthesis.

TIMING OF BREAST SURGERY

Current figures indicate that 12% of women alive today will develop breast cancer. The discovery of a possible tumor on mammogram, by self examination, or during exam by a health care professional is a very frightening experience. The patient must make a number of decisions at a time when the term stressful situation seems an inadequate expression. Some women may find it difficult or impossible to make a decision about the type of breast reconstruction which might suit them best. Other patients may have thought about this decision, at least in the abstract, or may feel comfortable in making a decision despite the stress of the situation. The main advantage of a delayed reconstruction is that the patient has more time to consider her options. Some, who weren’t certain prior to mastectomy, may find that the external prosthesis meets their needs and can then avoid the longer operation and anesthetic associated with immediate reconstruction. Many will later choose a procedure recommended by the plastic surgeon and will be more confident of their choice.

The patient who chooses immediate reconstruction must make the decision at a time of great stress but for some patients the idea of waking up with a breast mound relieves much of the stress surrounding the mastectomy. While some reconstructions can be completed in a single procedure, many techniques may require two or more operations for completion of the reconstructive process. The plastic surgeon will discuss this in detail during the initial consultation. Excellent results can usually be achieved by either immediate or delayed reconstructive techniques.