Breast reconstruction is the rebuilding of a breast, usually in women. It involves using existing flesh or prosthetic material to construct a natural-looking breast. Often this even includes the reformation of a natural-looking areola and nipple. This procedure may involve the use of implants.

Overview

Though this procedure was recently out of the question after surgical procedures such as mastectomy, this type of cosmetic surgery is becoming more common. Though most health plans cover the cost for this operation in the US, some do not, considering it to be cosmetic; paying for this procedure oneself may be very costly. However, most plans do cover this procedure as the cost may outweigh the converse cost of counseling for the individual as they try to cope with the emotional adjustment of losing a breast.

For individuals who have undergone a mastectomy due to cancer, they are only eligible for this procedure if the disease was eliminated due to the breast removal. It is possible for this procedure to be carried out immediately following the mastectomy, so the individual awakes with the newly formed breast already in place. As with many other procedures, those with high blood pressure, obese individuals or those who smoke are poor candidates for this operation.

Breast reconstruction is a large undertaking. Most procedures take several operations. Sometimes these follow-up surgeries are spread out over weeks or months. If an implant is used, the individual runs the same risks and complications as those who use them for breast augmentation.

Techniques

There are many methods for breast reconstruction. The two most common are:

• Skin expansion By far the most common method, the surgeon inserts a small balloon expander beneath the skin and periodically, over weeks or months, injects a saline solution to slowly expand the overlaying skin (see tissue expansion). Once the expander has reached an acceptable size, it may be removed and replaced with a more permanent implant. Reconstruction of the areola and nipple are performed in a separate operation after the skin has stretched to its final size.
• Flap reconstruction The second most common procedure uses tissue from other parts of the patient's body, such as the back, buttocks, thigh or abdomen. This procedure may be performed by leaving the donor tissue connected to the original site to retain its blood supply (the veins are tunnelled beneath the skin surface to the new site) or it may be cut off and new blood supply may be connected. This procedure has the downside of leaving scar tissue in both the donor and breast area, but, since the donor is the recipient, tissue rejection is not an issue. Also, the patient may end up with a better contoured abdomen if that was the selected donor area.

Follow-up

Recovery from skin expansion is generally faster than with flap reconstruction, but both take three to six weeks to recover from and both require follow-up surgeries in order to construct a new areola and nipple. Most scars will not disappear completely, but the better the quality of the reconstruction, the less noticeable and distracting the scars will be. All recipients of these operations should refrain from strenuous sports, overhead lifting and sexual activity during the recovery period (three to six weeks).

See also: breast reduction

External links

• Breast Reconstruction Following Breast Removal from the American Society of Plastic Surgeons
• In-depth breast reconsruction discussion from the University of Iowa
• A breast reconstruction FAQ