Congratulations on reaching the step of considering breast reconstruction. There are many options available in the breast reconstruction process. Perhaps a more important question is if YOU as the patient are ready for the process.
Breast reconstruction is a process. It is not a “one and done “procedure. No one can give you a perfect breast like you had before. We can merely attempt to give you something that looks like a breast. The reconstructed breast will never look or feel like your breast did before. The new reconstruction will be without sensation, it will feel numb.
It usually takes a number of procedures, at least 2 to 6 to obtain a good result. It is perhaps better to do the initial reconstruction and then wait for a period of 18 months before you continue with any additional procedures. The initial procedure is to give good durable soft tissue cover, maintain the fold under the breast and as far as possible maintain the round shape of the breast. The waiting period will give your body time to recover from the cancer management, rest and recuperate before you complete the reconstruction.
Breast reconstruction may occur during the initial surgical procedure, immediate breast reconstruction or later as a delayed procedure, months, weeks or even years later.
Breast reconstruction can be done for partial or complete breast removal. In partial breast removal or breast conservation surgery only part of the breast is removed. Various reconstructive options exist all under the prerequisite that the patient will need to receive radiation therapy. Radiation therapy affects the breast in various ways and thus has to be compensated for, if possible, during the initial reconstruction. Radiation also renders future operations difficult in the radiated field with increased complication rates. Radiation fixes things in time. The radiated breast will remain at a higher position and will not increase or decrease in size with weight fluctuations.
These changes include but are not limited to:
– Loss of volume – Initially the breast that will need radiation will be made slightly larger than the opposite breast.
– Fat Necrosis – Death of fatty tissue and formation of hard lumps. These may be managed conservatively and it may perhaps be best not to interfere and cause further fat necrosis. Otherwise we may elect to excise the hard tissue or inject some fat, all of which may only partially improve the condition.
– Skin changes
– Change of shape, contractures and fibrosis (tightening and hardening)
– Chronic pain. There are many reasons as to why a patient may experience pain. Firstly removing the breast or even part of the breast will be perceived by the brain as loss of an organ and may be interpreted as phantom pain. Radiation may cause pain and the reconstruction may cause pain. It is very important to start the management of pain early so as to prevent the development of chromic regional pain syndrome.
The reconstructive options available for breast conservation surgery are:
– Bilateral breast reduction pattern reconstruction
– Latissimus Dorsi reconstruction
– Lateral intercostal artery perforator flap reconstruction
– Thoracodorsal artery perforator flap reconstruction
– Other local and free flaps