Breast reconstruction after mastectomy is a very difficult decision. It is important to understand that it is your personal choice alone whether or not to proceed with it.
Some women choose not to reconstruct their breast, as it reminds them of their victory over cancer, they may fear the surgical aspect, or there may be other reasons.
It is equally important, before making any decision, to discuss with your doctor which options are available, to seek and receive psychological support if needed, and perhaps to talk with other women who went through the same experience.
Openness will help you better understand your own emotions, which is perfectly natural to vary.
When can I undergo breast reconstruction?
Breast reconstruction can be performed either immediately after mastectomy (primary breast reconstruction) or after the completion of all related treatments, in a delayed stage (delayed breast reconstruction).
What are the methods of breast reconstruction?
There are two main techniques: reconstruction with silicone implants and reconstruction with autologous tissue (using tissue from your own body).
However, in modern plastic surgery, there are further variations of these techniques, chosen by the plastic surgeon individually for each patient, depending on the areas of the body that can provide sufficient tissue.
Breast reconstruction with silicone implant:
After mastectomy, breast reconstruction can be performed either with immediate implant placement (rare) or more commonly in two stages. First, a tissue expander is placed to gradually stretch the skin, and then, usually after a few months, the expander is replaced with a permanent implant.
The advantages of this method include being less invasive, requiring shorter surgical time, and allowing faster recovery. The disadvantages include the fact that implants do not behave exactly like natural breast tissue, require at least one additional surgery, and carry the potential risks of augmentation procedures.
Breast reconstruction with autologous tissue:
This method uses flaps of tissue from the patient’s own body, which maintain their blood supply and are transferred to the breast site. Flaps play a crucial role in modern reconstructive plastic surgery.
Common flap options include:
– Latissimus Dorsi flap (from the back)
– DIEP or TRAM flap (from the abdomen)
– SCAP, IGAP, TUG, or PAP flaps (from thigh or buttock)
Flap from the back: This uses a muscle of the back together with overlying skin. It provides good quality tissue, especially important if radiotherapy is planned, but usually offers limited volume, so an implant may be needed.
Flap from the abdomen: The DIEP or TRAM flap uses abdominal tissue, sometimes combined with the rectus muscle. An additional advantage is that the procedure is combined with an abdominoplasty.
Flap from thigh or buttock: These are technically demanding, leave visible scars, and usually provide smaller volume. They are used when abdominal or back tissue is not suitable.
In general, flap transfer requires microsurgical expertise and leaves scars at both donor and recipient sites. Recovery is longer than with implants. However, when reconstruction is achieved with your own tissue, the result is more natural, and there is no concern about implants.
Do not hesitate to reach out to us with any questions regarding breast reconstruction. We are here to support and guide you clearly and honestly. Rest assured that in the end, you will regain your confidence and strength.
Remember: however difficult this journey, you can always receive the support you need and reclaim what was lost, looking to the future with optimism and new perspective.
References
- Yoon AP et al. (2018). Outcomes of immediate versus delayed breast reconstruction: a prospective multicenter study.
https://pubmed.ncbi.nlm.nih.gov/29102781 - Bjelic-Radisic V et al. (2022). Autologous vs. implant-based breast reconstruction after skin- and nipple-sparing mastectomy—A deeper insight considering surgical and patient-reported outcomes.
https://doi.org/10.3389/fsurg.2022.903734 - Cordeiro PG et al. (2023). Breast reconstruction: Review of current autologous and implant-based techniques and outcomes.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10131028
