Breast reconstruction is performed to replace skin, breast tissue and the nipple removed during a mastectomy.
The amount of missing tissue varies with each mastectomy and factors contributing to it include the width, size and location of the original tumor and its proximity to the axilla, where the lymph glands are removed. The ultimate goal of reconstruction is to restore symmetry between the two breasts.
After a mastectomy, the patient can choose to wear external breast forms or pads, make no attempt to alter the appearance or choose breast reconstruction, using either breast implants or her own tissue. The decision, however, is a personal one and often not easy to make.
Restoring the breast is not considered cosmetic surgery, it is reconstructive surgery. The Women's Health and Cancer Rights Act mandates that insurers provide coverage for breast reconstruction following mastectomy surgery since breast reconstruction after mastectomy is considered part of the treatment of a disease.
Breast reconstruction has psychological benefits, not only to physical appearance. It can be performed months or years after a mastectomy but if any chemotherapy or radiation treatments have already been started, reconstruction is usually postponed until those treatments are completed.
A variety of breast reconstructive techniques are available that offer cosmetically-appealing results and multiple factors, such as the patient's goals, medical condition, and previous surgery, are considered when choosing between reconstruction using breast implants or flaps of tissue moved from other parts of the body.
Nipple (areola) reconstruction is one of the procedures to consider after breast reconstruction because it is usually removed during mastectomy operation because it is breast tissue and is at risk of cancer recurrence.
It is usually done at a later date after reconstruction of the breast is complete because this allows new breast tissue to heal and settle into place so minor adjustments in size and position can be carried out when the nipple and areola are reconstructed.
Tissue for the nipple/areola is often taken from the newly constructed breast but the prosthetic nipple is another option that may be temporary or permanent.
First few days after surgery, the patient may experience some discomfort, but women will be given pain medication as needed. Soon after surgery, she will be encouraged to move her arms, but not for any forceful activity such as pulling herself up, getting out of bed or lifting heavy objects.
The length of hospital stay depends on the type of operation and how recovery progresses. The average length of hospitalization is one to two days for the implants and five to six day to flap procedures.
Most women return to normal activities within six weeks after surgery. It may be several weeks before strenuous exercise. Most scars will fade over time and the shape of reconstructed breast will gradually improve over the months following the reconstruction.
