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29 April 2011

Breast reconstruction

Breast reconstruction may be delayed or immediate. The aim is to create a breast that is similar to the breast as it was before the operation or similar to the other breast.

  • Delayed breast reconstruction
  • Immediate reconstruction
  • Types of reconstruction
  • Prosthetic reconstruction
  • Advantages and disadvantages of prosthetic reconstructions
  • Reconstructions using the patient’s own tissue
  • TRAM flap
  • Advantages and disadvantages of TRAM flap
  • Latissimus dorsi flap
  • What about the nipple in reconstruction
  • Breast reconstruction in summary

Delayed breast reconstruction

  • Mastectomy is not a very painful operation and the postoperative discomfort is often psychological as much as physical. Having the reconstruction makes the operation bigger and more painful.
  • Some women find that having a flat chest is acceptable and choose not to have a reconstruction after some time.
  • If postoperative radiotherapy is needed, it may cause distortion of the breast after reconstruction.

  • When a regular reconstruction has been done, the chest wall will be flat. In order to allow for a reconstruction, the skin either has to be "stretched" or skin has to be used from another part of the body e.g. the tummy or the back.

  • Only one procedure is necessary.
  • The mastectomy can sometimes be done through the nipple so the normal breast skin can be used for the reconstruction.
  • The results are better cosmetically.
  • The patient’s nipple may sometimes be used if the cancer is at the edge of the breast tissue.
  • The psychological trauma after the operation is less as the patient can wake up from the operation with a “breast”.

  • Prosthetic reconstructions: silicon or saline.
  • Reconstructions using the patient’s own tissue: this may be muscle from the back or fat from the tummy.

  • The operation is smaller than using the patient’s own tissue.
  • The size may be altered according to the size of the opposite breast.

  • Involves the insertion of a "foreign body". Although there is no good evidence to suggest that it causes any problems for the body, many women don’t like the thought of it.
  • The capsule may harden with time.
  • The capsular contents (silicon or saline) may leak out.

  • This reconstruction will give the best cosmetic result out of all the options and the most natural "feeling" to the reconstructed breast.
  • The tummy is "tucked" at the same time.

  • The operation is a big procedure. There may be a need for blood transfusions.
  • There may be patchy areas of skin loss around the nipple.
  • There may be problems with the abdomen - infection, pain or swelling.
  • The cosmetic results take six months to achieve their final appearance. The woman may be disappointed with the results in the meantime.

  • It is difficult to get enough muscle to recreate the shape of the breast.
  • The consistency is different from normal breast tissue.

  • It is not such a large procedure as a TRAM flap.
  • It can be used in combination with a prosthesis.

  • The stage of the cancer and the type
  • How healthy and young you are
  • What your figure is like
  • What the other breast looks like
  • What cosmetic result you will find acceptable and how much you are prepared to go through to achieve it

 
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