Breast Reconstruction after Mastectomy

A mastectomy is a surgery in which one or both breasts, including the nipple and areola are removed. A mastectomy is usually performed as a treatment for breast cancer such as invasive ductal carcinoma, invasive lobular carcinoma, medullary carcinoma, mucinous and tubular carcinomas, inflammatory carcinoma, Paget's disease, ductal carcinoma in situ (DCIS), and lobular carcinoma in situ (LCIS). Though this procedure may remove the existing breast cancer, it does not completely eliminate the chance of recurrence.

After a mastectomy, many women choose to have breast reconstruction surgery to reconstruct their breast. Two classes of breast reconstruction exist.  Using one’s own tissues or using an implant.  When a woman’s own tissues are used, typically the plastic surgeon uses a flap, which can contain a muscle or in some instances just involves skin and fat.  These types of reconstruction are called autologous reconstructions.  When an implant is used, the breast is reconstructed using a tissue expander and then later placing a “permanent” implant.  Breast reconstruction with implants is usually done in 2 stages. Occasionally, however, the implant is inserted in the first stage itself.  This is called a single stage breast reconstruction.  Dr. Davidson will help you decide when and how to have breast reconstruction.

Some women choose not to have breast reconstruction at all.  Rather, they may use a prosthesis in their bra, or choose to use nothing at all.

If breast reconstruction is performed along with the mastectomy, the oncologic surgeon typically removes only the skin around your nipple and areola to leave more skin. This is called a skin-sparing mastectomy.  This makes reconstruction easier for Dr. Davidson. If breast reconstruction is to be performed at a later time, the surgeon will remove enough skin over the breast during the mastectomy so as to close the skin flaps.

In an implant based reconstruction, Dr. Davidson will place a small tissue expander (pouch made out of silicone) under your chest muscle and skin. Your chest will look flat immediately after the surgery.  You will follow-up with Dr. Davidson every 1 - 2 weeks.  During these visits, Dr. Davidson will inject a small amount of saline through the skin into the tissue expander/implant. The tissue expander is slowly enlarged, stretching the skin to the right size for Dr. Davidson to place an implant. After reaching the right size, you will wait approximately 6 weeks before the permanent breast implant is placed.

Dr. Davidson will remove the tissue expander and replace it with a breast implant. Before the implants are placed, you will discuss with Dr. Davidson about the different breast implants. Implants may be filled with either saline or a silicone gel. You typically go home the same day. The results of a breast reconstruction surgery are usually very good. You may occasionally require small revision surgeries to further improve the symmetry.

Another minor procedure may be performed to remake the nipple and areola area. It will not restore normal sensation to the breast or the new nipple, but it may improve your sense of well-being and improve upon the appearance of your new breast.