Reconstruction of a breast that has been removed due to cancer or other medical reasons is one of the most exciting and rewarding surgical procedures available today, especially at Obi Plastic Surgery. Dr. Obi has implemented new and highly advanced techniques such as Adivive (Lipokit) Fat Transfer and the use of Your Own Adult Stem Cells that are allowing patients to again have breast(‘s) that are real tissue and body fat, just like before mastectomy. It is best to begin reconstruction immediately following breast removal (mastectomy). This can allow for aspects of the breast to be retained to help naturally reconstruct the breast, and allows the patient to wake up with at least a partial breast already in place, and be spared the experience of seeing herself with no breast at all. Candidates should however keep in mind that post-mastectomy breast reconstruction is a process that often requires many visits and treatments to fully regain your breast(‘s). Treatment or procedure approaches vary and Dr. Obi will discuss all options with you at length during your initial consultation.
The Best Candidates for Breast Reconstruction
The following information will give you a basic understanding of what is involved with breast reconstruction, the various options, when they are appropriate and what results you can expect. The approach that you ultimately proceed with will depend on your unique circumstances.
Most mastectomy patients are medically appropriate for reconstruction, many at the same time that the breast is removed. The best candidates, however, are women whose cancer, as far as can be determined, seems to have been eliminated by mastectomy.
Still, there are legitimate reasons to wait. Many women aren’t comfortable weighing all the options while they’re struggling to cope with a diagnosis of cancer. Others simply don’t want to have any more surgery than is absolutely necessary. Some patients may be advised by their surgeons to wait, particularly if the breast is being rebuilt in a more complicated procedure using flaps of skin and underlying tissue. Women with other health conditions, such as obesity, high blood pressure, or smoking, may also be advised to wait.
In any case, being informed of your reconstruction options before surgery can help you prepare for a mastectomy with a more positive outlook for the future.
All Surgery Carries Some Uncertainty and Risk
Virtually any woman who must lose her breast to cancer can have it rebuilt through reconstructive breast surgery. But there are risks, as with any surgery, associated with breast reconstructive surgery and specific complications associated with this procedure.
In general, the usual problems of surgery, such as bleeding, fluid collection, excessive scar tissue, or difficulties with anesthesia, can occur although they’re relatively uncommon. And, as with any surgery, smokers should be advised that nicotine can delay healing, resulting in conspicuous scars and prolonged recovery. Occasionally, these complications are severe enough to require a second operation.
If a breast implant is used, there is a remote possibility that an infection will develop, usually within the first two weeks following breast surgery. In some of these cases, the implant may need to be removed for several months until the infection clears. A new breast implant can later be inserted.
The most common problem, capsular contracture, occurs if the scar or capsule around the breast implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or “scoring of the scar tissue, or perhaps removal or replacement of the implant.
Breast reconstruction has no known effect on the recurrence of disease in the breast, nor does it generally interfere with chemotherapy or radiation treatment, should cancer recur. Dr. Obi may recommend continuation of periodic mammograms on both the reconstructed and the remaining normal breast. If your reconstruction involves an implant, be sure to go to a radiology center where technicians are experienced in the special techniques required to get a reliable x-ray of a breast reconstructed with an implant.
Women who postpone reconstruction may go through a period of emotional re-adjustment. Just as it took time to get used to the loss of a breast, a woman may feel anxious and confused as she begins to think of the reconstructed breast as her own.
Planning Your Breast Reconstruction Surgery
You can begin talking about breast reconstruction as soon as you’re diagnosed with cancer. Ideally, you’ll want your breast surgeon and your plastic surgeon, Dr. Obi, to work together to develop a strategy that will put you in the best possible condition for reconstruction.
After evaluating your health, Dr. Obi will explain which reconstructive options are most appropriate for your age, health, anatomy, tissues, and goals. Be sure to discuss your expectations frankly with him. He will be equally as frank with you, describing your options and the risks and limitations of each. Post-mastectomy reconstruction can improve your appearance and renew your self-confidence — but keep in mind that the desired result is improvement, not perfection.
Dr. Obi will also explain the anesthesia he will use, the facility where the surgery will be performed, and the costs. In most cases, health insurance policies will cover most or all of the cost of post-mastectomy reconstruction. Check your policy to make sure you’re covered and to see if there are any limitations on what types of reconstruction are covered.
Preparing for Your Breast Reconstruction Surgery
Your oncologist and Dr. Obi will give you specific instructions on how to prepare for reconstructive surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications.
While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.
Where Your Breast Reconstruction Surgery Will Be Performed
Breast reconstruction usually involves more than one operation. If you consult with Dr. Obi prior to your mastectomy, Dr. Obi will join the surgical team where the mastectomy is performed to consult with your mastectomy surgeon on retaining as much of your breast(‘s) attributes as possible. Then immediately after the mastectomy procedure, Dr. Obi will perform the initial steps of reconstruction.
Follow up stem cell treatments, fat transfers, laser lipo contouring, laser scar reduction and other advanced techniques to fully reconstruct your breast(‘s) will take place at our on-site state licensed ambulatory surgical center; The Samule Wells SurgiCenter® at Dr. Obi’s office location; Obi Plastic Surgery. After surgery you will recover in one of our private recovery rooms with immediate family if you wish.
The Types of Anesthesia that will be used
The first stage of reconstruction, creation of the breast mound, is almost always performed using general anesthesia, so you’ll sleep through the entire operation.
Follow-up procedures may require only a local anesthesia, combined with a sedative to make you drowsy. You’ll be awake but relaxed, and may feel some discomfort.
The Types of Breast Implants That May Be Applicable
If Dr. Obi recommends the use of a breast implant, you’ll want to discuss the type of breast implant that would most likely to create symmetry of your breasts. Saline breast implants consists of a silicone shell filled with saline (salt water). An alternative is the new “Gummy Bear” Shaped Gel Implant. This new type of implant has replaced liquid silicone gel and even if ruptured, will not leak, hence the nick-name “Gummy Bear” implant.
The Breast Reconstruction Surgery
While there are many options available in post-mastectomy reconstruction, you and Dr. Obi will discuss the one that’s best for you.
Skin Expansion: The most common technique combines skin expansion and subsequent insertion of a breast implant.
Following mastectomy, Dr. Obi will insert a balloon expander beneath your skin and chest muscle. Through a tiny valve mechanism buried beneath the skin, he will periodically inject a salt-water solution to gradually fill the expander over several weeks or months. After the skin over the breast area has stretched enough, the expander may be removed in a second operation and a more permanent implant will be inserted. Some expanders are designed to be left in place as the final implant. The nipple and the dark skin surrounding it, called the areola, are reconstructed in a subsequent procedure.>/p>
The expander is gradually filled with saline through an integrated or separate tube to stretch the skin enough to accept an implant beneath the chest muscle. However, Some patients do not require preliminary tissue expansion before receiving an implant. For these women, Dr. Obi will proceed with inserting an implant as the first step.
Flap Reconstruction: An alternative approach to implant reconstruction involves creation of a skin flap using tissue taken from other parts of the body, such as the back, abdomen, or buttocks. After the breast reconstructive surgery, the breast mound is restored. Scars can be and greatly reduced by Dr. Obi with laser scar removal. And the nipple and areola are reconstructed at a later date.
One type of flap surgery, the tissue remains attached to its original site, retaining its blood supply. The flap, consisting of the skin, fat, and muscle with its blood supply, are tunneled beneath the skin to the chest, creating a pocket for an implant or, in some cases, creating the breast mound itself, without need for an implant.
Regardless of whether the tissue is tunneled beneath the skin on a pedicle or transplanted to the chest as a microvascular flap, this type of surgery is more complex than skin expansion. Scars will need to be treated at both the tissue donor site and at the reconstructed breast, and recovery will take longer than with an implant. On the other hand, when the breast is reconstructed entirely with your own tissue, the results are generally more natural. In some cases, you may have the added benefit of an improved abdominal contour.
Follow-up procedures. Most breast reconstruction involves a series of procedures that occur over time. Usually, the initial reconstructive operation is the most complex. Follow-up surgery may be required to replace a tissue expander with an implant, laser contouring with the LifeSculpt laser or to reconstruct the nipple and the areola. Many surgeons recommend an additional operation to enlarge, reduce, or lift the natural breast to match the reconstructed breast. One of the primary objectives is to help you regain your breast in a way that matches your remaining breast as closely as possible.
After Your Breast Reconstruction Surgery
You are likely to feel tired and sore for a week or two after reconstruction surgery. Most of your discomfort can be controlled by medication prescribed by Dr. Obi.
Many reconstruction options require a surgical drain to remove excess fluids from surgical sites immediately following the operation, but these are removed within the first week or two after breast surgery. Most stitches are removed in a week to 10 days unless dissolving sutures are used.
Getting Back to Normal Day-To-Day Activities
It may take you up to six weeks to recover from a combined mastectomy and reconstruction or from a flap reconstruction alone. If implants are used without flaps and reconstruction is done apart from the mastectomy, your recovery time may be less.
Reconstruction cannot restore normal sensation to your breast, but in time, some feeling may return, especially when your stem cells are super concentrated and used. Scars can be significantly reduced and will also fade substantially over time, though it may take as long as one to two years.
Follow Dr. Obi’s advice on when to begin stretching exercises and normal activities. As a general rule, you’ll want to refrain from any overhead lifting, strenuous sports, and sexual activity for three to six weeks following reconstruction.
Your New Look
Chances are your reconstructed breast may feel firmer and have a slightly different appearance than your opposite breast. It may not have the exact same contour as your breast before mastectomy. But these differences will be more apparent to you than anyone else. For most mastectomy patients, breast reconstruction dramatically improves their appearance, quality of life and self confidence following surgery.