Breast reconstruction (reconstructive mammoplasty, postmastectomy) is generally used to restore one or both breasts following a mastectomy, lumpectomy or any other trauma caused to the breast. The goal of breast reconstruction is to return the breast to a normal shape, appearance and symmetry.
Breast reconstruction is most commonly undertaken to contribute to the positive psychological wellbeing of the patient, regain self-confidence and restore feelings of femininity and normality. An important consideration for a breast reconstruction is the effect of chemotherapy or radiation on the options available to the patient.
The procedure implemented by the surgeon will be dependent on the individual needs of the patient. The surgeon will modify the procedure to ensure the health and physical needs of the patient are met. The standard breast reconstruction surgical procedure starts with the surgeon inserting a tissue expander underneath the skin and chest creating a skin and muscle pocket. The tissue expander is a saline implant which starts off small and as the tissue and muscles move to create space, more saline is added. This process enlarges the pocket area gradually creating the space for the implant to eventually fit into. This process is very gradual and can take up to six months, requiring regular visits to the plastic surgeon. The next step requires surgery to have the expander removed and replaced by a soft breast implant (discuss the material of implant with the surgeon). Occasionally the saline implant and expander will be kept in place allowing the reconstructed breast size to change by adding or releasing saline.
A cellular dermal matrix (ADM) is a sheet of tissue that has had the cells removed leaving the collagen and elastin in the tissue to support the body and stimulate the body tissue to grow, eventually the cellular dermal matrix is replaced with the patient’s own collagen and blood vessels that develops.
Following the surgery, the patient can expect to feel tender in the area. Pain medication may be required especially in the first forty-eight hours. Comfortable loose clothes are advisable that are easy to get on and off, button up or zippers are preferable as it may be difficult to lift arms over head. Patients are encouraged to remain elevated to a forty-five-degree angle to assist with pain and circulation. The first few days the area will be sore but walking within the home short distances (ie, to the bathroom) is helpful in avoiding clotting. Gradually the area will improve and normal daily activities will resume gradually over the first three weeks following the procedure.
Regardless of the implant type selected the results should last the life of the patient, however regular checks with the plastic surgeon are encouraged. Recent studies indicate many implants require replacement after ten years.