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Breast reconstruction using implants or analogous tissue (after oncological diseases)

What is the Breast reconstruction using implants or analogous tissue?

Breast reconstruction can be divided into "implant-based" reconstruction or "autologous" (your own tissue) reconstruction. However, there are reconstructions, such as the latissimus dorsi flap from your back, which incorporates both your own tissue with an implant to create a breast of appropriate volume based on your preferences or to match the other remaining breast.

When implant-based surgery is performed, the implant is placed behind the pectoralis major chest muscle in a manner similar to what occurs during breast augmentation surgery.

For some women, implants may be placed as a one-stage process, where a permanent implant is used at the time of the mastectomy. However, most women require a two-stage process, using a tissue expander before the permanent implant is placed.

Breast reconstruction can be performed without implants, using a flap of your own tissue. A flap entails a combination of skin, fat, and/or muscle that is taken from one portion of your body and moved to your chest to create a breast.

A latissimus dorsi flap involves taking the skin, fat, and the latissimus dorsi muscle from your back, in the area below your scapula (shoulder blade) and tunneling it through the axilla (armpit) to create a breast. Sometimes it is possible to use this flap without implants in order to achieve the desired size. However, this technique often is used in conjunction with a tissue expander or implant to reconstruct the breast.

In some patients who are receiving a unilateral mastectomy, to achieve optimal results surgeons may recommend surgery on the contralateral (opposite) breast in order to make the breasts more symmetric. This may involve a breast reduction, breast lift, or breast augmentation.

Your surgeon will advise you on the type of reconstruction that’s most suitable for you. It will depend on:

- how much of your breast tissue has been removed;

- how healthy the tissue is on your breast and on other areas of your body that may be used (donor sites);

- whether you’ve had radiotherapy to the breast area or chest wall;

- the shape and size of your breasts;

- your preference;

- your general health and body build.

What is the procedure?

During implant-based surgery a tissue expander is an implant with a valve/port that can be filled with saline to stretch the remaining chest skin and soft tissues to make room for the breast implant. The tissue expander is placed under the pectoralis major muscle at the time of your mastectomy. After the incisions have healed, a small valve/port is accessed and saline is injected into the expander during several office visits, usually over a 6-8 week period of time. This gradual stretching creates more skin and soft tissue, not unlike how the skin of the abdomen stretches during a pregnancy. The tissue expander is filled until it is slightly larger than the desired size to assure that the skin and soft tissue can accommodate the permanent implant. At a second surgery, the tissue expander is replaced with a permanent saline or silicone implant.

What kind of result can you expect?

It’s important to have realistic expectations about the possible results of breast reconstruction surgery. It can’t give you a perfect breast. A reconstructed breast won’t have any sensation and may not ‘move’ as well as your natural breast. Although your surgeon will aim to make the new breast as good a match as possible to your other breast, there may be differences in the size, shape or position of the two breasts. In general most women are pleased with the results of their surgery.

The main advantages of breast reconstruction surgery are that you won’t have to wear an external breast form (prosthesis), when wearing clothes (including underwear or a swimming costume), your appearance will be similar to before your mastectomy and you will have a cleavage. Breast reconstruction can help to restore self-confidence and feelings of femininity, attractiveness and sexuality.

Studies show that reconstruction does not make breast cancer come back. If the cancer does come back, reconstructed breasts should not cause problems with chemotherapy or radiation treatment.

Recovery period and recommendations

After any type of operation, you’re likely to experience some pain or discomfort. The level of pain women experience after breast reconstruction varies greatly. Many women need painkillers for a few weeks after surgery. Make sure you ask for pain relieving medicines if you need them. In general, if your pain is well controlled you’ll recover more quickly after surgery.

How soon you can return to work depends on the type of work you do and on the type of operation you’ve had. In general, if your job doesn’t involve heavy manual work, you can go back to work sooner. But it’s important to remember that you’re likely to feel more tired than usual for a while.

There are no set rules about when you can begin wearing a bra following breast reconstruction. This will depend on the type of reconstruction you’ve had and the advice of your surgeon.

Some surgeons recommend that women wear a bra soon after reconstruction, but others advise women not to wear one to begin with. They believe this encourages a more natural droop of the reconstructed breast and that wearing a bra makes little difference to the cosmetic results of surgery.

If you’re advised to wear a bra to support the newly reconstructed breast, a soft supportive bra without underwires (such as a sports bra) will be more comfortable to begin with. If you have reconstruction with implants, you may be given a Velcro band to wear for several weeks. This sits on top of the implants and helps to make sure they stay in the correct position and don’t twist.

Once your wounds have healed, most surgeons recommend you massage the skin and scars over your reconstructed breast and at the donor site (if you have one) with body oil or cream at least once a day. Massaging the skin will help to keep it supple and in good condition. If you have a breast implant, massage can also help reduce the risk of capsular contracture.

Massaging along the length of the scar(s) using moisturizer or massage oil helps prevent it from sticking to tissue underneath as it heals. It can also help to speed up the healing process and soften your scars. Your surgeon or breast care nurse can tell you what they recommend, and show you how much pressure to use when massaging.

Possible side effects and complications

Bruising to the breast and donor site is very common after the surgery and usually goes away after about three weeks. Sometimes, 1-2 weeks after the surgery, there can be bleeding and a build-up of blood (a hematoma) in the breast or donor site. This can cause swelling and pain. If you notice these symptoms, contact your surgeon for advice.

After your surgery, it’s normal for some fluid to collect in the area around the wound (a seroma). You will have drains in place to take away this fluid. These are long, thin plastic tubes attached to vacuum drainage bottles. They are usually removed several days after your operation. However, after the drains are taken out, more fluid sometimes collects under the wound. This may need to be drained by a surgeon or nurse, using a small needle and syringe.

Usually, pain gradually reduces in the weeks following surgery. But occasionally, women continue to have pain for months or even years after the operation. Pain that continues for a long time is called chronic pain. There are several different causes of chronic pain, and many of these can be treated. If you experience pain and it doesn’t improve, talk to your breast surgeon. They can do tests to find out the cause or recommend a treatment that may help.

Once you’re home after your operation, check your wound(s) regularly. Tell your doctor immediately if you have possible signs of infection, such as:

- increased redness or change in color over the breast, around the scar area or both;

- discharge (fluid being released) from the wound;

- a fever;

- you feel generally unwell.

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