There are several options including reshaping remaining breast tissue, using tissue expanders and implants, or using tissue from elsewhere on the body to make the new breast. Sometimes a combination of techniques is required, and you will have the opportunity to fully discuss the best options for you during your visit with Dr. Oxley.
Tissue Expander and Implant Reconstruction
This technique involves two different surgeries: the first surgery for placing a balloon-like tissue expander under the skin and muscle of the chest, and the second surgery to replace the fully extended balloon-like tissue expander with a permanent, softer implant. This procedure can be done at the time of mastectomy (immediate) or at a later date (delayed). For some patients, a breast reduction or breast lift is done on the other breast to improve post-reconstruction symmetry.
It can take a few months to fully expand the reconstructed breast and this happens during visits with Dr. Oxley every 1 to 2 weeks. Some women find they can return to work within a couple of weeks, though most take an extended leave to help recover physically and mentally from the cancer therapy.
Once the tissue expander is inflated, the skin is allowed to settle for a few months before the next stage. Finally, a softer saline or silicone implant will replace the expander at the next surgery. This second surgery has a much quicker recovery time than the first and is a day care procedure. Nipple reconstruction and tattooing is then done at a later date under local anesthetic.
Radiation therapy or chemotherapy can affect the timeline for this reconstructive option and can increase the complication rates in some cases. These will be discussed with you at your consultation with Dr. Oxley.
Direct to Implant Reconstruction
Some people choosing an alloplastic, or implant reconstruction, can avoid the expander phase now thanks to the use of new products such as Alloderm or Dermacell. Using these new products allows for immediate expansion of the space under the muscle or in some cases allows the final implant to be placed above the muscle, greatly reducing downtime and pain. Alloderm is specially treated human skin that has had all the cells removed, leaving only the framework of the skin behind. Your body incorporates it over a few months, placing your own cells and framework in its place.
Unlike the expander, which can be filled after surgery until the desired size is reached, there is a limit to what size can be placed with one stage surgery and there is more reliance on surgeon judgment as to final size.
This is a good option for thinner women with smaller breasts and not too much droop or hang to the breast. It is a great option as well in bilateral reconstructions where the breasts are not going to be very large after.
The surgery is day surgery, meaning you can go home the same day. The risks are otherwise similar to the expander route as far as the long-term results go. The same type of implant is used as with the two-stage option.
Reconstruction With Your Own Tissue
This typically involves one of two options: skin and fat from your back (Latissimus Dorsi Flap) or tummy (TRAM Flap). Both involve taking a muscle from your back or tummy with overlying skin and fat and moving it into your breast to recreate the breast shape. Either procedure can be done at the time of mastectomy (immediate) or at a later date (delayed). Some women may also choose to have a reduction or breast lift on the other side to help improve final symmetry.
Both surgeries require between 3 and 5 days in the hospital after surgery and the overall recovery takes between 6 and 12 weeks. Some women find they can return to work within a couple of weeks, though most take an extended leave to help recover physically and mentally from the cancer therapy. Nipple reconstruction and tattooing are then done at a later date under local anesthetic.
Radiation or chemotherapy can affect the timeline for this reconstructive option and can increase the complication rates in some cases. These will be discussed during your consultation with Dr. Oxley.
Depending on the technique selected by you and Dr. Oxley, the full recovery can vary between a couple of weeks to many months. Nipple reconstruction is also covered in most cases.
What to Expect
During your consultation with Dr. Oxley, one of the key areas that will be addressed is your expected result from having the surgery.
For further detailed information on breast reconstruction, please feel free to visit the following site: breastreconstructioncanada.ca