Breast Cancer Reconstruction Process

The reconstructive process is very individualized. Your surgical and medical history, your lifestyle and your long term expectations, the invasiveness of the procedures, the need for radiation - all of these factors will be discussed during your consultation with Dr. Ma. Together you and she will decide on the reconstruction option that is best for you. Throughout your reconstruction, Dr. Ma will work with you and your other specialists to carefully plan the best course of treatment. In the end, her goal is to create the best possible looking breast.

A breast is essentially made of two components: breast volume and a skin envelope. Simply put, in order to reconstruct a breast, the skin envelope and the breast volume need to be built. For immediate reconstruction, the first stage is performed immediately after the mastectomy in the same surgery. Depending on the technique used, building a breast mound may be done in stages over several months. Once the breast mound is built, the nipple will be surgically created and the areola will be tattooed. In the case of a unilateral reconstruction, some women choose to have their native breast lifted or reshaped to create symmetry with the opposite breast.

One breast or two:

When one breast needs to be reconstructed, our goal is to build a breast that matches the opposite side. Both implants and tissue flaps can be used to rebuild a breast. Depending on the anatomy of the breast, a good volume match with the native breast can typically be achieved with an implant. In these cases, it may be necessary to rely on a bra to shape the native breast (as we do typically anyway) so that it more closely matches the reconstructed breast. In these cases, it is reasonable to expect breast symmetry in a bra, and reasonable symmetry in swimwear. A tissue flap can also be used (TRAM flap from the abdomen or latissimus flap from the back) to create a breast. In these cases, the surgery is more invasive and the recovery from surgery longer, but the aesthetic match with the opposite breast is often very good.

When two breasts need to be reconstructed, the goal is to create symmetrical breasts. The size of the breasts is a matter of personal choice. Implant and tissue flaps can both be used. If implants are used, the shape of the breast is often young and full. A common choice for bilateral breast reconstruction is to use tissue expansion and implants. It is also an option to use flaps for bilateral breast reconstruction. Here, latissimus flaps and implants can be used to reconstruct two breasts.

Tissue flaps versus implants:

Tissue flaps such as TRAM (abdominal) and latissimus (swimmer's back muscle) flaps can be used to reconstruct one or both breasts. The advantage of using tissue for reconstruction is that the reconstruction is made of your tissue. It will feel soft and move like breast tissue. It will change with you - if you gain weight, so will the flap. The tissue is alive and part of you - it is just living in your breast area instead of its original location. With flaps, it is possible to get an excellent match in size and shape with the opposite breast, making it a powerful tool in unilateral breast reconstruction, regardless of your native anatomy. When using flaps for reconstruction, one undergoes a moderately invasive operation at the time of the mastectomy and the recovery can last 6-10 weeks.

Tissue expander/implant reconstruction carries with it the advantage of not creating an additional surgical site. The entire reconstruction can be done using the incision through which the mastectomy is done. Immediately after the mastectomy is done, tissue expanders are put in place. You will wake up with breast "mounds" in place. Over the course of the next 6-8 weeks, the expanders will be gradually inflated in an office procedure every 1-2 weeks. These expansions will stretch the overlying skin to eventually recreate the breast skin envelope. The expanders are then allowed to mature for 3 months. Then the expander is removed and the implant is placed in a short outpatient procedure. This form of reconstruction involves two surgeries, however the overall invasivness is less than with flaps. The disadvantage of an implant reconstruction is the risk of infection and the mechanical issues associated with implants: rupture, displacement, encapsulation (scarring), and the need for maintenance of these implants over the years.

Immediate vs delayed reconstruction:

The advantage of an immediate breast reconstruction, where your breast reconstruction process is started during the same surgery as your mastectomy, is the profound psychological advantage of never seeing your body without breasts. When you awaken from surgery, you will have at least small breast mounds. The breasts will be built over the ensuing months. In some cases, it is wisest to delay the reconstruction process until after treatment for breast cancer has been completed. These details will be discussed during your consultation. Dr. Ma will discuss your case with your general surgeon and oncologist to determine the wisest treatment option for you.

If you have had a mastectomy without reconstruction in the past, you may still be able to have a reconstruction. The best option for your delayed recontruction will be discussed during your consultation with Dr. Ma.