Breast reconstruction is a surgery performed to restore the shape of breasts after the tissue is removed during mastectomy (conducted to treat or prevent breast cancer).
Breast reconstruction is performed by three methods:
- Using a tissue expander/implant
- Tissue flap reconstruction: using your own tissue (autologous)
- Combination of both
Tissue Expanders and Implants
This is a common 2-stage procedure. The first stage is the positioning of a tissue expander in a pocket formed in the breast after mastectomy. The expander is a saline (salt water) or silicon-filled balloon that is gradually inflated over a couple of weeks or months to allow breast muscles and skin to stretch to the desired breast size. This is then replaced by the permanent implant, which can also be filled with either silicone or saline. This preliminary procedure is done to ensure cosmetically desirable outcomes and avoid the risk of it bursting out through the surgical incision or skin itself.
This method is suggested for women with small to medium-sized breasts with mild ptosis (sag), undergoing bilateral mastectomy, and having healthy mastectomy flaps. The outcomes may not be so favourable for women who are obese, have large breasts, smokers or those who have had breast radiotherapy.
Expander/Implant and Acellular Dermal Matrix (ADM)
Immediate implant and ADM reconstruction is also an option in selected cases. More recently, expander/implant reconstruction is augmented with a surgical mesh called acellular dermal matrix, which cradles the implant and gives the breasts a natural shape, contour and droop. The matrix is a very thin white leather made from human or pig skin that is extensively processed and preserved to ensure the safe insertion among human tissues.
The mesh can be used with or without the expander in a one-stage implant reconstruction, most often in conjunction with nipple-sparing mastectomy. This method may be more useful following preventive mastectomy in younger women.
Nipple and Areola Reconstruction
The nipple and areola can be reconstructed at a later stage. A small elevation is made keeping the other nipple as reference. The normal pigmentation of an areola can be tattooed using a dye, which is carried out as an office procedure.
Symmetry in Breast Shape and Size
A small difference may exist in the size and shape of the two breasts following reconstruction, but may not be noticeable under a bra. However, for the more noticeable ones, women may surgically reduce, enlarge or lift the remaining breast to maintain symmetry.
Popularity of implants was found to be about 60% for immediate reconstructions (2008 US findings), and 40% for autologous reconstruction. Two factors that may be fuelling the popularity of implant reconstructions include a shift towards bilateral mastectomies and the increasing number of younger patients (49 years and younger) undergoing reconstruction, who generally do not have adequate tissue for autologous reconstruction.