Mastectomy & Reconstruction: Part 2

If you missed yesterdays blog, you might scroll down and read it before starting part 2. A little review from yesterday. You can choose to have mastectomy and reconstructive surgery at the same time, or you can opt for mastectomy and decide later about having reconstruction done.

There are several types of breast reconstruction available. They fall into one of two categories: implants or tissue flaps. Implant reconstruction typically uses a temporary expander that is placed under the pectoral muscle. Over a period of time saline is added to the expander and the muscle tissue and skin is expanded to a desired size. With this type of surgery the surgeon usually determines the size of the final implant before the procedure begins. There is some room for picking your size, but your available skin plays a large role in how big or small you will be. If you were a small "A" before you may not have enough skin elasticity to become a "D". So please do not go into this with unrealistic expectations. On the other hand though, if you have been wanting to downsize the girls this would be a good time for that. There are a few different methods to choose from if you are interested in implants.

The most common method is the one I have mentioned already. The expander is placed at the time of mastectomy. The overall time needed for expansion is highly variable. Women who have cancer and are undergoing treatment may need more time to recuperate between saline injections. There may be some pain and tension each time an injection is made. I have heard the analogy of having braces tightened or new rubber bands placed equated to this process. Each person will have a different experience. Expansion has been documented anywhere from 6 weeks to many months. After the process is completed a less invasive outpatient procedure will be preformed to replace the expander with an implant. Another decision - Saline or Silicone? (I am planning a full day for this discussion) Once the implant is placed your body is given some time for the implants to settle. If any adjustments need to be made they are done after the settling process is complete. This is the most common implant procedure, but there are slightly differing options.

Direct-to-implant ("One-step") reconstruction is a slightly different method. Not all women will be a candidate for this procedure, and there are not as many surgeons who use this method. First of all, you will need to find a plastic surgeon who will preform this method and go for a consult to see if you are a candidate. This method does not require expansion. In lieu of expansion the one step procedure uses an acellular dermal matrix to help create an instant pocket for an implant. Essentially this is a natural tissue that is stitched to the sides of the muscle. By extending the tissue in this manner there is no need for the expansion process. At the time of surgery the implant is placed, and your breasts are complete. After a few months of settling outpatient surgery can be preformed to achieve symmetry and correct any flaws.

Implants will never give you the feel of natural breasts. By choosing this option you may have less sensation than if you decided on a tissue flap method. On the other hand though, the girls will not be heading south anytime soon. They will remain perky and in place for as long as you have them. Tomorrow I will be discussing the different types of tissue flaps. For more information I would recommend the following.

http://www.breastrecon.com/id27.html
http://breastreconstruction.org/typesofreconstruction
The Brest Reconstruction Guidebook by Kathy Steligo