Introduction to Breast Reconstruction

Breast reconstruction is the rebuilding of a breast that has been removed due to cancer or other diseases. This procedure involves the use of implants or relocated flaps of the patients own tissue to create a natural looking breast and reformation of a natural looking areola and nipple.

The reconstruction is possible immediately following breast removal. But in individuals with medical problems like high blood pressure obesity diabetes and also in individuals who smoke. The surgery is delayed as they are considered high risk candidates. Breast reconstruction usually takes multiple operations, which are spread out over weeks or months.

Risks involved:
Bleeding fluid collection, excessive sear tissue complications with anesthesia can occur but are relatively uncommon. Smokers should be advised that nicotine can delay healing, resulting in conspicuous sears and prolonged recovery.

In rare cases, due to infection, the implants may be removed and new implants inserted again after the infection clears.

Capsular contracture occurs if the scar around the implants begins to tighten and cause the breast to feel hard.

Reconstruction does not generally interfere with chemotherapy or radiation treatment should cancer reoccur.

Techniques:
There are many methods of breast reconstruction. The two most common are:

1. Tissue expander-breast implants: this is the most common techniques used in world wide. The surgeon inserts a tissue expander a temporary silastic implant, beneath the pectoralis major muscle of the chest wall and over weeks or months, inject a saline solution to slowly expand the over laying tissue. Once the expander has reached an acceptable size it may be removed and replaced with a more permanent implant. Reconstruction of the areola and nipple are performed in a separate operation after the skin has stretched to its final size.

2. Flap reconstruction: the second most common procedure is using tissue from other parts of patient's body, such as back, buttocks, thigh or abdomen.

The latissimus dor muscle flap: it is the donor tissue on the back. It is large flat muscle which can be used without loss of function. It can be moved into the breast defect, still attached to its blood supply under the armpit. This flap is usually used to recruit soft-tissue coverage over an underlying implant.

Abdominal flaps: the abdominal flap for breast reconstruction is the TRAM flap. The abdominal tissue between the umbilicus and the pubis is used. It requires advanced microsurgical technique and less common. It provides enough tissue to reconstruct large breasts. The contour of the lower abdomen is improved by this procedure. TRAM flap procedure may weaken the abdominal muscles, but are tolerated well in most patients to prevent muscle weakness and hernias; a piece of surgical mesh is placed over the defect and sutured in place.

3. Nipple and areola reconstruction:

Nipple areola graft: if the contralateral breast has not been constructed and the nipple and areolar are sufficiently large, tissue may be harvested and used to recreate the nipple-areolar complex on the reconstruction sensation in the nipple and an unpleasant cosmetic result at the donor site. Cosmetic result can be achieved using tattoos.
Local tissue flaps: a nipple may be created by raising a small flap in the target area and producing a raised mound of skin.

To create an areola, a circular incision may be made around the new nipple and sutured back again the nipple and areolar region may then be tattooed to produce a realistic color match with the contralateral breast.

Recovery:
Recovery from implant based reconstruction is faster than with lap-based reconstruction, but both take at least three to six weeks to recover and both require follow up surgeries in order to construct a new areola and nipple. The patients should avoid active sports, over head lifting and sexual activity during recovery period. TRAM flap patients can show abdominal muscle weakness but most patients resume normal activities after recovery.