Women who undergo a mastectomy to remove one or both of their breasts due to cancerous tumors have at least three options after surgery. Some choose to not alter their appearance in any way, although this choice is more common in patients who have had both breasts removed. Others opt to wear an external breast form or pads to give the appearance of still having the breasts. For women who choose to have breast reconstruction surgery, they often have questions about the procedure itself as well as the best time to undergo it.
What to Expect During Breast Reconstruction Surgery
Once the patient’s anesthesia has taken effect, the reconstructive surgery typically has four steps. First, the plastic and reconstructive surgeon repositions the woman’s fat, muscle, and skin to either cover or create the breast mound. This action is necessary because radiation therapy or a mastectomy frequently leaves insufficient tissue on the wall of the chest to fully support an implant.
The donor fat, muscle, and skin usually come from the abdominal area in a process called the TRAM flap. Alternative methods that do not use muscle for repositioning transfers tissue to the chest area from the woman’s buttock or abdomen.
At this point, the surgeon stretches the healthy skin to provide coverage of the breast implant. This process requires several office visits in the four to six months immediately following surgery to ensure proper placement of the expander through a valve that gradually expands the skin. After the surgeon successfully stretches the skin, it’s time to place the saline or silicone breast implant. The patient and plastic surgeon will decide on the best type of implant during the initial consultation.
The final phase of breast reconstruction surgery involves creating a nipple and areola using a grafting procedure and other specialized techniques. Patients should plan on a recovery period that lasts for at least several weeks. Wearing a support bra or elastic bandage minimizes swelling during this time in addition to offering support for the reconstructed breasts.
A Matter of Timing
There is no ideal time to undergo breast reconstruction surgery that is appropriate for every woman. One-stage and two-stage reconstruction, which take place at the same time the surgeon removes the breasts and later when the mastectomy scar has healed, both have their advantages and disadvantages. Every woman needs to consider her cancer treatment, her appearance goals, and other medical conditions before deciding with the help of her reconstructive surgeon.
The main advantages of one-stage breast reconstructive surgery include only having to undergo one surgery and having to spend less time under anesthesia. Some potential drawbacks to consider are that the recovery time may be longer than just having a straight mastectomy and a greater chance of developing an infection. If the latter occurs, it could delay additional cancer treatments.
The primary benefit of opting for a two-stage procedure is that it gives women additional time to research their options. They may feel too overwhelmed when having a mastectomy to decide on such things as who to have performed it and which type of implant would be best. However, this also means the patient must subject herself to two surgeries, two recovery periods, and more time spent under anesthesia. It may also cause issues with insurance coverage if a woman initially chooses a breast form and then later changes her mind and wants to pursue reconstructive surgery.
For women who decide to postpone breast reconstruction surgery, deciding when to schedule the second procedure can be a challenge. Anyone facing a mastectomy should discuss all options with her surgeon, including the ideal time to schedule surgery if she decides on two-stage