Breast reconstruction is performed on women who have lost one or both breasts to mastectomy, or who lack breasts due to congenital or developmental abnormalities. The goal of breast reconstruction is to create a breast mound and nipple that resemble the natural breast as closely as possible in shape, size and position. It is important to understand that in many circumstances this should be viewed as a series of surgeries or rather a “process”. Many women find the process of breast reconstruction to be both a physically and emotionally rewarding experience, but it does have its challenges. In general, if a woman is healthy, age is not a factor and she is committed to the process and what is required she may be a good candidate for breast reconstruction—either immediate or delayed depending on various circumstances. However, women with health problems such as obesity, diabetes and high blood pressure, and those who smoke, are advised to wait rather than have breast reconstruction immediately following mastectomy.
The reconstruction method best tailored to you depends on many factors, including:
-Amount of available tissue
-Past and future radiation therapy
-Anticipated cancer treatment plan and how this relates to your reconstructive plans
-Current breast size
During your consultation with Dr. Jarrell, he will meet with you and discuss how these factors should be considered in developing the reconstructive plan that is right for you. The plan that best fits you may not be the one best suited for someone else and Dr. Jarrell understands that each case is unique and he approaches each patient in this manner.
Immediate versus Delayed Reconstruction
Timing of breast reconstruction is one component in deciding the plan that is right for you. There are several factors that need to be considered. There are certain advantages to immediate breast reconstruction including the possibility of fewer operations required to complete the process, utilizing available tissue at the time of mastectomy, and immediately or shortly after surgery having the shape of a breast restored to your chest. There are, however many factors to be considered with this including characteristics of the cancer, additional cancer treatment that may be required, factors specific to your anatomy, condition of the available tissues at the time of surgery and your specific goals and motiviations. All of these things should be considered and your consultation with Dr. Jarrell takes this personalized approach to determine if this is the right option for you.
In other circumstances a delayed reconstruction may be the best option. Again taking into consideration your personal case is important in this process. If delayed reconstruction is the choice for you, there is the advantage of focusing on treatment of the cancer before entering into the process of breast reconstruction which has its own challenges and in certain patients this may be the safest option. Whatever option is decided, Dr. Jarrell provides caring experience to get you through the process.
Techniques for Breast Reconstruction
Breast reconstruction is performed in several steps, and there are essentially two types. Which one is used depends on many factors, some of which were mentioned above. Whichever type is used, a woman's breast surgeon and plastic surgeon should work as a team during reconstruction.
Implant/Tissue-Expansion Breast Reconstruction
This technique is the most commonly used form of breast reconstruction and in Dr. Jarrell’s practice. In most cases, this is a two-stage process that can begin at the time of the mastectomy procedure or in other circumstances in delayed fashion. At the initial procedure a tissue expander is placed in the pocket (sub pectoral or pre-pectoral) and it may be either partially inflated or completely deflated depending on tissue requirements. This can be thought of as a space holder. Under most circumstances, Dr. Jarrell utilizes acellular dermal matrix (or ADM) to act as a support system for the implant reconstruction, provide additional coverage over the implant and to help re-establish some of the important anatomical features of the breast. One of the commonly used ADMs is Alloderm. (To learn more about this, see below.) Over the course of many post operative visits the tissue expander is filled which serves to mold or shape the breast and can serve to stretch the skin and establish the pocket for the implant that will be used to create the desired breast size.