Breast cancer is the most common cancer among women in the United States. One in eight women is expected to develop breast cancer within their lifetime. Many women undergo mastectomy or lumpectomy and radiation to treat this disease. Reconstruction of the breast is often needed to help reconstruct one or both breasts in order to achieve better symmetry. This may be done at the time of mastectomy (immediate reconstruction) or sometime later (delayed reconstruction). Sometimes adjunctive therapy like chemotherapy or radiation may delay your reconstruction. We want to make sure to treat the cancer first and then do the reconstruction so as not to delay the cancer treatment. Radiation may also change the plan of reconstruction as radiation changes the ability of the skin to stretch or sometimes changes the size or shape of the breast. By talking with the doctors at Parkway Plastic Surgery, we will decide together which reconstruction is best for you. Even if it is 10 years after your initial diagnosis, you can still undergo breast reconstruction or improve the original reconstruction as your body and needs change with time. Health insurance now covers not only reconstruction on your affected breast, but also reconstruction of the other breast in order to achieve better symmetry. There is no time limit for breast reconstruction.
There are many options for breast reconstruction in Jacksonville, FL. The most common option is the use of tissue expanders. A tissue expander is made of a silicone shell that has a small port within it very similar to a chemotherapy port. By accessing this port through the skin, we can add salt water (saline) to the expander to slowly inflate the expander to the desired size. The expansion only takes about 15 minutes and is done here at our office. The operation itself takes 1-2 hours to perform and if done as a delayed procedure can be done as an outpatient procedure or 23 hour hospital stay. Tissue expanders are often used in women who have undergone bilateral mastectomies as you are reconstructing with the same method on both sides. The expansion process usually takes about 2-3 months to finish. Then a second procedure is done approximately 4-6 months after your initial surgery to remove the tissue expanders and place more long term implants. The implants can be either saline or silicone depending on the needs of the patient. The FDA approved silicone implants in December of 2007. To read more about silicone implants, please refer to the ASPS national website at www.plasticsurgery.org. The website not only contains the newest information on silicone, but is also a great resource for all plastic surgery procedures.
Other options in breast reconstruction include using autologous tissue (your own tissue) in order to create a breast mound. The TRAM flap (short for tranverse rectus abdominus myocutaneous flap) is done by removing one of your rectus muscles (half of your "six pack") along with the fat and skin of your lower abdomen in order to create a breast mound. This method uses all your own tissue without needing an implant. The procedure is a big operation and takes about 5-6 hours to perform. The usual hospital stay is 5-7 days with a recovery period off work of 6 weeks. Although this is a big operation with a long recovery, it does give good long term results. It is often used in patients who are healthy and need a one sided reconstruction for a mastectomy. Not only do you get a new breast mound which has ptosis (or droop) to match your other natural breast, but you also get a tummy tuck at the same time. At the time of your initial consultation at Parkway Plastic Surgery, we will discuss whether you are a candidate for this procedure or if one of the other options of breast reconstruction is right for you.
Another option of breast reconstruction is the Latissimus Dorsi flap with or without an implant. The Latissimus muscle is located on your back. This is another flap which is autologous or your own tissue. This flap is often combined wit an implant to achieve the projection of a breast mound. We often use this flap in patients who have undergone mastectomies with radiation. The latissimus flap is beneficial because it adds new non-radiated tissue which stretches better than radiated tissue and provides a healthy new blood supply to assist in reconstruction. Not all patients who undergo radiation need new autologous tissue like a TRAM or latissimus flap. It all depends on the individual. The latissimus flap takes about 3-4 hours to perform and a 2-3 day hospital stay. Most women are off work for 2-3 weeks.
After we have completed the reconstruction of the breast mound, a nipple reconstruction is performed. By using small flaps of skin from the breast mound, the projection part of the nipple is made. Although, this used to be done by borrowing skin from other areas (like the groin), we now use skin from the breast mound. This is an outpatient procedure that takes less than 1 hour to perform. About 3 months after the nipple reconstruction, a nipple tattoo is done at our office at Parkway Plastic Surgery under a local anesthetic. This adds the finishing touches to the breast reconstruction by adding the color to the nipple. Tattoos do fade with time and may need a touch-up later to add more color.
From beginning to end, breast reconstruction may take up to a year to complete. Between operations, patients are still able to go about their regular daily activities. So even though the entire process does take a while, you can still work and go on vacation and participate in getting back to enjoying life. We will work around your schedule.