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| Reconstructive
Surgery
1. Implant Reconstruction 2. Flap Reconstruction 3. Postoperative Preparation 4. Postoperative Care Today, most cancer specialists agree that every woman is a candidate for breast reconstruction after mastectomy, regardless of the extent of her disease. This is a fairly recent consensus. Since 1981, the number of women seeking reconstruction has jumped by 114%. New techniques have enabled us to create a breast that comes very close to matching the opposite, natural one. Experts agree that in most cases, reconstruction does not interfere with chemotherapy and other types of cancer treatment, or with the physicians ability to detect any recurrence of the disease. Further, there is no evidence that breast reconstruction promotes cancer development. More and more women are undergoing breast reconstruction at the time mastectomy is done. Women who have immediate reconstruction wake up with a breast mound already in place and never experience the shock of having no breast at all, nor do they go through as much of a grieving process. Studies at the national Cancer Institute found that these women were less anxious, less depressed and less hostile. They were happy with the results of their reconstruction as were the women who waited. It also eliminates the need for another major operation. However, some women don't feel comfortable weighing all the options while they are struggling to cope with the cancer diagnosis and prefer to postpone reconstruction. You need to decide what is best for you. Now let's explore some of the reconstructive options available to you. In general terms, breast reconstruction often involves more than one operation. The initial stage, in which the breast mound is created, takes place in the hospital under general anesthesia. One or two additional procedures, such as surgery to replace a tissue expander with an implant or to reconstruct the nipple and areola, take place at a later date, often in an outpatient ambulatory surgical facility. Symmetry is a primary focus of breast reconstruction. The ability to achieve symmetry is largely dependent on choosing the reconstructive technique that will most closely bring to the chest wall sufficient tissue to match the size and degree of ptosis of the opposite breast. There are essentially three methods of breast reconstruction available to achieve these goals. 
Implant Reconstruction: Tissue expansion is similar to the stretching of a woman's abdominal skin during pregnancy. A silicone rubber balloon is placed below your chest muscle and skin and is gradually filled with saltwater solution over period of several weeks by way of a small valve placed near the armpit or within the implant itself. This is an office procedure that takes just a few minutes and is relatively painless though you may feel some discomfort for a few hours afterwards. After the skin has stretched enough, the expander is removed in a second operation and replaced with a permanent implant of the desired size. The skin has a natural tendency to contract when the expander is removed so it is common to slightly overstretch the skin prior to removing the expander. The benefits of tissue expansion are the technical ease of insertion and the ability to match a small, non-ptotic opposite breast with a minimal amount of surgery. Despite these advantages, skin expansion and implant reconstruction have significant drawbacks:
Flap Reconstruction: - Tram Flap - Back Flap - Buttock Flap Flap reconstruction is another type of restorative breast procedure which is more complex then breast implantation but often gives the most beautiful and natural looking results. This technique rebuilds the breast with tissue taken from other parts of the body such as the abdomen or back. Flap surgery is performed using a pedicle flap (in which the donor tissue remains tethered to it's original site, retaining it's blood supply) or a free flap (in which skin, muscle and arteries are completely detached and transplanted to the chest). Let's explore these procedures more carefully.
Preoperative Preparation Regardless of which procedure you chose we will want you to be in the best physical condition before your surgery. This involves cessation of smoking at least 2 weeks prior to surgery, which can have adverse effects on healing, control of any pre-existing medical conditions such as diabetes or high blood pressure and avoidance of aspirin containing medicine for at least two weeks before your surgery. Also, if you are overweight, and have the time prior to your surgery to loose weight, this can significantly improve your recovery and wound healing abilities. You will be asked to shower the evening prior to surgery and to avoid anything by mouth after midnight. If you are undergoing the TRAM flap procedure you may be asked to take a cleansing enema the day prior to your surgery. Although significant blood loss is uncommon, if time is available, you may also be asked to donate a unit of your own blood should you need it at the time of surgery.
Postoperative Care After flap surgery, you should expect to be hospitalized from 3-5 days. If you are undergoing implant reconstruction your hospitalization may be as little as 24 hours. During this time you will have drains which were placed at the time of surgery to evacuate any fluid that may accumulate under the skin. These drains are often removed prior to your leaving the hospital, however, if you are otherwise ready to go home, you may be sent with the drains in place, to be removed later in your doctors office. Stitches may need to be removed after surgery however, you will more likely have dissolvable stitches that do not require removal. At three weeks you will be allowed light aerobic exercises and non-strenuous activity. Full activity and heavy lifting can generally be resumed at six weeks. Most patients feel strong enough to return to work between 4-6 weeks after surgery. If you are to undergo tissue expansion this will most likely begin between 1-2 weeks after your surgery. Nipple-areola reconstruction will be performed once all the swelling has resolved and the new breast settles into position, usually about three months after your reconstruction. If you should require chemotherapy, nipple-areolar recontruction will often be delayed until your treatment is completed. You will be tired and sore for several days or weeks after your reconstruction. You may have temporary loss of sensation in the breast area as well as the abdomen if a flap procedure was performed. Additionally, you may experience tightness in the abdomen as well as lower back discomfort which may last several weeks. This is almost always temporary and will subside spontaneously. Your incisions will typically require no special care.
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