Breast Reconstruction
-Reconstructive surgery is performed on the breasts of both men and women
in order to correct some defect or abnormal structure that interferes with
activities of normal daily life:
-Reconstruction
of a woman's breasts after mastectomy
-Reduction mammaplasty to reduce the size and change the shape of large,
pendulous breasts that cause medical problems for a woman because of their
excessive size and weight
-Surgical correction of gynecomastia in men that does not resolve spontaneously
or respond to medical treatment
Postmastectomy Breast Reconstruction
The patient will not tolerate postmastectomy deformity for reasons that
may include the maintenance of personal, family or sexual relationships.
Selection Criteria and Risk Factors
Detailed application of selection criteria should be conducted in consultation
with the oncologist (if cancer is the reason for mastectomy), general surgeon,
plastic surgeon, and radiation therapist (if radiation is a pre- or postoperative
consideration). Significant risk factors include:
-Obesity (especially >25% over ideal body weight)
-Small
vessel disease (heavy smoking or smoking history, autoimmune disease, insulin-dependent
diabetes)
-Tumor cell type and characteristics
-Major concurrent pulmonary, cardio-vascular, psychiatric or other disease
-Substance abuse; personal and family problems
-Patient compliance (ability to understand procedures and options, ability
to tolerate pain)
-Abdominal scarring from previous surgery (may prohibit use of a pedicle
or free flap of abdominal myocutaneous tissue in breast reconstruction)
-History of radiation to the chest wall
Outcome and Patient Expectations
A breast reconstructed after mastectomy should have good contour and texture.
However, because most or all breast tissue has been removed at mastectomy,
it is highly unlikely that the reconstructed breast (1) can produce milk,
(2) can respond to hormonal signals, and (3) will experience normal sensory
perception.
Procedures
Immediate reconstruction after mastectomy may be a viable option after consultation
with the oncologist and plastic surgeon. Delayed reconstruction may be the
best option under other circumstances--e.g., given the patient's medical
history, type of breast cancer, need for postoperative therapeutic irradiation.
The procedure used for reconstruction may be (1) insertion of an implant,
(2) use of a pedicled or free myocutaneous flap of autogenous tissue to
form a new breast mound, or (3) a combination of implant and flap.
Postoperative Recovery
The patient is released from the hospital 3 to 5 days after an uncomplicated
procedure; stitches are removed after 7 to 10 days. Full recovery from a
mastectomy reconstruction or a flap procedure may require 6 weeks
Follow-up
The plastic surgeon will conduct regularly-scheduled examinations to ensure
the success of the breast reconstruction. The primary care physician should
coordinate other follow-up examinations--e.g.,mammography to detect any
recurrence of cancer locally in the chest wall or in the remaining breast
(if only one breast was removed). Suspicious radiographic findings should
be coordinated with findings on physical examination.
