Understanding Your Options for Breast Reconstruction
November 02, 2022 | Breast Reconstruction
5 Minute Read:
If you or a loved one has recently or has ever been diagnosed with breast cancer, you understand the rush of emotions, fears, and uncertainty that diagnosis brings. There is bound to be endless confusion in the initial weeks after learning of the disease, and chances are you are only retaining a part of all the information you are being given. First and foremost, you need to be sure that you and your breast surgeon or oncologist are on the right track treatment-wise, whether it be surgery, chemotherapy, radiation, or a combination of the three.
However, once you have wrapped your head around that information and feel comfortable planning for the future, it may be time to start considering breast reconstruction surgery. It’s never too early to learn about this plastic surgery technique because, for some qualifying patients, reconstructive work can begin at the same time as your mastectomy or lumpectomy.
This is not an option for every patient (which will be discussed later), but it can be an option.
How Long Will My Breast Reconstruction Take?
Breast reconstruction is hardly ever a one-time operation. It is a process that usually takes place over several months. This is because most women’s breast reconstructions involve multiple techniques that must be performed over time.
There are a few rare exceptions to this. The first is a technique known as direct-to-implant (DIT) reconstruction. Here, a final implant is inserted at the very same time the mastectomy is performed. While this sounds promising in theory, very few women are candidates for this technique, and there are associated risks. Because of this, it is not likely to be suggested.
Another exception is some tissue-based breast reconstructions that do not involve an implant or need for a tissue expander. If your breast mound is being rebuilt entirely with your tissue (DIEP flap technique) and you do not require an expander, the breast can be recreated in a shorter amount of time.
But even many DIEP flap patients benefit from some small secondary revision surgery.
What Are My Breast Reconstruction Options?
Women preparing to undergo breast reconstruction will become accustomed to hearing about two different techniques: implant-based reconstruction and tissue-based reconstruction. Some women choose one or the other; others incorporate both.
This technique (in theory) works similarly to traditional breast augmentation in the sense that breast volume is created using a synthetic implant. While similar, there can be some appearance differences because there is less tissue covering the implant.
Implant-based reconstruction is almost always completed in stages. First, a tissue expander is placed into the breast. This expander will be filled gradually (over several visits) to gently stretch the skin and tissue and prepare the body to receive (and support) the final implant.
Once the tissues have stretched, the expander is removed, and the implant is added.
This technique can be combined with tissue-based reconstruction or fat grafting to increase the amount of natural tissue in the breast.
Tissue (known as flaps) can be taken from numerous areas of the body to reconstruct the breast mound. One of the most common flaps used is called the DIEP flap. This tissue comes from the abdomen (between the belly button and the pubic bone).
During a tissue-based reconstruction, the tissue is transferred from the abdomen to the breast, and the blood vessels are reconnected.
This technique can be performed alone or with an implant for more significant breast volume. While not always necessary, women who choose to delay their breast reconstruction may still require a tissue expander for this technique.
When Can I Start My Breast Reconstruction?
As mentioned above, some women can begin their breast reconstruction at the same time as their mastectomy; others delay their surgery for months or even years.
There is no expiration date for women who choose to delay their procedure. You can choose to undergo reconstruction when you feel ready. Maybe this is after you have completed your treatment regimen and received a clean bill of health; perhaps this is when you’ve wrapped your head around what you and your body have just gone through; or maybe this is years down the line when you are in remission.
For women who wish to jump into reconstruction, this may be an option. It is not uncommon for tissue expanders to be placed or flap surgery to be performed at the time of the mastectomy.
Radiation can have an impact on the timing of one or more of the steps of breast reconstruction. Radiation can also impact technique choice. The topic of radiation’s impact on breast reconstruction is complex and case-dependent. Dr. Weinfeld will help guide you through the decision-making process.
What About Nipple Reconstruction?
Some women undergo non-nipple-sparing mastectomies, and their nipples are removed during surgery.
Nipple reconstruction is a part of breast reconstruction; however, it is not a requirement. Some women are eager to restore the look of the nipple; others are not as concerned. The right choice for this is the one that feels right to you. These are your breasts, and this is your journey.
If you do decide to reconstruct the nipple(s), this can be done in one of two ways:
- 3D nipple tattooing: This common approach uses very natural-looking shading techniques to create the look of a three-dimensional nipple. This option will not have any projection since it is a flat tattoo; however, some women prefer this look and enjoy the fact that they will never have to worry about their nipples showing through clothes.
- Nipple reconstruction: For women who want the look and feel of a projecting nipple and have the tissue needed, a physical nipple can be recreated using tissue and skin from the breast. This option is not always appropriate for women who have undergone radiation and will be determined on a case-by-case basis.
Breast Reconstruction in Austin, Texas?
Whether you are looking for breast reconstruction for yourself or you are supporting a mother, sister, aunt, or friend, it is beneficial to learn all you can about the available options. Dr. Adam Bryce Weinfeld is a board-certified plastic and reconstructive surgeon with a special passion for breast reconstruction.