ParfumGigi@aol.com

Dr Bridget Farham

Mon, 15 Oct 2007

Once a diagnosis of breast cancer has been made there will be many questions you will want to ask. If treatment involves taking off the diseased breast, by mastectomy, then you are faced not only with the prospect of a frightening disease, but also with the loss of a part of your body which is essential to your femininity: your breast.

Your specialists will be well aware of your fears, and the particular fear of disfigurement on top of everything else.

When you first discuss your surgery, you may not want to talk about breast reconstruction, but you will probably be offered it at some stage. This article is here to give you the information you need to help you make a choice about whether or not surgery is for you.

The goal of reconstruction is to provide two breasts which look the same when wearing a bra. When naked, there will still be obvious differences between the reconstructed breast, and the original.

Breast reconstruction surgery rebuilds the breast contour, and, if required, the nipple and areola.

There are two types of reconstructive surgery, an implant, and a muscle flap.

The choice between these two depends on the amount of suitable tissue remaining at the site of surgery, the desire to match the opposite breast, the recovery time, and the possible loss of muscle function. Each woman is different, and will have different possibilities offered.

This is an option for women who have lost an entire breast, and will be suitable for most women in this situation.

It is relatively unusual to have the reconstructive surgery at the same time as the initial surgery to remove the diseased breast. Most women only want to deal with one thing at a time after a diagnosis of cancer. If a breast is being rebuilt using skin flaps and underlying tissue, then it is often better to wait. Many specialists recommend waiting until after chemotherapy or radiation therapy.

This is a very common type of reconstruction. After mastectomy, an expander is placed between the skin and the chest muscle. This is a balloon-like bag, which is injected with saline solution at regular intervals until it reaches the same size as the other breast. Once the skin has stretched sufficiently, the expander is removed, and a permanent implant put in place.

Silicone implants are not used in the USA at the moment, since there are concerns about their safety. However, the evidence is generally that they are not a problem, and they are available elsewhere. Saline is another option.

If nipple reconstruction is wanted, this is done later.

There are several different types of muscle flap procedure available. They use tissue either from the back, the tummy, or the buttocks, to reconstruct the breast.

The operations leave scars in the areas where the tissue was removed, and on the breast. Blood vessels are usually involved, which means that these procedures are not usually offered to women with diabetes, connective tissue diseases, and some smokers.

Which procedure you are offered depends on individual factors, which will be discussed with your surgeon.

It can take up to six weeks to recover both from the mastectomy, and the reconstruction. If implants are used without flaps your recovery time may be less.

Reconstruction does not restore normal sensation to your breast, but some feeling may return with time. Most scars will fade, but will never go away entirely.

Ask your surgeon for advice on when to resume normal activity again. Generally, avoid overhead lifting, strenuous exercise, and sexual activity for four to six weeks following reconstruction.

If you are having trouble adjusting to your new breast, try to find other women who have gone through the same procedure, and form a support group.

Generally, the results of surgery are very good, and in a bra, the two breasts are indistinguishable.

Every woman is different, and not every type of breast reconstruction surgery is suitable for everyone. You may decide that this is not for you at all, and simply use a prosthesis in your bra.

Whatever the case, it is important that you ask as many questions of your surgeon as possible before deciding what to do.

Have a look at The plastic surgery information service to get a South Africa perspective on plastic and reconstructive surgery.