Choosing the Right Breast Reconstruction: Options After Mastectomy

·       Do you know breast implants are the most common form of breast reconstruction, and they involve the use of either silicone or saline (sterile saltwater) or silicone (gel) implants?

·       Do you know breast reconstruction performed at the same time as your mastectomy/ breast removal surgery helps allow you to get back to life more quickly without the hassle of an unwanted dual recovery phase?

·       Do you know silicone implants may look and feel more natural than saline implants?

·       Do you know several factors are at play in choosing the type of reconstruction surgery a woman has, including the size and shape of the breasts that are being rebuilt, age and medical health of the woman, surgical risk factors (alcohol or smoking behavior), the availability of extra fat in the body, and the location of the tumor in the breast?

Breast reconstruction after mastectomy or breast removal surgery due to cancer is a sophisticated task in terms of the timing of the surgery, requiring keen attention and a thorough evaluation.

What is the right time to perform breast reconstruction surgery so that quick healing and the transformation journey of breast cancer survivors can be easier without the hassle of lengthy mastectomy recovery; this is the point to discuss here in brief.

Dr. Karishma Kagodu (MS, MCh), a board-certified celebrity plastic surgeon and Managing Director of Dr. Karishma Aesthetics, noted that the most prominent factor influencing the timing of reconstruction surgery is whether a woman will need radiation therapy. Radiation therapy after mastectomy can cause wound healing problems in reconstructed breasts. However, it is a wise decision to delay the breast reconstruction, especially if a patient has undergone inflammatory breast cancer surgery until after radiation therapy is completed. In addition, due to advancements in techniques and surgical improvements, radiation therapy is no longer a restriction for breast reconstruction surgery, approving the possibility of immediate reconstruction with implants. Moreover, autologous tissue breast reconstruction is usually reserved for women who have had radiation therapy to improve the damage caused by radiation therapy to the breast and chest wall tissue. Secondly, immediate reconstruction is not a preferable option for women with inflammatory breast cancer, which usually requires more extensive skin removal, recommending the pause of breast reconstruction surgery until after the completion of adjuvant therapy. However, delayed reconstruction is a preferable option for women with inflammatory breast cancer.

Comparing different methods of breast reconstruction Surgery:

I.               Implant-based breast reconstruction:

Implants are prostheses placed underneath the skin or chest muscle following mastectomy. Implants are of two types, i.e., silicone shell filled and saline (sterile saltwater) or silicone gel. We prefer silicone implants at Dr. Karishma Aesthetics because they give a more natural effect and are softer than saline implants to the touch.

Key points for the reconstruction of breasts with implants must be thoroughly informed while deciding on an option:

·       There must be enough skin and muscle after mastectomy to cover the implant.

·       It is a shorter procedure than autologous tissue reconstruction, and less blood loss is reported.

·       Frequent follow-up visits may be required to inflate the expander and insert the implant.

·       The recovery period is shorter.

·       It may not be a preferable option for women who have had radiation therapy.

·       Implants will not last a lifetime and may need revision surgery in case of wear and tear issues or replacement after 10-12 years, as maintenance with periodic follow-up visits is required post-surgery.

·       In the case of immediate reconstruction, when breast reconstruction is done following mastectomy, placing a tissue expander under the skin or chest muscle is not required, as an implant can be placed in the breast during the same surgery.

·       Women with silicone implants are required to undergo periodic MRI screenings to avoid the risks of possible “silent” rupture of the implants, as recommended by the FDA.

II.           Autologous tissue/ flap Reconstruction:

Autologous tissue reconstruction is reserved for women who previously had more extensive skin removal due to the treatment of inflammatory breast cancer involving adjuvant therapy. However, delayed reconstruction with autologous tissue reconstruction will be a recommended option.

Autologous tissue reconstruction involves the removal of a piece of tissue containing skin, called flap, fat, blood vessels, and even muscle, from the donor areas and is used to reconstruct the breasts.

Autologous tissue reconstruction helps replace damaged chest wall tissue with healthier one from elsewhere in the body where extra fat is localized, and easier to obtain flaps such as the abdomen, thighs, back, buttocks, or love handles.

Women who previously had abdominal surgery may not be the right fit for an abdominally-based flap reconstruction.

Key points for the reconstruction of breasts with Autologous tissue in the view of surgery and recovery:

·       Autologous tissue breast reconstruction involves longer surgical hours than implants, as the first step is about harvesting fat and obtaining skin, blood vessels, and muscle from donor areas. Then, it is used to reconstruct the breasts. 

·       When tissue/ flap is obtained from the thighs, back, or buttocks, it is called a free flap often required when a woman has had a previous major abdominal surgery and does not have enough tissue to reconstruct the breasts. Moreover, a free flap often requires an implant to provide the desired breasts’ volume.

·       Recovery from the procedure and healing period is longer than implants.

·       One should be physically fit to undergo autologous tissue reconstruction, as obesity, diabetes, and smoking may increase the rate of complications.

·       Pain and weakness at the donor site from where the flap is harvested are usually common and can be managed effectively with prescription medications and post-op measures.

·       Autologous tissue transfer gives a more natural breast shape than implants and may feel softer and more natural to the touch.

·       Autologous fat tissue reconstruction can replace damaged tissue caused by radiation therapy.

Post-mastectomy Recovery Guidelines:

Mastectomy or breast removal surgery is performed to treat breast cancer in women, and the procedure lasts one hour or more depending on the extent of the procedure, the type of reconstruction technique used, the anatomical status of the patient, and the problem status. Usually, the recovery from mastectomy takes around 4-6 weeks for the wound to get completely healed and associated discomforts or side effects to be settled. However, strenuous activities or lifting over 10 pounds should be paused for four weeks, and limited arm movements until the surgical drains are removed is instructed. Moreover, recovery from a mastectomy without reconstruction typically takes about two weeks, while a mastectomy with reconstruction often takes 4 to 6 weeks.

Post-mastectomy instructions:

·       Allow yourself plenty of rest in the first few weeks following surgery to heal smoothly.

·       Take prescription pain medications as needed.

·       Sleeping on your back is prescribed until you achieve a fuller recovery, i.e., 4-6 weeks.

·       Getting enough sleep will help you heal faster.

What post-op items to have at home:

·       “Drain apron,” zip-up hoodie with pockets for drains.

·       Recliner for sleeping

·       Shower wipes

·       Extra pillow for support under the arm

·       Yoga pants for comfort at home during recovery.

Call us on 9108969006/ 7624809006 to know more about mastectomy, and breast reconstruction surgery.

To book your appointment at our Kinder Hospitals branch in Whitefield, Bangalore, please call 080 28888880 or 8618999833 or schedule an in-person consultation by visiting Kaesthetics’ contact page.