Breast reconstruction

Breast reconstruction is the rebuilding of a breast, usually in women. It involves using existing flesh or prostheticmaterial to construct a natural-looking breast. Often this even includes the reformation of a natural-looking areolaand nipple. This procedure may involve the use of implants.

Overview

Though this procedure was recently out of the question after surgicalprocedures such as mastectomy, this type of cosmetic surgeryis becoming more common. Though most health plans cover the cost for this operation in the US, some do not, considering it to be cosmetic; paying for this procedure oneself may be very costly. However, most plans do cover this procedure as the cost may outweigh the converse cost of counselingfor the individual as they try to cope with the emotional adjustment of losing a breast.

For individuals who have undergone a mastectomy due to cancer, they are only eligible for this procedure if the disease was eliminated due to the breast removal. It is possible for this procedure to be carried out immediately following the mastectomy, so the individual awakes with the newly formed breast already in place. As with many other procedures, those with high blood pressure, obeseindividuals or those who smokeare poor candidates for this operation.

Breast reconstruction is a large undertaking. Most procedures take several operations. Sometimes these follow-up surgeries are spread out over weeks or months. If an implant is used, the individual runs the same risks and complications as those who use them for breast augmentation.

Techniques

There are many methods for breast reconstruction. The two most common are:

• Skin expansion By far the most common method, the surgeon inserts a small balloon expander beneath the skin and periodically, over weeks or months, injects a salinesolution to slowly expand the overlaying skin(see tissue expansion). Once the expander has reached an acceptable size, it may be removed and replaced with a more permanent implant. Reconstruction of the areolaand nippleare performed in a separate operation after the skin has stretched to its final size.
• Flap reconstruction The second most common procedure uses tissue from other parts of the patient's body, such as the back, buttocks, thighor abdomen. This procedure may be performed by leaving the donor tissue connected to the original site to retain its blood supply (the vessels are tunnelled beneath the skin surface to the new site) or it may be cut off and new blood supply may be connected. This procedure has the downside of leaving scar tissue in both the donor and breast area, but avoids the risks of breast implants. Flaps generally tolerate radiotherapybetter than implants which tend to develop capsule when irradiated.

The latissimus dorsimuscle is the donor available on the back. It is a large flat muscle which can be employed without loss of function. It can be moved into the breast defect still attached to its blood supply under the arm pit (axilla). The amount of tissue available is not enough to reconstruct a large breast so an implant may be required as well.

The abdominal flap for breast reconstruction is the TRAM flap or its technically distinct variant the DIEP flap. Both use the tummy bulge between the belly button and the pubic hair. The DIEP always, and the TRAM usually requires microsurgical techniques. Both can provide loads of tissue to reconstruct large breasts. The contour of the lower abdomen is reliably improved by these procedures which remove the same tissue as and abdominoplasty(tummy tuck.)

• Nipple Reconstruction Nipple reconstruction is usually delayed until after the breast mound reconstruction is completed so that the positioning can be planned precisely. Usually a nipple is made from local tissue and a skin graft is used for the areola. The new areola will require tattooing to get colour match with the other side.
• The other breast One of the challenges in breast reconstruction is to match the reconstructed breast to the mature breast on the other side (often fairly 'ptotic' - droopy.) This often requires a lift (mastopexy) or reductionof the other breast. Occasionally women may request an augmentationof the other breast at the same time as their cancer reconstruction.

Follow-up

Recovery from skin expansion is generally faster than with flap reconstruction, but both take three to six weeks to recover from and both require follow-up surgeries in order to construct a new areola and nipple. Most scarswill not disappear completely, but the better the quality of the reconstruction, the less noticeable and distracting the scars will be. All recipients of these operations should refrain from strenuous sports, overhead lifting and sexual activityduring the recovery period (three to six weeks).

See also

• Breast reduction
• Breast implant

External links

• Breast Reconstruction Following Breast Removalfrom the American Society of Plastic Surgeons
• In-depth breast reconstruction discussionfrom the University of Iowa
• A breast reconstruction FAQnl:Borstvergroting

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This article is licensed under the GNU Free Documentation License.
It uses material from the http://en.wikipedia.org/wiki/Breast+reconstruction Wikipedia article Breast reconstruction.