Breast reconstruction can be done right after a mastectomy while you are still under anesthesia, or at a later time. Sometimes women wait because they are not emotionally or medically able to undergo additional surgery, or because they need radiation therapy following their breast cancer and mastectomy. Reconstruction is major surgery that may require more than one procedure. Women should be fully informed about what is involved.
Women have several options in breast reconstruction surgery, including implants and flap procedures.
Triple-negative breast cancer (TNBC) is defined as the absence of staining for estrogen receptor, progesterone receptor, and HER2/neu. TNBC is insensitive to some of the most effective therapies available for breast cancer treatment including HER2-directed therapy such as trastuzumab and endocrine therapies such as tamoxifen or the aromatase inhibitors. Combination cytotoxic chemotherapy administered in a dose-dense or metronomic schedule remains the standard therapy for early-stage TNBC. A prospective...
Implants involve stretching the skin with a special tissue expander, then inserting a silicone-gel or saline (salt water) implant. The tissue expander can be filled to a desired volume by injecting additional saline periodically, usually once a week for a few sessions. Many women find these sessions moderately painful, but are often pleased with the final result and the fact that they have more control over the final size of the breast. Because of safety concerns, in 1992 the U.S. Food and Drug Administration (FDA) banned silicone implants, except for those women participating in approved clinical studies. In 2003, an FDA panel that reviewed 10 years of data recommended the ban be lifted, as long as women were informed before the procedure and were monitored by an outside agency for 10 years after surgery. The FDA has not yet lifted the ban. For more information, see Breast Implants After Breast Cancer Surgery.
Tissue flap procedures involve using a woman's own tissue taken from the abdomen or back to create a breast mound to reconstruct the breast. Taking abdominal tissue is called a TRAM flap, which is short for transverse rectus abdominis muscle. Taking tissue from the back is called latissimus dorsi flaps. These procedures require a plastic surgeon who is experienced in this type of surgery.
The areola (darker area surrounding the nipple) can be tattooed. A nipple can also be constructed from tissue taken from the back or abdominal flap and tattooed to resemble the color of a nipple. In rare cases, the nipple from the original breast can be reattached, but only if the surgeon is convinced that tissue is cancer-free. While reconstruction improves the appearance of the breast, because of a lack of nerve connections, the nipple will not rise or flatten in response to touch or temperature.
Breast reconstruction usually does not interfere with chemotherapy. If radiation therapy is needed, some doctors prefer to delay the reconstruction.
Complications are not common but may include bleeding, scarring, and infection.