Ask the Cosmetic Surgeon: Breast Reconstruction

by Dr. Johnny Franco, Cosmetic Surgeon

Breast cancer affects one in eight women in America. However, because of improved surveillance and treatment, there are currently over 2.5 million breast cancer survivors in the United States.

In the United States, more than 70% of women are NOT aware of their breast reconstruction options. (Figure 1). These options include immediate or delayed (some time after the mastectomy) reconstruction, symmetrical procedure of the opposite breast and revisions to improve the appearance of the reconstructed breast.

Currently, less than 25% of women who have their breast removed because of breast cancer undergo reconstruction. It is a woman’s personal decision whether or not she decides to undergo breast reconstruction; still, it is important that she understands her options.

Many women choose to not undergo breast reconstruction at the time of treatment for a variety of reasons, but it is never too late. There is no deadline – whether it is months or years later, reconstruction is still an option.

In 2011, over 96,000 breast reconstruction procedures were performed in the United States. This was made possible in large part to the Women’s Health and Cancer Act that was passed in 1998, requiring insurance companies to cover breast reconstruction.

What is Breast Reconstruction? What Does This Include?

Breast reconstruction is performed when part of the breast, or sometimes the entire breast, is removed due to cancer or another cause. The specific type of reconstruction required is dependent on whether only a portion of the breast is removed, or the breast in its entirety.

Breast reconstruction also includes symmetrical procedures for the opposite breast, such as a reduction, lift or augmentation. Procedures may also include the creation of a nipple and tattooing to create an areola.

Many people are under the false impression that breast reconstruction is equivalent to breast augmentation, but that is not the case, and it is not uncommon to make small revisions to improve the appearance of the other breast.

Who Can Have Breast Reconstruction?

Every patient should have the discussion of breast reconstruction with their breast surgeon, oncologist or plastic surgeon if they are going have a mastectomy or lumpectomy.

There are many variables that determine whether a patient should have reconstruction at the time of their mastectomy or wait until a later date.

There are also multiple reconstructive options that can be tailored to each individual patient, as no one reconstructive method is perfect for every person.

How Can the Breast be Reconstructed?

Women have several options for breast reconstruction dependent on their individual desires and situation.

The most common method of reconstruction in the U.S. involves reconstruction with an implant.

This procedure is quite similar to what is used in breast augmentation surgery.

After breast removal, there is initially no space for a new breast implant.

Therefore, the skin needs to be stretched to accommodate the implant.

This involves the surgeon placing an expander (an implant that can be filled gradually with saline).

Over a period time the skin can be reshaped until the final implant can be positioned. (Figures 2 and 3).

The second option for patients is to use tissue from another part of the body to re-create the breast.

The abdomen is the most common area used for this procedure.

Most of us have a little extra tissue there that we wouldn’t mind giving up!

Taking the abdominal tissue for breast reconstruction from this area is similar to how the skin and fat is removed for a tummy tuck. (Figure 4).

Breast Reconstruction with Fat Grafting

The third and newest method of reconstruction is fat grafting, where fat is taken from other parts of the body via liposuction and used to reshape the breast. This can be done alone or in combination with either of the two above reconstruction methods.

It can also be used to improve a previous reconstruction or treat an area of lumpectomy and radiation. It re-creates the breast tissue that was removed and can improve any skin damage that was caused by the radiation treatment.

Fat grafting can also be placed over a previous implant based reconstruction to create a softer more natural breast. This re-creates the fatty tissue that was removed during the mastectomy. (Figure 5).

Recovery from Breast Reconstruction

Recovery from breast reconstruction depends on a number of factors including what type of reconstruction the patient has undergone.

Reconstruction done with a tissue expander and implant often requires one night in the hospital.

Patients that undergo reconstruction with tissue removed from the abdomen or elsewhere in the body often need a couple more days to recover from the procedure before going home.

Ultimately, your surgeon will decide how long you need to remain in the hospital after your breast reconstruction.

Breast Reconstruction: Some Concluding Thoughts

The most important thing to take away from this article is that you have options and that they should be discussed with your breast surgeon, oncologist or plastic surgeon.

Have the discussion before your breast surgery so that you can make an informed decision of whether you want breast reconstruction or not. Also, if you decided not to have breast reconstruction years ago, remember it is never too late and you can still see your plastic surgeon to discuss your options for reconstruction.

(published October 10, 2012)

Johnny Franco, M.D., earned his Doctorate of Medicine from the University of Texas Medical Branch at Galveston. Dr. Franco served his residency in Plastic Surgery at Saint Louis University School of Medicine, finishing as head resident. Fluent in both English and Spanish, Dr. Franco has become part of the team of cosmetic surgeons at Miami Plastic Surgery, where you can get more information on breast reconstruction cosmetic surgery, or schedule a personal consultation.