Losing part or all of the breast due to breast cancer or other reasons is a traumatic event. One of the ways to help in the recovery process is breast reconstruction. Breast reconstruction is a complex subject, with a number of decisions to be made to achieve the optimal result. These decisions are made based on a number of factors - patient wishes, physician advice, medical treatments planned, body characteristics, etc.
The first decision to be made is whether to perform the reconstruction immediately after a mastectomy or after a period of time ("delayed") has elapsed (usually for completion of chemotherapy or radiation treatment). This decision is usually made based upon physician recommendations in combination with patient preference.
There are two types of breast reconstruction - prosthetic reconstruction (tissue expander/breast implant) and autologous reconstruction (a patient's own tissue). Prosthetic reconstruction involves placing a tissue expander in the pocket left behind from removing the breast tissue and under the pectoralis muscle. Over a the course of a few weeks to a few months, the tissue expander is gradually inflated with saline until the desired size is achieved. Once this point has been reached, the tissue expander is replaced with a long term breast implant. These can be either silicone gel devices or saline devices, depending on which will provide the optimal result. Usually at that same time a nipple is reconstructed if need be, and any work that needs to be done on the opposite breast for overall symmetry is performed (augmentation, lift, or reduction). It is not uncommon to need additional surgeries down the line to exchange breast implants, remove scar tissue, etc.
If autologous tissue is chosen, the areas used to donate tissue (flaps) are the abdomen (TRAM flap or DIEP flap), back (latissimus flap), or gluteal region(SGAP/IGAP flaps). The specific area chosen depends on a patient's own body characteristics and physician preference. While the majority of the reconstruction is performed in one setting, there are often two to three additional surgeries to create symmetry to the opposite breast, reconstruct the nipple, revise scars, etc.
Recovery from breast reconstruction can vary from an overnight stay in the hospital to a multiple night stay, depending on which procedure is performed. The timing of secondary surgeries (nipple reconstruction, expander removal, etc.) also depends greatly on whether the patient will need chemotherapy and/or radiation treatments.