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Reconstruction with Implants
Reconstruction with Tram Flap
One of the primary symbols of womanhood is the breasts, especially in Western culture where fashion has stressed the value of a shapely figure. Many women who must undergo a total or partial removal of a breast as a result of cancer must simultaneously face the threat of disease and the loss of an important part of her feminine self-image. Today, because of modern technology, a remarkable surgical procedure, post-mastectomy reconstruction, can restore the form and appearance of a woman's breasts and, at the same time, dramatically improve her self-esteem and self-confidence.
Women who anticipate undergoing a mastectomy many want to discuss the possibility of having reconstructive surgery performed at the same time. In some cases, however, it may be necessary to delay the surgery for several months after the mastectomy. The physician determines the most favorable time to perform reconstructive breast surgery.
Prior to surgery, a complete medical history is taken in order to evaluate the general health of the patient. A thorough examination of the breasts is also made to determine the most effective surgical approach. The physician describes the type of anesthesia to be used, the procedure, what results might realistically be expected, and possible risks and complications.
Mammograms or x-rays, as well as photographs may be taken before surgery. Preoperative instructions often include the elimination of certain drugs which contain aspirin in order to minimize the possibility of excess bleeding. Birth control and other estrogen containing hormones may also be discontinued temporarily for the same reason. Antibiotics may be prescribed prior to surgery to prevent infection.
A breast reconstruction is usually performed in a hospital setting under general anesthesia with the patient asleep. The physician may choose from a variety of procedures, depending on the type of reconstruction needed. The choice depends upon the amount of skin cover and muscle available as well as the proposed size, shape, and contour of the breast. Prior to surgery, premedication to relax the patient is administered, and breasts are carefully marked to indicate where incisions are to be made.
When there is adequate skin cover, implanting a prosthesis may be all that is necessary. With this procedure, the mastectomy incision is usually reopened and a pocket is created above the chest wall. A saline implant is then inserted. Sutures are used to close the incision. If skin cover is mildly deficient or if the patient desires a larger breast size, tissue expansion may be used in order to create a larger, more natural breast reconstruction. A tissue expander, or plastic balloon, is placed above the chest wall. The expander is then inflated at intervals until the correct size is obtained. Occasionally, the explained is over-inflated temporarily in order to create a more natural breast shape. Most women who undergo a modified radical mastectomy quality for this type of reconstructive surgery.
Patients whose skin is too tight or thin to accommodate the posthesis may require the addition of skin and muscle from the back, the Latissimus dorsi, located immediately behind the area to be reconstructed, is used. With this procedure, a flap, which includes skin and muscle as well as blood vessels which nourish the tissue, is removed from the back and moved under the skin to the chest wall. A prosthesis is then inserted in the pocket that is formed and the incision is closed.
A muscle taken from the abdomen may also be used to form a flap. This long flat muscle, the rectus abdominus, extends along the entire length of the front abdomen. With this procedure, the flap is also moved beneath the skin to the breast area. In some cases, the amount of tissue from the muscle is enough to create a sizable mound eliminating the need for an implant.
Often a procedure is performed on the oppose breast so that it will match the breast reconstruction. This may include a breast enlargement or reduction, a breast lift, or in certain cases a removal of breast tissue with immediate breast reconstruction.
Reconstruction of the nipple may be done during the initial reconstructive surgery or at a later time. Skin and tissue from the nipple and areola of the other breast, the thigh or other parts of the body may be used.
After the incisions are sutured, bandages are placed over the treated area. In a day or two, bandages are replaced with a surgical bra. Patients may go home the day of surgery or require more prolonged hospitalization, depending on the type of procedure performed. Pain in both breasts and donor areas is minimal to moderate and is controlled with oral medications. Antibiotics may be prescribed to prevent infection. On the day of surgery and for a day or two following, instructions may include bed rest and limited activities. The physician determines when normal activities can be resumed. Strenuous activities and overhead lifting should be avoided for several weeks in order to permit healing.
Sutures are removed in about a week. Numbness around the treated area may occur, but this condition is usually temporary. Swelling and discoloration disappear in a few days, and, though scars from the incisions are permanent, they fade significantly with time.
Complications of infection and slow healing may occur, but can be treated with medications. There are certain inherent risks connected with every surgical procedure which should be thoroughly discussed with the physician. Patients can minimize complications by carefully following directions given by the physician.
If you are interested in learning more about breast reconstruction, please call our office at 570-674-6525 and we will be happy to answer your questions.
The Renaissance Center for Plastic
Surgery
113 North Memorial Highway
Shavertown, PA 18708
570-674-6525 voice
570-674-6520 fax