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Breast Reconstruction
Dr. Jain has a personal passion for helping patients that require Breast Reconstruction for any reason.
Reconstruction of a breast that has been removed due to cancer or other disease is one of the most rewarding surgical procedures available today, both for the patient and for Dr. Jain. New medical techniques and devices have made it possible to create a breast that can come close in form and appearance to matching a natural breast.
Frequently, reconstruction is possible immediately following a mastectomy, so the patient wakes up with a breast mound already in place, having been spared the experience of seeing herself with no breast at all.
Post-mastectomy breast reconstruction is not a simple procedure. There are often many options to consider as you and Dr. Jain explore what's best for you.
This information will give you a basic understanding of the procedure -- when it's appropriate, how it's done, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask Dr. Jain if there is anything you don't understand about the procedure.
The Best Candidates For Breast Reconstruction
Most mastectomy patients are medically appropriate for reconstruction, many of these procedures can be performed the breast is removed. The best candidates, however, are women whose cancer, as far as can be determined, seems to have been eliminated by mastectomy.
Many women aren't comfortable weighing all their options while they're struggling to cope with a diagnosis of cancer. Others simply don't want to have any more surgery than is absolutely necessary. Some patients may be advised by their surgeons to wait, particularly if the breast is being rebuilt in a more complicated procedure using flaps of skin and underlying tissue. Women with other health conditions, such as obesity, high blood pressure, or smoking, may also be advised to wait.
In any case, being informed of your reconstruction options before surgery can help you prepare for a mastectomy with a more positive outlook for the future.
Planning Your Surgery
You can begin talking about reconstruction as soon as you're diagnosed with cancer. Ideally, you'll want your breast surgeon and Dr. Jain to work together to develop a strategy that will put you in the best possible condition for reconstruction.
After evaluating your health, Dr. Jain will explain which reconstructive options are most appropriate for your age, health, anatomy, tissues, and goals. Be sure to discuss your expectations frankly with Dr. Jain and he will be equally frank with you, describing your options and the risks and limitations of each.
Post-mastectomy reconstruction can improve your appearance and renew your self-confidence, but keep in mind, the desired result is improvement, not perfection
Dr. Jain will explain the anesthesia he will use, the facility where the surgery will be performed, and the costs. In most cases, health insurance policies will cover most or all of the cost of post-mastectomy reconstruction.
Preparing For Your Surgery
Your oncologist and Dr. Jain will give you specific instructions on how to prepare for surgery, including guidelines on eating, drinking, smoking, and taking or avoiding certain vitamins and medications
The Surgery
While there are many options available in post-mastectomy reconstruction, you and Dr. Jain will discuss the one that's best for you.
Skin expansion - The most common technique combines skin expansion and subsequent insertion of an implant. Following mastectomy, Dr. Jain will insert a balloon expander beneath your skin and chest muscle. Through a tiny valve mechanism buried beneath the skin, he will periodically inject a salt-water solution to gradually fill the expander over several weeks or months. After the skin over the breast area has stretched enough, the expander may be removed in a second operation and a more permanent implant will be inserted. Some expanders are designed to be left in place as the final implant. The nipple and the dark skin surrounding it, called the areola, are reconstructed in a subsequent procedure.
Some patients do not require preliminary tissue expansion before receiving an implant. For these women, Dr. Jain will proceed with inserting an implant as the first step.
Flap Reconstruction - An alternative approach to implant reconstruction involves creation of a skin flap using tissue taken from other parts of the body, such as the back, abdomen, or buttocks.
In one type of flap reconstruction surgery, the tissue remains attached to its original site, retaining its blood supply. The flap, consisting of the skin, fat, and muscle with its blood supply, are tunneled beneath the skin to the chest, creating a pocket for an implant or, in some cases, creating the breast mound itself, without need for an implant.
Another flap technique uses tissue that is surgically removed from the abdomen, thighs, or buttocks and then transplanted to the chest by reconnecting the blood vessels to new ones in that region. This procedure requires the skills of a plastic surgeon who is experienced in micro vascular surgery.
Regardless of whether the tissue is tunneled beneath the skin on a pedicle or transplanted to the chest as a micro vascular flap, this type of surgery is more complex than skin expansion. Scars will be left at both the tissue donor site and at the reconstructed breast, and recovery will take longer than with an implant. On the other hand, when the breast is reconstructed entirely with your own tissue, the results are generally more natural and there are no concerns about a silicone implant. In some cases, you may have the added benefit of a improved abdominal contour.
Follow-up procedures - Most breast reconstruction involves a series of procedures that occur over time. Usually, the initial reconstructive operation is the most complex. Follow-up surgery may be required to replace a tissue expander with an implant or to reconstruct the nipple and the areola. Many surgeons recommend an additional operation to enlarge, reduce, or lift the natural breast to match the reconstructed breast. Keep in mind, this procedure may leave scars on an otherwise normal breast and may not be covered by insurance.
After Your Surgery
You are likely to feel tired and sore for a week or two after the reconstruction. Most of your discomfort can be controlled by medication prescribed by your doctor.
Depending on the extent of your surgery, you'll probably be released from the hospital in two to five days. Many reconstruction options require a surgical drain to remove excess fluids from surgical sites immediately following the operation, but these are removed within the first week or two after surgery. Most stitches are removed in a week to 10 days.
Getting Back to Normal
It may take you up to six weeks to recover from a combined mastectomy and reconstruction surgery, or from a flap reconstruction surgery alone. If implants are used without flaps and reconstruction is done apart from the mastectomy, your recovery time may be less.
Reconstruction cannot restore normal sensation to your breast, but in time, some feeling may return. Most scars will fade substantially over time, though it may take as long as one to two years, but they'll never disappear entirely. The better the quality of your overall reconstruction, the less distracting you'll find those scars.
Follow Dr. Jain's advice on when to begin stretching exercises and normal activities. As a general rule, you'll want to refrain from any overhead lifting, strenuous sports, and sexual activity for three to six weeks following reconstruction.
Your New Look
Chances are your reconstructed breast may feel firmer and look rounder or flatter than your natural breast. It may not have the same contour as your breast before mastectomy, nor will it exactly match your opposite breast. These differences will be apparent only to you. For most mastectomy patients, breast reconstruction dramatically improves their appearance and quality of life following surgery.
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