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 the 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.

Before surgery
Women who anticipate undergoing a mastectomy may 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 the surgery, a complete medical history is taken in order to evaluate the general health of the patient. A thorough examination of the breast area 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.

X-rays as well as photographs may be taken. Preoperative instructions often include the elimination of certain drugs which contain aspirin for several days before surgery in order to minimize the possibility of excess bleeding. Birth control and other estrogen containing hormones may also be discontinued for the same reason. Antibiotics may be prescribed prior to surgery to prevent infection.

The procedure
A breast reconstruction is usually performed in a hospital setting under general anesthesia in which the patient is asleep. The physician can choose from several procedures when performing a breast reconstruction. The choice depends upon the amount of skin cover and muscle wall available as well as the proposed size, shape and contour of the breast. Prior to surgery, pre medication to relax the patient is administered, and the area is 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 beneath the chest wall muscles. An implant is then inserted. This implant may contain a silicone gel, saline solution or a combination of both. 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 beneath the chest wall muscles. The expander is then inflated at intervals until the correct size is obtained. Occasionally, the expander is over-inflated temporarily in order to create a more natural breast shape. Most women who undergo a modified radical mastectomy qualify for this type of reconstructive surgery.

Patients whose skin is too tight or thin to accommodate the prosthesis may require the addition of skin and muscle tissue from another part of the body. Often the 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 of the 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 a prosthesis.

Often a procedure is performed on the opposite breast so that it will match the breast reconstruction. This may include a breast enlargement or breast reduction, a mastopexy or breast lift or, in certain patients, a removal of breast tissue with immediate 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 (dark, pink skin surrounding the nipple) of the other breast, the thigh or other parts of the body may be used.

Following surgery
After 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 the breast and donor areas is minimal to moderate and is controlled with oral medication. 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 activity and overhead lifting should be avoided for several weeks in order to permit healing.

Sutures are removed in approximately one week. Numbness around the treated areas may occur, but this condition is usually temporary. Swelling and discoloration disappear in a few days, and, though scars 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.

Will insurance pay for this surgery?
Some insurance companies will pay all or part of the costs of this surgery. Each insurance carrier, however, is different, and it is recommended that individuals check with their own agent to determine if there is coverage.