Special Considerations in Breast Reconstruction

Today, women have several choices when it comes to breast reconstruction. The new breast can be created using:

- a breast implant

- your own muscles as a flap

- or a combination of an implant and muscles flap

There are several areas from the body where muscles can be mobilized and brought over to the breast area. The most common of these muscle flaps is the TRAM flap). It is a muscle brought over from the abdominal wall and transposed on to the breast.

Breast reconstruction can be done immediately or delayed after a mastectomy.

Immediate reconstruction has some advantages which include:

- one less surgery

- not requiring to undergo a second anesthesia

- The most important advantage is that the tissues still have not been exposed to radiation therapy. Radiation therapy always makes the skin surface hard and leathery like. In addition, reconstruction of the radiated breast is always more difficult and prone to slightly more complications

Some women elect to delay the breast reconstruction. This period of delay may be months or years after the initial mastectomy. Delayed reconstruction may be preferable if a woman is going to need immediate radiation therapy. In some cases, delayed reconstruction is recommended if there is doubt about reconstructive capability and the prognosis of the patient.

Reconstructive breast surgery has come a long ways. The techniques are more refined and the results are pleasing. Still the decision about undergoing breast reconstruction depends on the following:

- The health of the patient. The surgery is long and can be complicated.

- Stage of the breast cancer, if the breast cancer is advanced and the likelihood of survival is short, reconstructive surgery is not recommended.

- Size of breast. Women should have adequate skin and muscle tissue to allow for breast reconstruction. Women with smaller breasts usually are more difficult candidates

- Availability of muscle flaps. In some women who have had prior surgery, the muscle flaps may have been injured or cut and may not be available for reconstruction

- The desire to have symmetrical breast

- Have enough money. Reconstructive breast surgery after a mastectomy is usually covered for the first procedure but all subsequent procedures are not. All cosmetic changes which occur later on are also not covered by medical carriers

- What the individual wants- simple implant or a muscle flap

- What size of breast reconstruction is required

- That you do not want any more surgeries

- You are worried about scarring. Reconstructive breast surgery does cause scars and there is no way round it. For those who do not like scars, reconstructive breast surgery should be avoided

- Your expectations. Breast reconstruction is not ideal and will never mimic the original breast in size shape, feel, consistency or feeling

- Your healing ability is impaired

- If you are a smoker it is best to wait because healing can be compromised

- If you are too thin

Breast reconstructive surgery even though produces good results is still not an ideal procedure. It does not produce the same results in all individual and in many cases, scars; numbness and asymmetry do occur. This is not always the fault of the surgeon

It is essential that you understand and know about your reconstruction options before surgery. Being realistic is essential in having the desired result.

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