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Breast Reconstruction

Many women choose to have breast reconstruction to restore the shape of their breast after mastectomy. Plastic and reconstructive surgeons use advanced techniques to rebuild a woman’s breast, giving her a more natural and balanced appearance.

A woman considering reconstruction will need to discuss with her doctor when to have the surgery and what type of surgery to have.

When to Have Breast Reconstruction

Your plastic and reconstructive surgeon will help you weigh the risks and benefits to help you determine the best timing for your breast reconstruction surgery. 

Women with smaller breasts may have the option to pursue breast reconstruction at the same time they have their mastectomy.

Your surgeon will place a silicone pouch called a “tissue expander” underneath the chest muscle to gently stretch your skin and soft tissue.  The tissue expander has a valve that allows your surgeon to slowly fill it with saline (salt water) over the course of many months.  This will enlarge the space under the pectoral muscle to allow for the implant to be inserted during a second surgery.

Types of Breast Reconstruction

Skagit Regional Clinics offers women the option of implant reconstruction or natural tissue reconstruction. 

Breast implants are round or tear-drop shaped silicone shells filled with saline (salt water) or silicone gel that are placed underneath the pectoral muscle.

Saline Implants – The majority of breast implants use saline-filled implants.

Silicone Implants – Many people prefer the look and feel of silicone implants, as the texture of the gel is similar to natural breast tissue. If a silicone implant ruptures, it is more difficult to detect and repair than saline implants. 

Advantages of Implants

  • Surgery and recovery times for patients who choose implant surgery are typically less than those who choose natural tissue reconstruction.
  • Surgical results are more predictable due to the predetermined shape of the implants.
  • Patients who choose to have implant reconstruction typically have fewer scars.  Your reconstructive surgeon is often able to use the scar from your mastectomy for your implant, so no new incisions will be made.  
Disadvantages of Implants

  • Implants come in predetermined shapes, making it more difficult to match the look of your other breast.
  • The process of using a tissue expander can be time consuming.  It will require frequent visits to your surgeon’s office and more than one surgery.
  • Patients who have undergone radiation may not respond well to the process of tissue expansion.  Radiation can cause scarring, making skin less able to stretch to accommodate the implant.
  • Infection is possible when adding a foreign object to your body.
  • Implants have the potential to leak at which time the implant would need to be removed or replaced. Rupture occurs in approximately 10% of women during the first ten years after surgery.
  • Scar tissue can form around the outside of the implant, making the breast feel hard.  Another surgery would be necessary to replace or remove the implant.
  • The implant can shift, causing a wrinkle or dent in the shape of the breast.
  • Implants do not change in size or shape, even if you do.  If you gain or lose weight, your breast may appear disproportionate to the rest of your body.
Natural tissue reconstruction uses your own body tissue from your abdomen, buttocks, thigh or back to recreate your breast.  The Transverse Rectus Abdominis Muscle (TRAM) Flap Reconstruction uses skin and body fat from your lower abdomen and is the most common type of natural tissue reconstruction. 
Advantages of Natural Tissue Reconstruction

  • Your reconstructive surgeon can sculpt your tissue to create a breast that resembles your other breast.
  • Natural tissue is used to create the breast, so it will better reflect changes in your weight by growing or decreasing in size as you gain or lose weight.
  • Use of your own tissue in reconstruction eliminates the possibility of needing an implant replaced later.
  • Implant surgery often requires two surgeries, whereas natural tissue reconstruction can be immediate (at the time of mastectomy) or delayed.
Disadvantages of Natural Tissue Reconstruction

  • This is a complex surgery.  Reconstruction will take more time on the front end when compared to implant surgery and recovery time will be longer (6 to 8 weeks).
  • Patients will have an additional scar where tissue was removed to create the new breast.
  • An additional surgery may be needed to revise the breast shape.
  • A small number of women will experience tissue loss in part or all of their new breast or other complications.
Speak with your reconstructive surgeon to discuss these options in greater detail.