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Breast
Reconstruction to Help You Move Forward
Over 180,000 women in the US each year are diagnosed with breast cancer. You are
not alone. Like you, many women have the option of Breast Reconstruction after
their mastectomy. There is a growing acceptance and popularity for breast
reconstructive surgery among mastectomy patients and in the medical community.
Be sure to ask your breast surgeon or general surgeon about your Breast
Reconstruction options early on in your treatment plan.
While not everyone chooses to have Breast Reconstruction,
women with Breast Reconstruction have reported an increase in self-confidence,
gained emotional well-being, renewed body image and an increased sense of
femininity and sexuality.
While you're considering your treatment options, empower
yourself and make an informed decision about Breast Reconstruction. This is a
personal choice that your breast surgeon (or general surgeon) and plastic
surgeon are ready to discuss with you, and plan for, right at the
onset of your treatment for breast cancer.
Fully exploring your options will help you make the best
choice for your body and your life after cancer. And research has shown that the
more informed you are about Breast Reconstruction upfront, the better your plan
will be. This look at Breast Reconstruction provides insight for a knowledgeable
decision.
While Breast Reconstruction can be performed at the time
of your mastectomy or delayed months or even years, knowing your options now can
reduce your fear and strengthen your decision. Once
you have read this information, be sure to consult with your breast/general
surgeon and plastic surgeon to determine what option is right for you. |
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“I wanted to be myself, not a ‘cancer victim,’ and getting my breasts back helped me to feel attractive and empowered. The truth is that after I was diagnosed with cancer, I felt that my body had let me down. Breast Reconstruction helped me become friends with my body again.”
Alex, age 49, underwent breast implant surgery following a double mastectomy |
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You Have Options
There are different types of Breast Reconstruction
surgeries available. Although the options your plastic surgeon can offer you
will not look or
feel exactly like your natural breasts, the field of Breast Reconstruction has
made great strides in recent years to create a more aesthetic breast
shape that looks and feels more like real breasts. |
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The
Women's Health and Cancer Rights Act (WHCRA) requires group health plans
and health insurers that provide medical benefits covering mastectomy to also
cover the cost of breast reconstructive surgery for women who have undergone
mastectomy. Coverage must also include all stages of reconstructive surgery of
the diseased breast, procedure to restore and achieve symmetry on the opposite
breast, and the cost of prostheses and complications of mastectomy. For more
detailed information about WHCRA, please refer to the Department of Labor's
"Your Rights After Mastectomy" website at
www.dol.gov/ebsa/Publications/whcra.html. |
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A Look at the Most Commonly
Performed Breast Reconstruction Procedures
Your plastic surgeon may offer the following
Breast Reconstruction procedures. At the end of the overview
you will find a summary chart for these surgical options.
Two-Stage Reconstruction
with Breast Implants |
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Two-Stage Breast Reconstruction
procedure use tissue expanders to create pockets for the placement of breast
implants. |
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This process creates a new
breast shaped pocket in preparation for your next stage of reconstruction:
placement of the implant. |
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Stage One - A
tissue expander is a silicone shell that is filled slowly over time with
saltwater to stretch the skin and make room for your implant.
The expander is placed under your chest skin at the site of your planned
reconstructed breast. A small needle is used to fill the expander with
sterile saline. The needle is inserted through the skin to a "fill port" located
inside the expander. Gradually over time, the overlying tissues
expand, much like a woman's abdomen during pregnancy. |
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Stage Two - The placement of your breast implant is the second part of
the Two-Stage Breast Reconstruction process. After your tissue
expander has reached an ideal pocket size, your plastic surgeon will perform
surgery to remove the tissue expander and place your saline or
gel-filled breast implant. This is a routine procedure that usually takes 1 to 2
hours and should require no hospital stay. You should fully recover
from the procedure in 2 to 3 days, completely able to resume your normal
activities. |
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Before nipple-sparing
mastectomy |
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Stage1 with Natrelle®
Tissue Expander |
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Stage 2 with
Natrelle® Style 20 500cc gel-filled Beast Implant |
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Before total
mastectomy |
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Stage1 with Natrelle®
Tissue Expander |
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Stage 2 with Natrelle® Style 20 400cc gel-filled Beast Implant, and
Nipple Reconsruction |
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Your Breast Reconstruction Choices with
Breast Implants |
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| Silicone - Gel Breast Implants |
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• Natrelle® silicone gel-filled breast implants have experienced worldwide
acceptance for more than 25 years in over 60 countries.
• They were approved by the Food and Drug
Administration (FDA) for use in the US in November 2006.
• A Gel-filled breast implants has an elastic silicone
rubber shell and is filled with cohesive silicone gel.
• The safety of Natrelle® silicone gel-filled breast implants meet one of the most rigorous standards of
all medical devices. |
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| Saline Breast Implants |
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• Saline-filled breast
implants were approved by the FDA in May 2000.
• A Saline-filled breast implants has an elastic silicone
rubber shell and is filled with sterile saline (saltwater).
• During the breast implant stage of your reconstruction,
empty implants are placed in the newly formed pockets under your breast tissue
and then filled with saline fluid to the size you and your plastic surgeon
agreed upon. |
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A further look at the Safety of
Silicone Gel-Filled Implants
Like many other medical devices on the market today, silicone gel-filled breast
implants have evolved substantially over the
last two decades. Today's Natrelle® silicone gel-filled breast implants have an advanced technology and enhanced
safety profile
thanks to several refinements in product design and manufacturing. The most
significant advancements available today include a
more cohesive silicone gel and a thicker, yet supple shell with an additional
barrier layer that is distinct from earlier breast
implant devices. |
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Low long-term
rupture rates: To assess the long-term safety of Natrelle® breast implants, Allergan conducted extensive clinical studies
both in the United States and in Europe. These studies show that silicone
gel-filled implants have low long-term rupture rates. In fact, the results of
the European research found that after 11 years, 92 percent of implants were
still intact. |
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“The reason was simple: my breasts had been with me for the first 50 years of my life and I wanted them there, in place, for the next 50 years as well. My goals for surgery were to look and feel like myself again and to feel ‘whole again.’ It was my way of dealing with the trauma I, along with many other women, had suffered and prevent my disease from leaving a permanent imprint on my body.”
Dr. Christine Rodgers, cancer survivor and plastic surgeon |
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Rigorous testing:
Today's breast implants in the Natrelle® Collection undergo thorough testing and meet the very high standards of Allergan
quality. They are backed by an unsurpassed warranty that reflects the Allergan
commitment to quality.
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Ongoing research:
Through ongoing research Allergan is constantly assessing the impressive
long-term safety record of our full line of elegant silicone gel-filled breast
implants. |
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Natrelle® silicone gel-filled breast implants are one of the most studied
FDA approved medical devices in existence. There have been hundreds of
peer-reviewed studies and published reports involving silicone gel-filled breast
implants, including robust epidemiological studies supporting their use. The
Institute of Medicine of the National Academies (IOM), concluded in its landmark
report (IOM, 1999) that "a review of the toxicology studies of silicones and
other substances known to be in breast implants does not provide a basis for
health concerns." More information about the safety of silicone gel-filled
implants can be found in the IOM report at
www.iom.edu/CMS/3793/5638.aspx.
For safety data on implants go to
www.fda.gov/cdrh/breastimplants and please
read the complete patient information at
www.natrelle.com/safety_info.aspx. |
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Tissue Flap Breast Reconstruction Options
Breasts can also be reconstructed by surgically moving a section of skin, fat
and muscle from one area of your body to your chest, this is referred to as an
Autologous Reconstruction.
In Autologous Reconstruction, tissue is taken from your
abdomen, upper back, upper hip or buttocks. Depending on your plastic surgeon's
surgical plan, the tissue flap may be left
attached to the blood supply and moved to the breast area through a tunnel under
the skin
called a Pedicle Flap, or it can be removed completely and reattached to the
breast area by
a microsurgical technique called a Free Flap.
The advantage of flap surgery is the replacement of chest
area tissue. This is an important consideration if: |
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“A plastic surgeon specializing in Breast Reconstruction, worked in tandem with my surgical team so that I came out of the mastectomy with ‘expanders’ where my breasts had been, which would make room for my permanent silicone implants. I chose
NATRELLE® silicone gel-filled breast implants because I felt that they were the most natural appearing option.”
Alex, age 49, Denver, CO,
underwent breast implant surgery
following her double mastectomy
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Your chest tissue has been damaged and is not suitable
for tissue expansion |
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Extra tissue is needed to recreate a large breast without
a breast implant
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Extra tissue coverage is needed over a breast implant |
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Unlike Two-Stage Breast Reconstruction
with breast implants, Flap Reconstruction is a major surgery. It requires a
hospital stay of several days and longer recovery time than the tissue expander
and implant reconstruction process.
Flap surgery also creates scars at the site where your flap was taken and
additional scars are possible at the site of your reconstructed breast.
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It is important to reinforce that tissue
flap surgery, particularly the TRAM and DIEP flaps, are major surgeries, more
extensive than your mastectomy. They require good general health and strong
emotional motivation.
If you are very overweight, smoke, have had previous surgery in the area the flap
would be taken, or have any circulatory problems, you may
not be a good candidate for a tissue flap procedure. If you are very thin, you
may not have enough tissue in your abdomen or back to create a breast using this
method. |
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The Three Most
Frequent Types of Flap Surgery
TRAM
Transverse
Rectus
Abdominus
Myocutaneous
Flap |
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TRAM surgery involves moving fat, skin
and muscle from the lower abdomen (C) to create a new breast mound (A).
The surgery is approximately 3 to 6 hours long, requires a
hospital stay of 2 to 5 days and 6 to 8 weeks to resume normal daily activity.
Some women refer to this as the "tummy tuck" procedure,
because a flatter stomach is often part of your result. Obtaining the flap for
your new breast will leave a scar on your abdomen. |
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DIEP
Deep Inferior
Epigastric Perforator
In simple terms, DIEP is a TRAM surgery without using the muscle from your
abdomen; just the skin and the fat. This
procedure uses microsurgery to reattach the blood supply to the flap once it is
placed on your chest. And like a TRAM
flap, DIEP surgery is approximately 3 to 6 hours, requires a hospital stay of 2
to 5 days and 6 to 8 weeks to resume
normal activity. The scarring concerns are the same as with the TRAM procedure. |
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Latissimus Dorsi Flap
Sometimes called the Latiss Flap, this procedure involves taking the latissimus
muscle from your back and rotating it around to your front to create, or help
create a breast mound. Sometimes an implant is used when the muscle isn't large
enough to produce the desired size. This will leave a scar on your back.
The surgery is approximately 2 to 4 hours, requires a
hospital stay of about 2 to 3 days and 2 to 3 weeks before you can resume normal
activity.
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“Breast reconstructive surgery helped me feel whole again following my mastectomy. It was an essential part of my recovery process and I’m so happy reconstructive surgery was an option for me.”
Bliss, age 58, Long Beach, CA,
Underwent Two-Stage Breast Reconstruction surgery |
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Summary Chart of Surgical Options |
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Additional Breast Reconstruction
Considerations
Whether you have breast implants placed following a
tissue expander or a tissue flap reconstruction, the following surgical
procedures are
options your surgeon may consider to complete your breast reconstruction. For
some women it is important to leave the unaffected breast
entirely as it is. You should discuss this with your plastic surgeon to assure
the right breast reconstruction method is presented to meet your
goals. |
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Improving Symmetry
If you have a unilateral mastectomy, it may be difficult for the surgeon to
exactly match the remaining breast, particularly if you have large breasts or if
your breasts have sagged with age or from bearing children. In order to help
improve symmetry between your natural and reconstructed breasts, your plastic
surgeon may recommend:
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“I didn’t realize how closely
connected my breasts were to
my sense of self until I was faced with the idea of losing them. I wasn’t going to let
cancer take away my spirit
or my curves.”
Margaret, age 44,
Golden, CO |
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Mastopexy: A breast lift |
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Mammoplasty: A breast reduction |
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Augmentation Mammoplasty: A breast enlargement |
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surgeon considerations. |
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Nipple
and Areola Reconstruction
If the nipple is removed with the breast tissue during a mastectomy, but there
are
nipple reconstruction solutions. Your nipple can be reconstructed using a small
skin
graft or by taking part of the nipple from your opposite breast. And your areola
may be reconstructed with a skin graft, or by tattooing the area to enhance the
color to
match your opposite breast. |
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Your nipple and areola reconstruction may be performed at
the time of your implant placement or as a separate outpatient procedure after
the
initial reconstruction surgery is complete. |
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Questions Your
Plastic Surgeon Can Answer
If you are considering breast reconstruction, a
plastic surgeon can provide you with information that fully explains the risks
and complications associated with breast implants, tissue flaps and with breast
reconstruction surgery itself. You can find a plastic surgeon in your area by
using
the Find a
Surgeon directory on Natrelle.com.
It is recommended that you read all of the information
provided before scheduling your surgery, so that you have plenty of time to ask
questions
and evaluate all of your options. |
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“My breast cancer diagnosis was traumatic enough, and just when I felt at my lowest, suddenly there were so many decisions to make. I was grateful for the many treatment options, but when faced with a life-threatening illness, the information can be really overwhelming. Finding a doctor that took the time to answer all of my questions made all the difference.”
Bliss, age 58, Long Beach, CA. Cancer survivor and Two-Stage Breast Reconstruction patient |
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What are all my options for breast reconstruction? |
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What are the risks and complications of each type of
breast reconstruction
surgery and how common are they? |
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What if my cancer recurs or occurs in my other breast? |
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Will reconstruction interfere with my cancer treatment? |
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How many steps are there in each procedure, and what are
they? |
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How long will it take to complete my reconstruction? |
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How much experience do you have with each procedure? |
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Do you have before and after photos I can look at for
each procedure? |
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What results are reasonable for me? |
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What will my scars look like? |
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What kind of changes in my reconstructed breast can I
expect over time? |
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Can I talk with other patients about their experiences? |
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What is the estimated total cost of each procedure? How
much is my
insurance expected to cover? |
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How much pain or discomfort will I feel, and for how
long? |
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How long will I be in the hospital? |
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Will I need blood transfusions, and can I donate my own
blood? |
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When will I be able to resume normal activity (or sexual
activity or
athletic activity)? |
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Where can I get more information? |
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Is there a warranty that covers my
implant(s)? |
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