Breast Reconstruction is typically performed following mastectomy surgery. The initial procedure is carried out on the same day as the mastectomy (immediate reconstruction) or at a future date (delayed reconstruction). It is important to recognize that breast reconstruction is actually a sequence of operative and non-operative steps that requires a commitment by the patient and patience regarding the time required for completion. Several subsequent operations are often recommended to obtain reasonable shape, volume and symmetry. These may include: additional surgery of the reconstructed breast, modification of the normal/opposite breast, nipple reconstruction and areolar tattoo.
Breast Reconstruction techniques include use of a patient’s tissue (autologous methods), and use of tissue expanders and implants (prosthetic methods). Occasionally a combination of the two methods is appropriate. The selected method(s) are based on several issues including the patient’s age and health status, smoking history, history of radiation therapy/need for post-mastectomy radiotherapy, tumor stage and type, donor site factors and the size and shape of the opposite/uninvolved breast. The complexities involved in selection cannot be adequately distilled here and certainly require a thorough consultation.
Significant advances in the field of breast reconstruction are noteworthy, including “Acellular Dermal Matrix” use to help define pockets for tissue expansion and preserve the inframammary fold. Improvements in tissue expander designs and permanent gel implants over the past few years have greatly impacted outcomes. Advances in autologous tissue reconstruction allow for enhanced tissue volumes for reconstruction and potentially less donor site morbidity.
Nipple-sparing mastectomy and skin-sparing mastectomy approaches are frequently offered to patients, depending on their tumor pathology and/or reasons for mastectomy surgery. Much of the planning is coordinated between the general surgeon who performs the mastectomy and the plastic surgeon that provides the reconstruction. General surgeons and plastic surgeons work as a team to provide breast cancer patients with the optimal disease-free survival and optimal aesthetic outcomes. Breast reconstruction is typically covered by Medicare and health plans in California, and is based on medical necessity. Authorization for services is always required before procedures can be scheduled.
If one were to search the plastic surgery literature, it would become abundantly clear that the number of papers and presentations on breast reconstruction is overwhelming. This is indeed an exciting era for plastic surgeons as we work to assist patients to achieve satisfactory reconstruction following mastectomy. A satisfactory consultation requires roughly one hour in the office to (1) review pertinent medical records, (2) discuss the general surgeon’s recommendations, (3) discuss the patient’s motivation and expectations, (4) review pertinent medical and surgical history, (5) perform an examination, (6) discuss findings and provide alternatives for treatment, (7) make recommendations regarding definitive reconstruction, and (8) discuss risks and anticipated post-operative recovery.