For women, losing a breast to cancer is a fearful event that negatively affects their body image, identity and self-esteem. Advancements in breast reconstruction procedures have enabled plastic surgeons to replace the breast mound. Follow along what a typical breast reconstruction patient goes through as she goes on a personal journey to reclaim a healthier body, mind and spirit.
Step 1: Evaluating Breast Reconstruction Post-Mastectomy
Faced by mastectomy after breast cancer, women must confront and endure the emotional pain and psychological trauma of losing a breast. While family, friends or doctors may offer suggestions following cancer treatment, a woman will independently decide whether to replace their breast via non-surgical options or breast reconstruction.
As an elective procedure, breast reconstruction is covered by insurance. By law, insurance companies are required to cover breast reconstruction at any time after mastectomy and may include surgeries on the opposite breast for achieving symmetry. Deciding whether or not the advantages of having a new breast outweigh the costs of surgery, the breast cancer patient must evaluate how reconstruction will ultimately affect their lives.
Step 2: Making a Decision to Go Ahead with the Procedure
With the comfort to replace their breast, women will make the decision to undergo reconstruction to reclaim identities and get their lives back to normal. Breast reconstruction may help women feel better about their bodies, feeling more balanced, feminine and confident. Upon making a decision, Loma Linda University Medical Center (LLUMC)’s experienced patient support staff stands by the patient’s side to facilitate approval for reconstruction. Our staff works with all major insurance companies to help our patients sort through the details of their individual insurance plans.
Step 3: Consulting with a Plastic Surgeon
Once a woman is accepted to be a candidate for breast reconstruction, she will have an extensive and detailed consultation with one of LLUMC’s board-certified and fellowship-trained plastic surgeons. The patient will be fully informed about her surgical options and guided to make the best decision possible.
Our plastic surgeon will provide their recommendations for the most appropriate treatment based on her preferences, lifestyle, anatomy, medical condition as well as the best suited options in the occurrence of future cancer treatments. These same factors will also determine when the breast reconstruction procedure will be performed – either at the same time as the mastectomy (immediate reconstruction) or at a time after the mastectomy (delayed reconstruction).
Step 4: Undergoing Breast Reconstruction All the Way to Completion
After consulting with one of our plastic surgeons, patients undergoing breast reconstruction to completion will go through staged surgery. The two major kinds of breast reconstruction procedures are implant or natural tissue-based surgery (and oftentimes, the procedure may include a combination of the two). Depending on the surgical procedure, the process for reconstruction will vary accordingly for each individual patient.
Additionally, since insurance companies pay to treat the opposite breast for symmetry, it is usually at this stage in which the plastic surgeon will perform a breast lift, augmentation or reduction on the opposite breast to provide the patient a matching pair of breast mounds.
- Implant Reconstruction Surgery
Breast reconstruction using the tissue expander/implant technique requires two-stages, based on the patient’s breast size. The first surgical procedure involves the placement of a tissue expander – a silicone balloon (which will be filled with saline) – below the chest muscle to accommodate the size of the implant needed for matching the opposite breast. Generally, this initial surgery to place the tissue expander under the muscle takes about an hour or two to complete. It can be performed on an outpatient basis, but may require a hospital stay overnight.
After a one to two week recovery period following the tissue expander placement, the LLUMC plastic surgeon will start a series of expansions. A patient will be set up for weekly appointments with the plastic surgeon to fill their expander with sterile saline, inducing expansion of the overlying skin. Patients are able to continue their day-to-day lives during the process of expansion.
Approximately one to three months after the tissue expander is fully expanded to the correct size, the patient undergoes a second surgical procedure in which the tissue expander is exchanged and is replaced with a permanent saline or silicone gel-filled breast implant.
- Natural Tissue-Based Surgery:
Resource link: Information about Tissue Expansion
While natural tissue reconstruction can be done using other sites including the back, abdomen or buttock, the most common type is the TRAM Flap reconstruction procedure that uses skin, fat and muscle from the patient’s lower abdomen to recreate the breast via either the pedicle flap or free flap technique.
In the pedicle procedure, the tissue is separated from its original location without being disconnected to the blood supply. It is brought up through the mastectomy site and is sculpted to look like the other breast. The Free TRAM procedure uses the same tissue, but instead of remaining attached, the tissue is completely removed from the body. The tissue is sculpted to the shape that matches the other breast and is then reattached to the blood vessels around the chest using microsurgical procedures.
During the first few days after the procedure, our patients are carefully monitored for potential complications. While the patient must deal with longer hospitalization (approximately four or five days) and recovery, the patient’s breast mound is essentially complete.
Step 5: Attending Follow-up Appointments and Procedures
The patient will have a month or so to let the reconstructed breast mound settle. Patients are later brought in for a simple outpatient procedure. To complete the surgical process, nipple areolar reconstruction is performed by the plastic surgeon using tissue locally off of the breast mound and rearranging it to form and resemble a raised nipple. After about six weeks of healing, the patient returns to achieve symmetry of the breasts, whereby the skin is tattooed to resemble the texture and pigment of the opposite nipple and areola.
Step 6: Feeling Whole Again
After a brief recovery period, breast reconstruction patients are able to return to work and get back to the daily activities they enjoy doing. They benefit in overcoming the emotional, physical and mental consequences of dealing with a mastectomy. Months or even a year following a procedure, many patients come to a realization that the restoration of their breast has positively impacted their body image and self-esteem. Aside from improving their lives, our patients feel like a whole person again.
Undergoing Breast Reconstruction at LLUMC
Whether immediate or delayed, all breast reconstruction procedures are done over 3-5 different operations. Please keep in mind that additional operations may be needed for further revisions. Read and sign our patient letter below to learn more about the surgical process here at LLUMC:
Make a Breast Reconstruction Appointment Today
When you lose a breast to cancer, it is comforting to know that surgical options are available for you to replace it and feel better about your body. Combined with the ease of scheduling an appointment, LLUMC’s highly accredited staff is deeply dedicated to helping you get back on track to a healthy life. Our commitment to whole person wellness begins with your request for a consultative appointment with one of our plastic surgeons. To set up a breast reconstruction appointment, please call us at 909-558-2100 or e-mail the Department of Plastic Surgery.