Breast Reconstruction After Mastectomy

Improved quality of life, less anxiety and depression, and feeling more whole are the top reasons why women choose breast reconstruction after mastectomy. Though historically fewer older women have had breast reconstruction after the surgery, that trend is changing. There may be slightly more risk for older women as a group, but the emphasis is on the word “slight.”

According to a study published in Plastic & Reconstructive Surgery, the overall success rate of reconsructions for women younger than age 65 was 99.6 percent, whereas the success rate for women over age 65 was 96.3 percent. Another study reported that older women demonstrated higher sexual well-being for both reconstruction procedures (described below), and better physical and psychosocial well-being than younger women.

Statistics are important to consider, but what’s vital is making decisions based on an individual’s health and personal preferences.

 “No one single reconstruction is offered to all patients,” says Jaco Festekijan, MD, UCLA Division of Plastic Surgery. “It depends on multiple factors. What does skin look like after mastectomy? Does the patient have other illnesses? Can the patient tolerate long surgery? Is the patient going to receive radiation afterwards?”

According to Dr. Festekijan, reconstructions done at the same time as the mastectomy tend to have better outcomes. For more details on the procedures, see his video at http://tiny.cc/d541hz.

Autologous Reconstruction

The term “autologous” refers to using a person’s own tissue. Compared to prosthetic implants, autologous reconstructions can appear more natural, and they tend to last much longer, avoiding the need for revision surgery. UCLA plastic surgeons specialize in what’s considered the gold standard of autologous breast reconstruction, the deep inferior epigastric perforator (DIEP) flap. This operation is a muscle-sparing procedure that uses only fat and skin taken from the abdominal area. Preserving the rectus abdominal muscle decreases postoperative pain and minimizes the risks of abdominal weaknesses and bulging. This surgery also gives you a tummy tuck. If there is not enough tissue in the belly area, surgeons can also remove it from the buttock, hip, or thigh area to a create a new breast mound. On the downside, compared to implants, autologous procedures require two surgeries, the breast area and the area from which tissue is removed. Scars can be significant, though they do fade in time. Recovery time can also be longer with autologous reconstructions.

Prosthetic-Implant Reconstruction

Implants are filled with either saline or silicone. The saline method involves use of a tissue expander to slowly stretch the tissue. The process isn’t reported to be painful, but a slight pressure may be felt. After several weeks the desired size and shape are achieved, and the appropriate-sized implant is placed. For women who have undergone nipple-sparing mastectomy, a silicone implant can be positioned at the same time of the mastectomy. While both types of implants have a silicone shell, one is custom filled with saline; the other is prefilled with silicone. Silicone implants require follow up MRIs every two to three years to check for implant leaks. Leaks are possible with saline implants, but the body will absorb the saline, whereas silicone remains trapped within breast tissue. In either case, surgery will likely be needed to remove and replace the implant. It’s estimated that up to 20 percent of implants will need to be replaced within 10 years.

Managing Expectations

Recovering from mastectomy and reconstruction can take six to 12 weeks. As with all surgeries, there is risk of infection. Arm and shoulder range of motion might be restricted, and there is a possibility that scar tissue can form and create hard patches around the implant. Though you will likely be able to feel pressure when touched, normal sensation will not return to reconstructed breasts.

If you’ve been recently diagnosed with breast cancer, consider consulting with a multidisciplinary team of medical professionals to form a comprehensive treatment plan for your needs. Plastic surgeons should be part of that team, along with breast surgical oncologists, radiation oncologists, breast oncologists, and wellness counselors. You can find such teams at UCLA and other major medical centers nationwide.

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