What is breast reconstruction?
Many women who have a mastectomy—surgery to remove an entire breast to treat or prevent breast cancer—have the option of having the shape of the removed breast rebuilt.
Women who choose to have their breasts rebuilt have several options for how it can be done. Breasts can be rebuilt using implants (saline or silicone). They can also be rebuilt using autologous tissue (that is, tissue from elsewhere in the body). Sometimes both implants and autologous tissue are used to rebuild the breast.
Surgery to reconstruct the breasts can be done (or started) at the time of the mastectomy (which is called immediate reconstruction) or it can be done after the mastectomy incisions have healed and breast cancer therapy has been completed (which is called delayed reconstruction). Delayed reconstruction can happen months or even years after the mastectomy.
In a final stage of breast reconstruction, a nipple and areola may be re-created on the reconstructed breast, if these were not preserved during the mastectomy.
Sometimes breast reconstruction surgery includes surgery on the other, or contralateral, breast so that the two breasts will match in size and shape.
How do surgeons use implants to reconstruct a woman’s breast?
Implants are inserted underneath the skin or chest muscle following the mastectomy. (Most mastectomies are performed using a technique called skin-sparing mastectomy, in which much of the breast skin is saved for use in reconstructing the breast.)
Implants are usually placed as part of a two-stage procedure.
- In the first stage, the surgeon places a device, called a tissue expander, under the skin that is left after the mastectomy or under the chest muscle (1,2). The expander is slowly filled with saline during periodic visits to the doctor after surgery.
- In the second stage, after the chest tissue has relaxed and healed enough, the expander is removed and replaced with an implant. The chest tissue is usually ready for the implant 2 to 6 months after mastectomy.
In some cases, the implant can be placed in the breast during the same surgery as the mastectomy—that is, a tissue expander is not used to prepare for the implant (3).
Surgeons are increasingly using material called acellular dermal matrix as a kind of scaffold or “sling” to support tissue expanders and implants. Acellular dermal matrix is a kind of mesh that is made from donated human or pig skin that has been sterilized and processed to remove all cells to eliminate the risks of rejection and infection.