Modern surgical technology makes it possible to construct a natural-looking breast after mastectomy (breast removal) for cancer or other diseases. The procedure is commonly begun and sometimes completed immediately following mastectomy, so that the patient wakes with a new breast mound instead of no breast at all. Alternatively, reconstruction may begin years after mastectomy. Many insurance companies cover reconstruction following breast cancer surgery, and legislation is currently before Congress to make coverage mandatory.
Women whose cancer seems to have been eradicated with mastectomy are the best candidates for breast reconstruction. Those with health problems such as obesity and high blood pressure and those who smoke are advised to wait. Others prefer to postpone surgery as they come to terms with having cancer, consider the extent of the procedure, or explore alternatives.
The reconstruction itself consists of multiple operations, the first of which involves creation of the breast mound and is performed during or after mastectomy in a hospital under general anesthesia. Later surgeries, if necessary, may be done in the hospital or an outpatient facility, with either general or local anesthesia.
There are several ways to reconstruct the breast, both with and without implants; your breast surgeon and plastic surgeon should work together with you in deciding which approach is best for you.
Breast reconstruction has not been proven to affect the recurrence of cancer or other diseases, chemotherapy or radiation treatment.
Nevertheless, in addition to the complications possible from any surgical procedure (bleeding, fluid collection, excessive scar tissue, or difficulties with anesthesia), there are some risks inherent in breast reconstruction, including infection around the implant, if an implant is used, and capsular contracture, when the scar (capsule) around the implant tightens, causing the breast to feel hard. Treatment for capsular contracture varies from "scoring" the scar tissue to removing or replacing the implant. Some patients may need time to come to terms emotionally with their new breasts.
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While many women are happy with their breast augmentation performed by other surgeons, some patients come to us seeking revision surgery after unsatisfactory results from their initial procedure. These feelings of unhappiness may be caused by the shape, size or placement of the implant, or by complications that occurred after the procedure. Other patients also come to us because of safety concerns caused by their initial procedure. Even patients who are happy with the results of their initial procedure require additional procedures to replace their implants after a certain amount of time.
Revision breast augmentation is often performed through a procedure very similar to the initial augmentation surgery, with slight modifications made depending on the reason for revision. After these procedures, patients are able to fully enjoy the breast size, shape and position they desire.
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