Understanding Breast Reconstruction
What do I need to know?
Learn more about the reconstruction options available to you after treatment.
Breasts are made up of a complex network of milk ducts and glands surrounded by fat and connective tissue that helps to hold everything in place. The breast itself does not have any muscle, but the chest muscle (pectoralis major muscle) is located directly beneath the breast.
The amount of fat in your breasts largely determines their size, shape and feel. Breast tissue is sensitive to changes in hormone levels and the size and shape of your breast may change over time, particularly during puberty when the breasts begin to grow, through periods of weight loss or pregnancy, and following menopause when breast tissue volume often decreases.
Figure 1: Anatomy of the Breast. Reference: https://breast360.org/topics/2017/01/01/breast-anatomy/
After treatment care will help you monitor your physical recovery process and overall health. Breast reconstruction and reconstruction alternatives offer a way to regain a sense of wholeness and conﬁdence.
When you have completed your breast treatment, it is important to keep regular appointments with your doctor to monitor any lingering side effects, be alert to signs of recurrence and address any other symptoms that concern you.
Initially, your follow up appointments will be scheduled every three to six months.
After ﬁve years without disease recurrence, your follow-up appointments may be reduced to annual visits. If you did not have a mastectomy—and so your breast was conserved—you will continue to need yearly mammograms.
If your doctor suspects recurrence at any time, he or she may order imaging scans, biopsies and/or blood tests.
Taking care of your emotional well being, as well as your physical health, should be one of your top priorities. Our coping tips will help you on your path to regaining your familiar sense of self and improving your quality of life.
Breast reconstruction is a highly personal choice with many factors to consider when deciding if it is right for you. Learning as much as possible about reconstruction, getting a realistic idea of what can be achieved and understanding how each of the options might impact on you and your lifestyle is important. By starting the conversation with your surgeon early on in your breast journey you will be optimising the choices you potentially have available.
Most women will have surgery as part of their treatment for their disease and will have either;
Both types of surgery usually involve removal of one or more lymph nodes from the armpit to determine if the disease has spread outside the breast.
The type of surgery you are offered or recommended will depend on your individual situation and your personal preference and will take into account such factors as your age, the size and grade of your disease, the likelihood of recurrence spread and whether you carry a genetic mutation.
Before any surgery occurs it is important to understand and to discuss your breast reconstruction options with your surgeon to decide whether reconstruction is right for you, what type of reconstruction would be best, and whether to have it at the same time as your mastectomy (immediate reconstruction) or some time later (delayed reconstruction).
Total mastectomy (also called simple mastectomy): In this procedure, the entire breast tissue is removed, but the axillary (under-arm lymph nodes) contents are undisturbed. Sometimes the decision is made to remove the healthy breast alongside the diseased tissue in order to reduce the risk of recurrence. This procedure is called a contra-lateral prophylactic mastectomy.
Modified radical mastectomy: This procedure is usually recommended for women with invasive disease. It involves removing the entire breast as well as one or more lymph nodes under the arm. Examining the lymph nodes helps to identify whether disease cells may have spread beyond the breast.
Skin sparing mastectomy: With this technique, the skin of the breast is preserved, but not the nipple and areola, which are removed. The breast tissue is removed through a conservative incision made around the areola (the dark part surrounding the nipple). The increased amount of skin preserved, as compared to traditional mastectomy resections, aids breast reconstruction procedures as it results in less scarring and a better aesthetic outcome. It is often used with immediate reconstruction procedures. Not all patients will be suitable for skin sparing mastectomy
Nipple sparing mastectomy: This procedure not only preserves the skin of the breast, but the nipple and areola complex too. Reconstruction following a skin and nipple sparing mastectomy usually results in a better cosmetic outcome, with less scarring, but is not always a possibility for all women. It is however the treatment of choice for prophylactic cases or for mastectomy due to benign disease.
Partial mastectomy: Partial mastectomy is the removal of the diseased part of the breast tissue and some normal tissue around it. While lumpectomy is technically a form of partial mastectomy, more tissue is removed in a partial mastectomy than in lumpectomy.
Radical mastectomy: This was the earliest form of mastectomy and the procedure involved removing the entire breast, the underlying chest wall muscles as well as the lymph nodes in the region. It is rarely performed these days because in most cases, modiﬁed radical mastectomy has proven to be just as effective.
Breast reconstruction is the rebuilding of your breast. Breast reconstruction can take place during or soon after your mastectomy. In some cases, this can be many months or even years after mastectomy.
While breast reconstruction is not for everyone, many women ﬁnd that it is an opportunity to get back something that has been taken away. Some women view it as a positive step in reclaiming their lives after their disease.
Breast reconstruction may be carried out by your breast surgeon (who may have had specialised training in oncoplastic techniques), or by a reconstructive plastic surgeon, depending on the procedure to be performed.
Reconstructive surgeons specialise in their preferred procedures, and each surgeon may recommend something different for you, so if you can, it is a good idea to get more than one opinion.
To achieve the ﬁnal result, breast reconstruction may take several procedures over many months. The aim is to create a natural shape when you are clothed but it is important to understand that your new breast will not look, respond, or feel the same as the breast you had removed, and this can take a while to adjust to.
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