It is often possible to construct a breast mound after mastectomy for cancer or other diseases. The procedure is commonly begun immediately following mastectomy, or alternatively, reconstruction may be done even years after the mastectomy (delayed reconstruction). There are pro and cons to both types. Breast reconstruction following mastectomy is covered under MSP in British Columbia.
Women whose cancer has been eradicated with mastectomy are candidates for breast reconstruction but also in some cases reconstruction can be a benefit to patients following partial mastectomy. Those with health problems such as obesity and high blood pressure and those who smoke are advised to resolve these issues first. Others prefer to postpone surgery as they come to terms with having cancer, consider the extent of the procedure, or explore alternatives.
The reconstruction may require several 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 using your own tissues. Your general surgeon and plastic surgeon will review with you the possible options.
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 that uses an implant, 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.
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Large breasts can cause pain, improper posture, rashes, breathing problems, skeletal deformities, and low self-esteem. Breast reduction surgery is usually done to provide relief from these symptoms. Performed under general anesthesia, the one and a half hour procedure removes fat and glandular tissue and tightens skin to produce smaller, lighter breasts that are more in proportion to the rest of the body.
During the breast reduction procedure an anchor-shaped incision or vertical is made from the new location of the nipple down to and around the crease beneath the breast. The surgeon removes excess glandular tissue, fat, and skin, relocates the nipple and areola, and reshapes the breast using skin from around the areola before closing the incisions with stitches. Liposuction may be needed to remove excess fat from the armpit area, and in cases when only fat needs to be removed from the breasts, liposuction alone is used for breast reduction.
For a few days after surgery the breasts are bound with an elastic bandage or a surgical bra and you may be given surgical drainage tubes for fluid removal. Stitches come out in a week and the surgical bra must be worn for about a month.
A little pain is normal after breast reduction, whether it's mild discomfort, swelling during menstruation, a measure of numbness or sensitivity, or random, shooting pains that may last for a few months. Swelling, bruising, crusting and slight changes in breast size are also common. Most patients return to work in about two weeks, although you should avoid heavy lifting for three to four and only gentle contact with the breasts should occur for six weeks.
Scars fade with time but will not disappear, although they can be hidden with a bra, bathing suit or low-cut top.
Risks are rare and usually minor but may include bleeding, infection, reaction to the anesthesia, small sores around the nipples, slightly mismatched breasts or unevenly positioned nipples, and permanent loss of feeling in the nipple or breast.
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