Breast cancer in most of the advanced cases is usually initially treated by surgical intervention such as mastectomy, which is the removal of one or both breasts that have been affected by cancer cells or by lumpectomy in case of localised lumps.. The breast tissues are completely/ partially removed, followed by chemotherapy and radiotherapy. Chemotherapy can also be followed by radiotherapy in some cases. After surgery, the scars may remain visible for quite some time, after which the swelling will reduce and the marks fade.
For women who lose their breasts, this can be a time of extreme distress. It affects their confidence and strength to return to their social life. Most women avoid physical contacts or hugs, lest someone should find out that they have lost a breast.
In these cases, the onco-surgeon shall inform you about breast reconstruction. Breast reconstruction helps build the shape and look of the breast. But at the same time, it should be kept in mind that breast reconstruction only restores the shape and size of the breast. It does not bring back the feelings or sensations native to the natural breast tissues.
It often takes multiple surgeries to give the best possible breast shape as an outcome.
WHAT IS BREAST RECONSTRUCTION?
Breast reconstruction is the recreation of breast shape after surgery. It can be done after complete removal of breasts, or as a part of breast conservation surgery.
If you choose to go for breast construction immediately after surgery, it is known as immediate reconstruction. If you choose to wear prosthesis after surgery and go for breast reconstruction later, it is known as delayed reconstruction.
The new breast shape can be created using a breast implant, or by using your own tissues from other parts of the body. The aim is to create a breast structure that matches the breast shape, size and form on the other side, but there would still be differences in the remaining breast and the reconstructed breast. After reconstruction, you should give ample time to the breast structure to heal and swellings to reduce and finally come to it’s breast shape, before going for another surgery, if needed.
If both breasts are being reconstructed, the breast shape is created in a way that it goes with the body proportion. It is mentionable here that having a breast reconstruction has no connection with breast cancer recurrence.
BREAST RECONSTRUCTION IS COMPLETELY YOUR DECISION
Choosing when to have a breast reconstruction, or whether you want to have a breast reconstruction at all, is completely your own personal decision. You may choose to go ahead with breast reconstruction surgery, or choose to wear a breast prosthesis, or choose neither.
Your surgeon shall let you know about breast reconstruction options that you have. You will also be notified about any risks associated to your health, if you go ahead with breast reconstruction surgery. There are possibilities of you being advised to not take up breast reconstruction in your lifetime as well.
WHO SHOULD YOU DISCUSS YOUR BREAST RECONSTRUCTION
The discussion about breast reconstruction is best done with an oncoplastic breast surgeon, who is a plastic surgeon trained with the techniques of breast reconstruction surgery. A detailed discussion about breast reconstruction surgery is important, because they will want to make sure you fully understand the reconstruction process and have realistic expectations of how your reconstructed breast will look and feel.
If you decide to go ahead with the surgery, the oncoplastic surgeon shall discuss it with your oncologist and decide the best time to go ahead with the surgery. If you need to undergo radiotherapy after chemotherapy, your breast reconstruction surgery may be delayed. This is because after radiotherapy, the skin may be inflamed and scars tissues might tighten, spoiling the shape of the breast form.
WHY CHOOSE BREAST RECONSTRUCTION FOR YOURSELF?
Losing one or both breasts is most likely to affect the look and feel of women. Most women find it difficult to accept their look, and even harder to return to social life. Breast reconstruction gives confidence and freedom to socialise to breast cancer survivors. Also, women feel more comfortable while getting intimate with their partners.
LIMITATIONS OF BREAST RECONSTRUCTION
A lot of women who undergo breast reconstruction surgery are more or less satisfied with the result. Their former looks are almost restored. But there are few limitations of this surgery:
- Reconstructed breasts would lack the movement and sensations of real breast.
- If you lose or gain weight, artificially reconstructed breasts shall not be affected, which might affect the overall body structure of yours.
- Recovery might take longer, as compared to mastectomy without breast reconstruction It might take several surgeries and follow ups to the hospital in order to achieve a proper breast shape and size for you cosmetically.
- There might be visible scars on other parts of the body, which might have been caused while removing the tissues from that area.
- Reconstructed breasts are usually without a nipple, but a nipple can be created later using tattoo, or prosthesis.
A reconstructed breast will not look and feel like a real breast, but it is usually not noticeable with clothing. The scarring shall usually fade away with time. Artificial breasts, especially created using implants, do not change over time. Natural movements usually are not possible as muscle contractions do not take place.
Despite all limitations, most women feel that breast reconstruction surgery has given them confidence about the way they look. If you are using breast prosthesis temporarily after mastectomy, unless advised, you have the option to undergo a breast reconstruction surgery later in life.
RECONSTRUCTION WITH BREAST CONSERVING SURGERY
Breast conserving surgery is wide local excision or lumpectomy, and is the removal of the cancer with a margin (border) of normal breast tissue around it. In this surgery, the cancer cells are removed, with a small lining of healthy breast cells, in order to preserve the shape and symmetry of the breast. The volume of the breast can be replaced by moving some of the remaining breast tissue around the breast to the hollow created during surgery.
RECOVERY AFTER BREAST RECONSTRUCTION SURGERY
The surgery is done under general anesthesia and the duration of surgery depends on the type of procedure being undertaken. The recovery time also depends on the same.
After you regain your senses, the breast that has been reconstructed would be dressed. In case tissues have been removed from other parts of the body to reconstruct the breast would also be dressed. You would be kept under observation for a few days to ensure that blood supply to the parts where surgery has been done is proper, and there is no swelling.
You might have drains placed in the areas of surgery to remove any excess fluid that may build up. If your surgeon advises you to be on the bed, you would also have a urinary catheter placed to drain out the urine from your body, till you are fit enough to use the toilet all by yourself.
You would be given antibiotics and painkillers to help in further recovery. The time taken for recovery shall depend on the type of surgery procedure undertaken and your inner strength.
RESUMING YOUR DAILY ACTIVITIES
The newly reconstructed breasts may take a while to settle and resemble the other natural breast. The breast form may be bruised and swollen initially, and the scars shall settle later on.
In due course of time, you would be able to resume your daily activities. It is advisable that you slowly reintroduce yourself to these activities. Restrain yourself from activities like driving, swimming and profuse physical exercises while you are recovering. Stop immediately if you feel your are feeling over exerted with any activity. In case you experience bleeding, pain, infection or blood/ fluid build-up, you should immediately report to your surgeon.
When you feel strong enough, you can return to work, however, you would still need to attend regular follow up sessions with your doctor.