Breast cancer is the most common cancer that afflicts women, and it can be life-altering. Life after cancer is never the same anymore, and a lot has to do with the mental and emotional trauma and the body-image issues that women face. Breasts are an extremely important asset for women. Mastectomy is the partial or complete removal of one or both breasts and is a treatment for breast cancer. If you or a loved one are undergoing treatment for breast cancer, then you must have come across the term breast reconstruction surgery. It is a surgery to rebuild your breast(s) and may be performed immediately or after a hiatus after mastectomy. For women losing their breasts can be extremely traumatizing, and can make them depressed and anxious, and can tremendously affect their relationships and self-confidence. Some women may opt for reconstruction surgery, prosthetics or for some, they are willing to embrace their new body with aplomb. Consult with your oncologist and plastic surgeon to decide the best course of action, but it ultimately depends on what you desire. Read on to learn more about breast reconstruction post-mastectomy. Facts about breast reconstruction There are two options for breast reconstruction, depending on several factors: · Implants or prosthetics using saline or silicone. · Autologous or skin flap surgery can be performed by taking tissue from other parts of the body like abdomen, back, buttocks or thigh. Sometimes doctors might use both methods to attain a more natural form of the breasts, but it won’t have the look or feel of your original breasts. The reconstructed breasts will lose sensation. Breast reconstruction surgery can be started at the time of mastectomy known as immediate breast reconstruction or it can be done after some time and is known as a delayed mastectomy. The timing will depend on your medical conditions and cancer treatment. If you have to undergo chemotherapy and radiation post-surgery then the doctor might suggest the latter option. Also, women with inflammatory breast cancer may have to wait for some time before reconstruction surgery since there is extensive skin removal. Implants Implant procedure occurs in two steps. Firstly, a tissue expander is placed under the skin or chest muscle and it is slowly filled with saline or silicone gradually over several weeks. In the second step, after the chest tissues have healed, the expander is removed and an implant is inserted. In some cases, the doctor might use an implant directly and not use an expander. For this method to be viable enough skin and muscle have to remain to cover the implants. It is a shorter surgical procedure with minimal blood loss. Autologous or skin flap surgery It is a highly critical and complex surgery, wherein tissues from one part of the woman’s body, containing skin, fat, blood vessels and even muscle is taken to rebuild the breast. It can be done by 2 methods: · Free flap surgery In this method, the plastic surgeon will remove tissues along with blood vessels and is attached by micro-surgery to the blood vessels at the breast area. The various methods of this reconstructive surgery are: 1. IGAP flap-the tissue along with skin, blood vessel and fat is taken from the buttock area. 2. PAP flap-tissue without muscle is taken from the inner thigh 3. SGAP flap-the tissue is obtained from the woman’s buttock region 4. TUG flap-tissues from the inner thigh is taken along with the muscle. · Pedicled flap surgery in this method, the doctor doesn’t remove the tissue from its blood vessel but rotates it to reconstruct the breast. If the tissue is taken from the abdomen, it is known as TRAM flap and if taken from the back then it is called the LD flap. Autologous reconstruction is a longer surgical procedure and the initial recovery period is much longer. Nipple reconstruction In a mastectomy, unless your oncologist suggests nipple-sparing mastectomy, the nipple and areola are removed. In the reconstruction surgery, after the chest tissues have healed, the plastic surgeon might reconstruct the nipple and areola. Skin can be taken from the abdomen and back to create the nipple and areola is created by tattooing. Prosthetic or 3-D nipple tattooing is also an option. Recovery from breast reconstruction surgery You would need to remain hospitalized for several days in the hospital after breast reconstruction surgery. It takes about 6-8 weeks for women to return to their daily activities. During this period, you might experience fatigue, pain, bruising, swelling, and soreness in the area of the surgery as well as the area from where the tissue was taken. The shape improves over time and the scars heal too. The surgeon might restrict certain activities like overhead liftings and laborious exercises. The plastic surgeon will check your breasts regularly. If reconstruction is performed on only one breast, then mammography has to be performed on the other breast. Always have a realistic expectation from the breast reconstruction surgery, since neither will the new breast look like your original breast nor will it have the same sensation as before. Risks and complications involved · Internal bleeding and clots · Infection · Necrosis of the transplanted tissue · Fluid build-up · Uneven breast · Rupture or leakage of the implant · Loss of muscle strength · Need for further surgeries · Complication with anesthesia · Fatigue · Slow healing and scar tissue formation · Change in breast and nipple sensation Your age and overall health will determine the line of treatment and for the surgery to be successful, women who smoke would be required to quit. Choosing to have a breast reconstruction surgery is extremely personal and it is important to make the choice after proper deliberation. Breasts are associated with a woman’s sexuality, posture, and confidence. So it is imperative to have a strong support system to help a woman recover from this extremely difficult phase. You can also opt for counselling and visit a support group of cancer survivors. Remember ladies, it is your body and your choice to have surgery or wear prosthetics or to not opt for any of the two.