Breast Reconstruction/Difficult Cases

 Background
 Classfication Of Reonstruction Cases
 Patient Concerns and Planning
 Preparing for Surgery
 The Operation
 Recovery
 At Home
 Office Visits and Follow-up
 Outcome and Complications
 Case Histories (Before and After)

BACKGROUND
Plastic Surgeons are called upon to perform breast reconstruction in situations of:
1. Severe alterations of breast shape including marked asymmetry.
2. When there are major alterations of shape as a result of previous breast surgery.
3. Restorative surgery as a result of cancer treatment including mastectomy and radiation change.
4. Planned mastectomy in patients at extreme risk of developing breast cancer by virtue of a strong family history of early breast cancer and when multiple breast tumors place a patient in a fearful state.

Some of the reconstructive types of breast procedures are covered in the Revisionary Surgery Section, and in the Breast Augmentation Section, but for the most part this section covers the most challenging problems encountered by the Plastic Surgeon. Ordinarily, a patient's insurance may covered all or part of the services covered for reconstruction. In recent times with restriction of medical benefits particularly in patients who have silicone gel implants, the patient must seek help outside the bounds of third party reimbursement. A planned approach to these types of breast problems must take into account the financial burden that may be born by the patient, and the usual multiple staged operations that may be standard such as for mastectomy reconstruction. A single-stage focused strategy may be necessary in order to treat these patients and deliver the best possible Plastic Surgical care in one operation.

In patients of record who may experience early or late complications of breast implants and breast lift, the surgeon usually provides services of corrective surgery at a reduced surgeon's fee. Sometimes the services may be covered by insurance for the hospital and anesthesia services. The most common problems in this category include wound healing problems that may occur rarely in augmentation with lift surgeries. Infection can lead to implant removal and surgical treatment of the inflamed tissues that can lead to consequences of poor healing, scarring, and asymmetry.

When there are problems such as leaking implants or saline implant deflation, the manufacturer will usually replace the implant at no charge, and within a set period of time, will help with finances for the replacement costs themselves. Each manufacturer has extended warranty programs at a modest cost to help defray costs of implant replacement if there is implant failure.

For patients who are advised to have a prophylactic removal of one or both breasts due to a strong family history of cancer, and frequent surgeries to remove breast tumors and lumps, the decision to remove normal and non-cancerous breast tissue requires careful counseling with the patient and the family. The results of reconstruction for prophylactic or protective mastectomy may not be as pleasing as with primary breast restorative surgeries including augmentation, lift, and reduction. The reduction in psychological stress, worry, and fear are less in women who have high risk breasts treated by mastectomy, but the aesthetic satisfaction with the results of breast reconstruction in this situation may fall below expectations.

Minimally invasive mastectomy and skin-sparing mastectomy for precancerous breasts and those with cancer have been available in selected cases since the early 1990s. A careful combined strategy by general surgeon and plastic surgeon in the right patient can provide a proper cancer operation for disease and a proper reconstruction with more residual skin left behind. The type of reconstruction in cases of breast cancer will depend on tumor cell type, stage of disease, patient general health, and skill plus experience of the surgical staff. Often the changes in a woman's body that can occur with cancer treatment may influence the results of even a well performed reconstructive breast surgery. These surgeries require a particularly close relationship of the patient, general surgeon, oncologist, and plastic surgeon. Early detection of breast cancer is the single-most important factor that can influence the success of a planned mastectomy with reconstruction, as it may provide for skin and breast sparing procedures that can improve the chances of a better reconstructive result.