Special Concerns For Breast Reconstruction

Special Concerns for Women with Breast Cancer

Here are some of the known risks or problems with breast implant surgery for women with breast cancer:
The physical and cosmetic results with breast implants may be affected by chemotherapy, radiation therapy, or any other factor which significantly alters the healing process.
Skin necrosis (dying skin) may occur because circulation to the remaining tissue has been changed by a mastectomy or other trauma to the breast area. Also, skin necrosis may be increased as a result of radiation treatment.
It usually takes more than one operation to achieve the desired cosmetic outcome, especially if this procedure includes rebuilding the nipple. Timing for Reconstruction with Breast Implants
Reconstruction can be done either at the time of breast cancer surgery or at a later date. If breast surgery and implant surgery are done at the same time, the surgeon usually uses the same incision to insert the implant. Another option is to insert a temporary tissue expander. In this case, in a second operation after the skin has stretched sufficiently, the surgeon will remove the expander and replace it with an implant. Another option is to insert the implants at some time after the mastectomy. With delayed insertion, the surgeon may still be able to use the mastectomy or lumpectomy scar to insert the implant. The surgeon should discuss with you which approach is the most desirable for you, and the associated risks.
Recreation of the Nipple and Areola following Reconstructive Surgery
After your breast has healed from the original implant surgery, you may want your nipple and areola (darker skin around the nipple) rebuilt. This procedure can usually be performed on an out-patient basis. Ask your surgeon to explain the various ways this can be done.
Your Expectations -- Reconstruction or Augmentation
Your consideration of breast implants, for reconstruction or for augmentation should be based on realistic expectations of the outcome. To help you get an idea of what results may be possible, look at before and after pictures of patients who have had this surgery. Your doctor may have some to show you. You may also want to talk with other women who have had this surgery at least a year before with the same surgeon. Keep in mind, however, that there is no guarantee that your results will match those of other women.
Your results will depend on many individual factors, such as your overall health; chest structure and body shape; healing capabilities (which may be hindered by radiation and chemotherapy, smoking, alcohol and various medications); bleeding tendencies; prior breast surgery(ies); infection; skill and experience of the surgical team; the type of surgical procedure; and, the type and size of implant.

Scarring is a natural outcome of surgery, and your doctor will try to keep scars as subtle as possible. She or he can explain the location, size, and appearance of the scars you can expect to have. For most women, scars will fade over time to thin lines, although the darker your skin, the more prominent the scars are likely to be. Usually the body will develop a fibrous capsule which can be thick or thin around the implant which is a normal physiologic response to a foreign object in the body.
It is important to remember that implants age over time and may need to be replaced. Although your implant may last for many years, you should not expect it to last indefinitely.