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Breast Reconstruction
is one of the most rewarding surgical procedures. Breast removal due
to cancer or any other disease is generally a traumatic experience
for the patient. After a mastectomy (breast removal surgery), the
patient usually feels depressed due to the loss of one or the two
breasts. Thanks to new medical devices and techniques, Dr. Metwally
is now able to create a breast that is quite similar in appearance
and form to the natural breast. For most mastectomy patients, breast
reconstruction immensely improves their appearance and self-esteem. |
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What is a Breast Reconstruction Surgery?
Breast Reconstruction Surgery
is a surgical procedure performed to create a breast similar to the
normal one that has been removed due to cancer or any other disease
or is missing due to a congenital anomaly. If the chest muscle
(pictorial muscle) is available the most common procedure used
involves expanding your breast skin to make enough room to later
insert an implant. The nipple and areola (dark area around the
nipple) are usually reconstructed in another procedure. If your
pictorial muscle has been removed during your mastectomy a graft
from another part of the body is extracted. In some cases the flap
is used as a pocket to place an implant, and in other cases the flap
may act as the breast itself with no need for an implant. Breast
reconstruction almost always requires more than one procedure for
skin expansion or flap creation and for nipple and areola
reconstruction and sometimes for enlarging, reducing or lifting the
natural breast to achieve as much resemblance between the two
breasts as possible. It’s a long road but the results of a good
breast reconstruction surgery are usually very satisfactory.
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Are You a Good Candidate for Breast reconstruction?
Most mastectomy patients or patients with a congenital anomaly of
the breast are good candidates for reconstruction. In some cases of
mastectomy, the reconstruction can be done immediately with the
mastectomy during the same surgery. However, the patient’s doctor
may advise her to wait until they are quite sure that the cancer has
been totally eliminated. Despite the fact that reconstruction has no
effect on the disease recurrence, nor does it interfere with
chemotherapy or radiation, some patients like to wait taking a break
from surgery as they complete their cancer treatment. In all cases,
being informed of reconstruction before mastectomy usually makes
patients more positive about their mastectomy.
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Preparing for Your Surgery
Before your surgery, Dr. Metwally will perform a complete evaluation
with you. It is very important that Dr. Metwally along with your
mastectomy doctor work together possibly even as early as the cancer
diagnoses to develop a plan that will give you the best possible
results from reconstruction. According to your case and the
reconstruction options available for you, Dr. Metwally will discuss
with you your options and explain to you the procedure that best
serves your case. You will need to arrange for someone to drive you
to and from our center the day of the surgery. You should wear loose
fitting clothes and bear in mind that your outfit may get soiled. Do
not wear jewelry, contact lenses, or bring valuables to the
operating room. Remove all body jewelry from pierced body parts.
Anesthesia Used
All breast reconstruction procedures are performed under general
anesthesia (you will be asleep throughout the procedure) except for
the areola and nipple reconstruction this can be done under local
anesthesia with sedation (you won’t be totally asleep but you will
be relaxed and drowsy and won’t feel anything during the procedure).
You will be ready to leave after 2 to 3 hours from the completion of
your procedure.
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During Your Surgery
Skin Expansion: During your surgery if skin expansion is the
technique you and Dr. Metwally have decided upon, a small incision
on your same mastectomy scar usually 1 to 2 cm will be made through
which an expander will be placed in your breast beneath the chest
muscle. Your expander will be inflated with saline (salt-water
solution) using a small valve mechanism buried under the skin
through sessions 1 to 2 weeks apart (according to the extent your
skin will flex with the expander). This process usually takes around
5 to 6 visits after which your breast will have enough skin for the
implant to be placed. After that the expander is removed in a second
procedure. Another procedure for placing an implant behind your
muscle will be performed. After that you will have a procedure to
reconstruct your areola and nipple, where a skin graft usually from
the labia minora (the dark skin surrounding the vagina)is extracted.
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Some patients chose to use an artificial areola;
this is simply worn by the patient at home. After
that you may need 1 last procedure to enlarge,
reduce or lift your other breast to make the 2
breasts as symmetrical as possible. Some congenital
anomalies patients do not require preliminary tissue
expansion before receiving an implant. In this case
Dr. Metwally will insert the implant immediately.
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Flap Reconstruction: This approach involves, using a skin graft
extracted from the abdomen or back where this graft is either used
to form the entire breast dome (if the patient has enough tissue
extracted from the other body part), or used as a pocket where the
implant is placed. The flap, composed of the skin, fat, and muscle
with its blood supply, is tunneled beneath the skin to the chest.
After that the areola and nipple are reconstructed in another
procedure (as explained above). And a procedure to adjust the other
breast may also be made (as mentioned above).
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Duration of the Surgery
As mentioned above, breast reconstruction is usually achieved
through more than one procedure. The skin expansion technique
usually requires 4 procedures. In the 1st procedure an expander is
placed in the breast, which takes around 30 minutes. The inflation
of the expander takes around 5 minutes for each inflation session.
The implant placement takes 30 minutes for one breast. The procedure
for areola and nipple restoration by taking a graft from the labia
minora takes around 1 to 2 hours. If an artificial areola is used it
takes no time to place it and the patient wears it on her own. For
modifying the other breast through an augmentation procedure it
takes around 30 minutes. For breast reduction or lifting it takes
around 1 and a half hour. The flap reconstruction technique requires
3 to 4 hours.
After Your Surgery
After all breast reconstruction procedures, Dr. Metwally will
prescribe to you an antibiotic along with a pain killer to prevent
infection and alleviate pain. Showering is permitted 1 week after
every procedure. You will need 3 to 5 days of rest after every
procedure. After the procedure where an expander will be placed you
will feel a little sore for the first 3 days but nothing medication
can’t control. After the implant placement, you will feel some
pressure more like muscle exercise pain. After the flap
reconstruction, you may feel some pain for around 1 week and
medication will make the pain minimal. You may also have drains to
remove any fluids for 2 to 3 days. After the areola and nipple
reconstruction you will almost feel no pain; this is a minor
procedure with maybe just a little discomfort. For all procedures
minimal dressing will be applied for 3 to 5 days. For the implant
placement your stitches will be removed after 2 weeks and you will
be asked to wear a special bra for 4 weeks. Stitches for the other
procedures need 10 days to be removed. Overall you may need up to 6
weeks to heal from breast reconstruction by flap reconstruction and
almost 4 weeks by implant placement. You should avoid strenuous
exercise for 4 to 6 weeks.
Seeing Your Result
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How soon the result starts to show often varies from one person to
another depending on many factors. Some people heal faster than
others for reasons like age, skin color and skin type.
Other factors are related to the level of correction made in the
surgery and the surgeon’s skills. Usually you can see the result
from your implant placement immediately although your breast may
feel a bit hard and swollen for the first 2 weeks. With the flap
reconstruction you may take up to 3 months till everything rests in
its new place and you see your final result. However you will notice
upon the completion of your surgery that your breast has increased
in size. Your scars will take 12 to 18 months to fade. Breast
reconstruction patients with realistic expectations are almost
always very satisfied with their results.
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