Definition & Overview

Breast reconstruction refers to a procedure used to restore the appearance of a woman’s breast usually after a mastectomy, which is the partial or complete removal of one or both breasts as part of breast cancer treatment. It is performed using either autologous tissue or synthetic materials, such as breast implants with the goal to recreate a breast that mimics the natural appearance of a real one. It also involves the reconstruction of the areola and the nipple and thus requires a series of surgical procedures.

Who Should Undergo and Expected Results

Breast reconstruction, which is purely an elective procedure, is recommended for patients who have lost one or both breasts due to a partial or complete mastectomy as part of cancer treatment. Some patients who have undergone lumpectomy (another breast cancer treatment wherein only a portion of the breast is removed) may also take advantage of the procedure.

How is the Procedure Performed?

Methods that are used in breast reconstruction are:

  • Flap reconstruction – With this technique, the surgeon takes a flap of tissue from another part of the patient’s body and implants it in the breasts. The flap includes skin, fat, and muscle that are used to create a normal-looking breast mound. In some cases, surgeons use a flap of tissue taken from a donor’s body.

  • Breast implantation - In this procedure, the surgeon uses a breast implant and places it under the pectoral muscles of the chest wall. The surgeon also has the option to insert a tissue expander, which expands as saline solution is injected into it over a period of weeks to months. The tissue expander will then expand to the desired size, after which it will be removed and replaced with a permanent implant. This is followed by the reconstruction of the areola and nipple.


Both procedures are performed in a hospital on an inpatient basis and under general anaesthesia. Follow-up procedures, on the other hand, are performed under local anaesthesia and on an outpatient basis.

After the procedure, it is normal for patients’ reconstructed breasts to feel slightly numb and to be less sensitive than real breasts. Also, while natural breasts change in appearance over time, particularly due to age, reconstructed breasts will not change much. Thus, as time passes, they may become more noticeable.

Possible Risks and Complications

Breast reconstruction is a major cosmetic surgical procedure. Hence, it carries certain risks, some of which may warrant the delay of the procedure. These risks include:

  • Infection
  • Bleeding, which is why patients who suffer from bleeding conditions are advised against the procedure
  • Capsular contracture, or the hardening or tightening of the scar tissue surrounding the implant material
  • Scarring, which may occur either on the breasts or in the part of the body from where the flap is taken
  • Necrosis, or tissue death
  • Implant rupture, which can occur if synthetic breasts are used


These risks and potential complications are more likely to affect patients with medical comorbidities, such as:

  • High blood pressure
  • Obesity
  • Diabetes
  • Smoking
  • Ongoing cancer therapy

    References:

  • Cordeiro P. “Breast reconstruction after surgery for breast cancer.” The New England Journal of Medicine. 2008; 359:1590-1601. http://www.nejm.org/doi/full/10.1056/NEJMct0802899#t=article

  • Thiruchelvam P., McNeill F., Jallali N., Harris P., Hogben K. “Post-mastectomy breast reconstruction.” British Medical Journal. http://www.bmj.com/content/347/bmj.f5903

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