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Cost of Breast Reconstruction Surgery

  • Posted on- Apr 04, 2018
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Breast Reconstruction Surgery after Mastectomy

Mastectomy is a surgical procedure in which one or both breasts are removed partially or completely. A mastectomy is usually carried out to treat breast cancer. Many women with early stage cancers can choose between breasts conserving surgery (BCS) and mastectomy.

Many women who have a mastectomy (surgery to remove an entire breast to treat or prevent breast cancer) have the option of having the shape of the removed breast rebuilt.

Women who had surgery as part of their breast cancer treatment can choose breast reconstruction surgery to rebuild the shape and look of the breast.

How do surgeons use implants to reconstruct a woman's breast?

Implants are inserted underneath the skin or chest muscle following the mastectomy. (Mostly mastectomies are performed using a technique called skin-sparing mastectomy, in which most of the breast skin is saved for use in reconstructing the breast).

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  • In the first stage, the surgeon places a device, called a tissue expander, under the skin that is left after the mastectomy or under the chest muscle. The expander is slowly filled with saline during periodic visits to the doctor after surgery.
  • In the second stage, after the chest tissue has relaxed and healed enough, the expander is removed and replaced with an implant. The chest tissue is usually ready for the implant 2 to 6 months after mastectomy.

How do surgeons use tissue from a woman's own body to reconstruct the breast?

In autologous tissue reconstruction, a piece of tissue containing skin, fat, blood vessels, and sometimes muscle is taken from elsewhere in a woman's body and used to rebuild the breast. This piece of tissue is called a flap.

  • With a pedicled flap, the tissue and attached blood vessels are moved together through the body to the breast area. Because the blood supply to the tissue used for reconstruction is left intact, blood vessels do not need to be reconnected once the tissue is moved.
  • With free flaps, the tissue is cut free from its blood supply. It must be attached to new blood vessels in the breast area, using a technique called microsurgery. This gives the reconstructed breast a blood supply.
  • DIEP flap: Tissue comes from the abdomen and contains only skin, blood vessels, and fat, without the underlying muscle. This type of flap is a free flap.
  • Latissimus dorsi (LD) flap: Tissue comes from the middle and side of the back. This type of flap is pedicled when used for breast reconstruction. (LD flaps can be used for other types of reconstruction as well.)
  • TRAM flap: Tissue comes from the lower abdomen as in a DIEP flap but includes muscle. It can be either pedicled or free.
  • IGAP flap: Tissue comes from the buttocks and contains only skin, blood vessels, and fat.
  • PAP flap: Tissue, without muscle that comes from the upper inner thigh.
  • SGAP flap: Tissue comes from the buttocks as in an IGAP flap but includes a different set of blood vessels and contains only skin, blood vessels, and fat.
  • TUG flap: Tissue, including muscle that comes from the upper inner thigh.

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How do surgeons reconstruct the nipple and areola?

Usually, the new nipple is created by cutting and moving small pieces of skin from the reconstructed breast to the nipple site and shaping them into a new nipple.

Sometime after nipple reconstruction, the surgeon can re-create the areola. This is usually done using tattoo ink. However, in some cases, skin grafts may be taken from the groin or abdomen and attached to the breast to create an areola at the time of the nipple reconstruction.

What factors can affect the timing of breast reconstruction?

One factor that can affect the timing of breast reconstruction is whether a woman will need radiation therapy. Radiation therapy can sometimes cause wound healing problems or infections in reconstructed breasts, so some women may prefer to delay reconstruction until after radiation therapy is completed.

However, because of improvements in surgical and radiation techniques, immediate reconstruction with an implant is usually still an option for women who will need radiation therapy.

Autologous tissue breast reconstruction is usually reserved for after radiation therapy so that the breast and chest wall tissue damaged by radiation can be replaced with healthy tissue from elsewhere in the body.

What are some new developments in breast reconstruction after mastectomy?

In general, women who have a lumpectomy or partial mastectomy for early-stage breast cancer do not have reconstruction. However, for some of these women, the surgeon may use plastic surgery techniques to reshape the breast at the time of cancer surgery.

This type of breast-conserving surgery, called oncoplastic surgery, may use local tissue rearrangement, reconstruction through breast reduction surgery, or transfer of tissue flaps. Long-term outcomes of this type of surgery are comparable to those for standard breast-conserving surgery.

  • Autologous fat grafting

A newer type of breast reconstruction technique involves the transfer of fat tissue from one part of the body (usually the thighs, abdomen, or buttocks) to the reconstructed breast. The fat tissue is harvested by liposuction, washed, and liquefied so that it can be injected into the area of interest.

Fat grafting is mainly used to correct deformities and asymmetries that may appear after breast reconstruction. It is also sometimes used to reconstruct an entire breast. Although concern has been raised about the lack of long-term outcome studies, this technique is considered safe.

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