Breast Reconstruction: Treatment, Cost and Side Effects

Breast reconstruction is a technique used to rebuild or reconstruct a breast, generally in women. This process makes use of autologous tissues or prosthetic materials to rebuild or reform a woman’s breast, and provide a natural look. Breast reconstruction surgery is usually done, following a mastectomy (Removal of a whole breast), especially due to breast cancer or due to risks of developing breast cancer. There are many, different forms of breast reconstruction techniques. The two main techniques of breast reconstruction are Implant reconstruction and autologous reconstruction. Implant reconstruction is a process wherein an implant, which is usually made up of saline or silica gel or a combination of the both is inserted or implanted. Autologous reconstruction is also known as flap reconstruction and this type of breast reconstruction uses autologous tissue that is transplanted from another part of the body like the belly or the thigh. Breast reconstruction surgery can be either done immediately after mastectomy or months or years after the mastectomy has been performed (Delayed reconstruction). Breast reconstruction can also be done after a breast conserving surgery, where a part of the breast is removed. The surgery creates a new breast that looks as natural as possible and matches the other breast in size, shape and position. The reconstruction of nipple can be done or left, depending upon the choice of the individual. Sometimes, surgery is performed on the other, natural breast to make both the breasts look proportional to the shape of the body. The sensation in the breast and nipple cannot be restored with breast reconstruction surgery.

Breast reconstruction surgery is performed either with silica or saline (salt water) implants or with autologous tissues or flaps, transplanted from other parts of the body. Breast reconstruction surgery using implants is done by stretching the skin using a tissue expander and inserting the implants which is made up of salt water (saline), silicone gel or a combination of these both. The tissue expander, is then filled up by adding saline to a desired volume, once in a week, for a few sessions, which are often painful. Breast reconstruction surgery using flaps is performed using autologous tissue transplanted from other parts of the body like back, thigh or belly to create a mound, which is used for the breast reconstruction. Breast reconstructions using implants are generally considered to be easier to perform and also easier to recover from. Autologous tissues reconstruction is more difficult to perform, more time consuming and takes a longer period to recover. But as time passes, flaps remain better than implants because implants are more prone to problems and will require many extra procedures to correct them. Implants also have the tendency to rupture, causing infection and pain. New techniques are being developed by plastic surgeons to make breast reconstruction more simple.

Women who have undergone mastectomy or breast conserving surgery can have breast reconstruction surgery performed on them. They can either go in for immediate breast reconstruction surgery, which is done immediately after the mastectomy or delayed breast reconstruction surgery, which is performed after a long time after the mastectomy. Delayed breast reconstruction surgery is generally considered better than immediate breast reconstruction surgery. Breast reconstruction surgery is purely a personal choice and for some women, having a breast reconstruction surgery restores their confidence, that was lost with the removal of one or both of their breasts.

People who have existing medical conditions that may increase the risk of complications, following surgery, must not undergo a breast reconstruction surgery. If the patient requires radiotherapy after surgery, then the result of the breast reconstruction surgery can be affected. Women who are not eligible for breast reconstruction surgery due to their medical conditions or women who do not prefer to have a breast replacement surgery can opt for other alternative methods. It is better to consult the surgeon to know if the individual is eligible for a breast reconstruction surgery or not.

There are a lot of side effects associated with breast reconstruction surgery. There will be swelling and inflammation, following the surgery, which will take about 6 to 8 weeks, to decrease and become normal. The reconstruction sessions, where the implants are filled are quite painful, but in some cases, instead of feeling pain, the person may feel numbness and tightness. There will also be scars, which will fade over time. Problems with anesthesia and bleeding are also prone to occur. Chances of blood clots are also very high. The surgery can cause extreme fatigue and can increase the risk of contracting infections at the site of the surgery and wound healing problems. There is also a risk of fluid buildups in the flaps which can cause extreme pain and inflammation.

There is a heavy risk for the implants to rupture and cause infection, after the surgery. There is also the risk of necrosis or tissue death. There will be a loss or change in the sensation in the breast, and around the nipple, and it will never go back to normal, after the surgery. Additional surgeries will be required to maintain the implants and there will be loss of muscular strength at the site of operation. There will also be some changes in the arms on the side of the reconstructed breast. There is a great risk for capsular contracture.

The individual must patiently wait for the pain and swelling to decrease and go away. The person must follow all the guidelines and ask for the advice of the surgeon. The individual should discuss with the surgeon about the type of bras they can wear after the surgery, depending upon the type of surgery they had. Stretching exercises and even normal activities must be performed only after consulting the surgeon. It is generally good to avoid heavy exercises like over head lifting, strenuous sports and some sexual activity for at least 4 to 6 weeks, after the breast reconstruction surgery. Regular Magnetic Resonance Imaging (MRI) and mammograms are required, to keep a check on the implants. Bathing, showering and wound care should be done following the advice of the surgeon. Several visits to the hospital and regular medical check ups are also necessary.

The first few days, following the breast reconstruction surgery will be filled with pain, swelling and discomfort. The patient will be required to avoid all strenuous activities and even some normal, regular activities for a few days. The hospital stay may range from one day to one week, depending upon the type of surgery. It will generally take about 6 to 8 weeks to start performing normal activities. Recovery time will generally be longer, when the person opts for a delayed breast reconstruction surgery.

The price of breast reconstruction surgery in India is usually greater than Rs.80,000 and can generally range between Rs.100,000 and Rs.300,000 in private hospitals, depending upon the type of the surgery performed.

The results of the breast reconstruction surgery may be permanent, but it generally depends upon the type of surgery that was performed.

For women who do not want to, or cannot undergo breast reconstruction surgery, there are some alternatives like wearing a prosthesis (an external form of breast), inside their Bra or attached to their clothes. Some women do not wear prosthesis nor undergo surgery. For people who do not want to undergo nipple reconstruction surgery, prosthetic nipples that can be stuck on, can be used.