Breast Reconstruction
By Dr. Douglas Grace, B.Sc., M.D., F.R.C.S.C.

Mastectomy is a very traumatic experience for any woman.  Breast reconstruction is an alternative for women of any age providing the health is good enough to tolerate a general anesthetic.

There are two basic ways of reconstructing a breast or both breasts; prosthetic implants or using your own tissue.  Dr. Grace will discuss the risks and benefits of implants versus using your own tissue to reconstruct your breast(s).

Prosthetic implants usually consist of silicone shell implants enclosing saline (salt water), or silicone. 

The implants are usually placed underneath the muscle of the chest wall.  Although implant surgery is usually simpler and shorter than using your own tissue, the complication rate of implant surgery and the need to re-operate at a later date is higher with implants.  Implants have a higher rate of complications if you have had radiation to the chest skin.

Implants placed under the skin are more convenient than prostheses placed in your brassiere.  However, the body’s reaction to these can be a capsule or envelope surrounding the implant, making the breast hard and tender.  In addition, implants do not have the same natural feel as would transplanting your own tissue.

Using one’s own tissue is called autologous reconstruction.  Autologous reconstruction involves transferring soft tissues (skin, fat) from other areas of the body.  Because of the frequent excess tissues and because of the convenient anatomy, skin from the lower belly is often a preferred area for harvesting autologous tissues for breast reconstruction, (TRAM flap reconstruction).  Less commonly, other areas can also be harvested, i.e., buttock, thigh or back.

Complications of using your own tissue include the small chance that the transplanted tissue does not survive.

There are other complications associated with the four hour surgery including hernia if the tissue is taken from the abdomen.

Most women can get back to work 2-4 weeks after implant surgery, although repeated visits to see Dr. Grace for soft tissue expansion may be required along with the second operation to insert a “permanent” implant.  After autologous tissue reconstruction, most women are back to work by one to two months.

It is important to understand that a “normal” breast will never be obtained with a breast reconstruction operation and realistic expectations are in order.  However, patient satisfaction is generally high.