Breast Reconstruction

For many women diagnosed with breast cancer, mastectomy, or breast removal, is an unfortunate and inescapable option. Women who have undergone this surgery can choose to have breast reconstruction. This procedure recreates the size and shape of the patient's natural breast and can renew a woman's sense of beauty and femininity.

The Surgery
The most common breast reconstruction technique combines skin expansion with a breast implant (a silicone shell filled with a saline solution). The surgeon makes an incision in the crease of the armpit, and inserts a balloon expander under the chest muscle. The incision is then stitched. Over a period of weeks, the surgeon injects saline solution into the expander through a tiny valve that lies just below the skin's surface. Once the skin has stretched sufficiently, the doctor removes the expander and replaces it with a permanent implant. A final operation reconstructs the nipple and areola (the dark skin surrounding the nipple). In some cases, no tissue expansion is required and the permanent implant can be inserted during the initial surgery.

Alternative Approach
Breast reconstruction can also be accomplished through a technique called flap reconstruction. In one approach, the surgeon creates a flap of chest tissue (skin, fat, and muscle still attached to its blood supply) that serves as a pocket for an implant or as the chest mound itself. The surgeon may decide to create flap tissue from the abdomen, back, thigh, or buttocks and relocate it to the chest area. Breast reconstruction generally involves multiple procedures, and is almost always performed under general anesthesia. The initial surgery is performed in a hospital, while follow up procedures are often outpatient based.

After Surgery
Following the surgery, patients experience some fatigue and soreness for several weeks. Postoperative conditions such as bruising, swelling, and discomfort are typically reduced through medication. Patients can expect to return home in two to five days.

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Breast Reduction

Breast reduction, or reduction mammoplasty, is designed for women who experience medical problems and discomfort due to excessively large breasts. Problems may include back and neck pain, skin irritation, skeletal deformities, and breathing problems. Although the procedure is typically used to alleviate medical problems, it can also help women who feel self-conscious about the size of their breasts.

The Surgery
The most common procedure involves the surgeon making an anchor-shaped incision around the dark area of the nipple (areola). This incision is then extended downward, following the natural curve of the crease beneath the breast. The surgeon removes excess glandular tissue, fat, and skin, and adjusts the nipple to its new position. The skin from each side is pulled down and around the areola, thereby reshaping the breast. The surgeon then stitches the incision, always aiming for the least amount of scarring. In certain cases, the vertical part of the scar can be eliminated. It should be noted that smoking prior to or following surgery increases the visibility of scarring. Stitches are usually removed in one to three week's time. A breast reduction is performed in a hospital, usually requiring a two to three day stay. The procedure itself takes between two and four hours and is done under a general anesthetic.

After Surgery
Once the surgery is complete, an elastic bandage or surgical bra wraps the breasts to provide comfort and support. The bandage is removed within a few days while the surgical bra stays on until the bruising and swelling subsides (up to several weeks). A small tube may be placed in each breast to drain excessive fluids. Patients may experience minor pain in the days following the surgery, although this subsides in seven to ten days. Most women can return to work after two weeks.

Post-Op Instructions

Health Concerns
As with any cosmetic surgical procedure, complications are rare, but can include bleeding, infection, a reaction to the anesthesia, and small sores around the nipple (usually immediately following the surgery). Some women temporarily lose feeling in their nipples, a condition that almost always fades over time. Patients may also experience some discomfort in the breast area for up to a year. Occasionally, the surgery removes milk ducts leading to the nipples, impairing a woman's breast-feeding ability. To maximize the success of surgery and to minimize the risk of complication, always follow doctors' instructions for surgical preparation and postoperative care.

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Gynecomastia

Gynecomastia, or large male breasts, is a condition that exists, in varying degrees, in almost half of all men. While the surgery may be performed on men of any age, it is discouraged for those who suffer from obesity, as well as for men who drink alcohol excessively and/or smoke marijuana. Surgery for gynecomastia extracts excess fat and tissue from the breast to produce a flatter, more masculine shaped chest.

The Surgery
A surgeon may perform the procedure using a scalpel, liposuction, or a combination of the two. In the first technique, an incision is made, typically around the areola or tan area around the nipple. The surgeon then removes excess breast tissue, fat, and skin from the chest region and stitches the incision. If, however, the gynecomastia is to remove mostly fatty tissue, then the surgeon may opt for liposuction. This technique involves a slim hollow tube (a cannula) that sweeps through the layers of the chest, breaking up the fat and suctioning it away. Once the fat and tissue is removed, the surgeon stitches up the incision. These procedures last one to two hours and are typically performed on an outpatient basis.

After the Surgery
Following surgery, the incisions are dressed and the chest is wrapped in an elastic bandage. A small tube is sometimes used to drain away excess fluids. The surgeon generally removes the stitches in seven to fourteen days, while the bandage stays on for up to a month. Patients can generally return to work in two weeks time.

Post-Op Instructions

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