MASTECTOMY AND FEMALE PSYCHOLOGY
A woman who has lost one or both of her breasts is likely to be subject to a deep psychological wound. She may feel that she has lost a major part of her femininity and she is not attractive. In general, she may feel less of a woman.
The breast is most likely to have been removed due to the presence of a malignant tumor, but also in some cases due to benign conditions (fibrocystic breast disease, etc.). The reconstruction of the breast is necessary to repair the female patient’s damaged psychology.
OPERATION INTERVAL AFTER MASTECTOMY
If the surgeon determines that the case is appropriate for this operation, he may call upon the plastic surgeon, so that breast reconstruction can be performed alongside the mastectomy. Otherwise, the reconstruction may be performed whenever the patient’s condition allows. This means that in such cases, initially, the patient must undergo a mastectomy in order to eliminate the disease, and then to proceed to the aesthetic reconstruction.
The appropriate time to do so will be determined based on the seriousness of the patient’s condition, but also on the completion of the supplementary treatments (chemotherapy, laser treatment etc.).
METHODS OF BREAST RECONSTRUCTION AFTER MASTECTOMY
There are several methods of reconstruction. None of them, however, will produce a fully working breast, i.e. one that can be used to breastfeed. It will be an aesthetic reconstruction only. However, this reconstruction should be sufficient to give the women in question a psychological lift.
In addition, it should be made clear that the two breasts will not be completely symmetrical, since, after all, their tissue or the materials of which they are constructed will have differing composition. Therefore, the patient should be prepared for some degree of asymmetry.
The methods of correction differ, and the most important of them are the following:
1. USING SILICONE IMPLANTS:
The procedure is usually done in two stages. During the first stage, the plastic surgeon places an expander under the skin and muscles. The expander resembles a balloon made of silicone. After the expander has been placed, the plastic surgeon begins to inflate it, adding a small quantity of saline water to it every week. The expander features a valve which is situated under the skin, and the surgeon is able to insert the saline water through it. Slowly, the balloon will inflate, thus creating an excess of skin, which is useful for the formation of the new breast. A few weeks later, once the expander is fully inflated, a sufficient excess of skin will have been created.
At this point, the plastic surgeon can then perform a second operation to remove the expander and place the silicone implant, thus forming the new breast. An adjustment upon the other breast may be required at the same time, provided it features some sagging, so that the two breasts have as a high a degree of symmetry between them as possible. In addition, a new nipple may be constructed during this stage. The nipple may also be constructed later, replicated by a tattoo or using a section of skin taken from the area near the genital organs, where the skin is darker in hue. The construction of the nipple is a localized procedure which can be performed independently, under local anaesthesia. The entire procedure usually requires approximately 6 months to be completed.
It is possible for the operation to be performed at some point using Becker-type implants. These implants have the unique property of being both expanders and implants. This means they have an external layer consisting of silicone, similar to regular implants, as well as an inner pocket where saline water may be deposited. Becker-type implants are put in place during an operation and afterwards, again once a week, saline will be deposited in them until they reach the desired size. At this point, the implant is left as is, and is not replaced by another silicone implant. The advantage of this choice is that is one-stage procedure and is not requiring a second stage as the ordinary tissue expansion.
2. USING A SEGMENT OF TISSUE FROM THE ABDOMEN:
In this case, the reconstruction requires only one session. The plastic surgeon removes a section from the lower end of the abdomen, i.e. beneath the navel, and employs it as material to construct the new breast. This section of the stomach consists of skin, fat and a fraction of muscle. The blood vessels that supply it may originate from the abdominal muscle, or they may be connected with the blood vessels in the breast’s immediate area. This technique is referred to as T.R.A.M. The procedure offers the advantages of being able to be completed in one session, that the breast consists of the patient’s own tissue, and that it can also correct sagging in the region of the abdomen, since essentially an abdominoplasty is being performed. The main advantages are that the operation has a much longer duration, and that the chance of creating a hernia in the region of the stomach is increased, as part of the wall may have been weakened.
3. USING FAT:
This is a recently developed technique, wherein the plastic surgeon obtains fat from various parts of the body and places them in the breast, in order to add bulk and construct a new breast. The fat is obtained via liposuction and, after being filtered, is administered to the breast via injection. It is best (but not required) for a device similar to a suction device, similar to a cup to be used beforehand, and attached to the breast for a few weeks before the operation. The procedure of implanting fat can be repeated a few times, until one has achieved the desired result.
The most appropriate method for each patient is a matter that will be determined following a discussion with the doctor, and depending on each patient’s particularities. The wishes of each patient are particularly important, once the doctor has analyzed the pros and cons of each method.