Before making any decisions regarding reconstruction, the first thing to do is stop and ask yourself a few questions. How important is it to you to re-create your breast? Does it have to be there all the time or can you live with something that you can take off and put back on again? Do you need two breasts to feel whole? The more time you spend sorting through your emotions, needs, and priorities, the easier it will be for you to move forward with the loss of a breast.
Prosthesis
One of the major benefits of wearing a prosthesis is that it fills the void instantly. With everything you've been through physically and emotionally, a prosthesis gives you the opportunity to at least get up, get dressed in the morning and walk out without looking any different.
They come in many shapes, sizes and materials. Silicone gel, foam, fiberfill, weighted vs. not weighted. When shopping for a prosthesis, try to find one with the best shape (nipple included), weight, balance, and motion.
It's best to get 2 different kinds. One that's lightweight (polyfill or foam/machine washable) for the recovery period following surgery which can also be used for informal activities thereafter. And one that's more lifelike (silicone/hand washable) and aesthetically pleasing. Most women prefer the silicone prosthesis for formal occasions and sex. You can choose between asymmetrical (one for the left side, one for the right side) and symmetrical (worn sideways to fill out the side or straight up for center fullness and cleavage).
If you're up for spending the extra money, you can buy a prosthesis, custom made just for you. It's cast to match the natural contours of your body and your other breast for an excellent look and fit. The cost usually runs around $3,000.
You can usually find prosthesis in surgical supply stores, pharmacies, and custom lingerie shops (go to one that has trained fitters if possible). There are even private home services that send someone with various samples to your home so that you can try on different sizes and shapes under your own clothes. Special bathing suits and lingerie, designed to hold a prosthesis, are also available for women who had breast cancer. Sears, Nordstrom and the internet are a few places to try.
Reconstruction
Not all women are satisfied with a prosthesis. Some feel that without two breasts, they will never be whole again. In fact, seventy-five percent of women who have mastectomies go for reconstruction. Approximately half of these women decide to have implants. Most of the rest opt for the TRAM flap.
Before you proceed with reconstruction, find out what your medical insurance company will cover. Some will pay for the entire procedure, even years after the mastectomy. Some will pay for the reconstruction of the removed breast. An example of a "nonessential" would be the altering of the other breast to accomplish symmetry. If your insurance company resists providing payment for reconstruction, you and your doctor have every right to mount a strong case for it in advance of the surgery. In many cases, persistence pays off.
Implants
They involve the least amount of surgery. Small breasted, slim women are the best candidates. Although some women can have an implant in place immediately, most need to expand the skin in order to accommodate the implant. Doctors usually stretch the skin with a device called a tissue expander. It's a balloon-like silicone bag that is inserted underneath the chest muscle. With the injection of saline, it slowly expands until it reaches the size you and your doctor have predetermined. (Think of the way skin on the belly stretches during pregnancy)
This process takes about six months. At the end of the six months, the expanding device is replaced with a permanent saline or silicone-gel filled implant. At this point, your body makes scar tissue that encapsulates the implant. Some women (about 5%) form hard capsules around the breast that can be painful. They can distort the breast as well. Massaging the breast and exercising it so that it moves the implant around may reduce this risk. You may also find that the implant has a tendency to move upward. To keep it in place, simply massage it down into the right position.
For more information on breast implants including the risks involved, go to the US Food and Drug Administration's website at www.fda.gov/cdrh/breastimplants/.
Other surgical procedures are available which involve the movement of tissue from one area of the body to the chest to re-create a breast or breasts. The tissue can be taken from several areas including the abdomen, the back, and the buttock. It can be removed as a detached piece or as a flap connected to its own blood supply. It is then sewn into place where the breast was removed.
The TRAM Flap
(named for the transverse rectus abdominus muscle)
This is the most popular of all reconstruction choices. One of the fringe benefits of this option is that women with excess belly fat or stretched-out post pregnancy abdomens get a tummy tuck in the process. The TRAM flap isn't an option for thin women though because it requires excess tissue. Women who smoke, have compromised blood vessels, or multiple surgical scars on the abdomen (c-section scars are usually ok) are not candidates for the procedure either.
How it's done: An ellipse of skin, fat and muscle is taken from the lower half of the abdomen. Surgeons then slide it up through a small tunnel under the skin to the breast area, with the tissue's blood vessels still attached when possible. (No organs are disturbed during the procedure.) The tissue is then shaped into a breast and sewn into place. From start to finish, the procedure takes about 3 hours.
For women who had a double mastectomy, reconstruction is performed in a similar way. A single piece of tissue is removed from the abdomen, then divided in half and positioned in paired openings on the chest for the best symmetry of two new breasts.
For women who had a lumpectomy that resulted in considerable deformity of the breast, you can reconstruct it by transplanting tissue from your abdomen or side as well.
So now that you have your new breast or breasts, let's talk about sensitivity. The newly transferred abdominal tissue will feel most natural to the touch of the toucher because it most resembles the consistency of a natural breast. You probably won't get much sensation from the touching though. Because the nerves are cut when the tissue is removed the area is usually numb.
Symmetry
Obviously you want two breasts that look the same. Symmetry is the ideal goal. Weight gain has the biggest impact on symmetry. With the TRAM flap procedure, a reconstructed breast will gain weight with the rest of the body. For women who get an implant and put on weight, the natural breast will gain with the rest of the body while the implant will not.
The most difficult thing to achieve in reconstructive surgery is the natural droop of a normal breast. Over time, a natural breast may droop or sag but a reconstructed breast will continue to hold its upward perkiness.
Manage your expectations
There is no guarantee that you will be 100% satisfied. It's important to be realistic with your expectations. Your new breast or breasts may not be as soft as you would like. They may not look natural. The symmetry may not be exact. There are risks involved in any surgery as well. Try to keep all of these things in mind if you're considering reconstruction and talk to your doctor or surgeon to get as much information as possible so that you will be prepared for the outcome of the procedure.
Weiss, M. and Weiss, E. Living Beyond Breast Cancer: A Survivor's Guide for When
Treatment Ends and the Rest of Your Life Begins. New York: Three Rivers Press; 1997. p79-83.
