NCCN Guidelines for Patients® | Stage 0 Breast Cancer - page 33

NCCN Guidelines for Patients
Stage 0 Breast Cancer, Version 1.2014
Breast reconstruction
After mastectomy
After mastectomy
Sparing breast skin
If you will have a total mastectomy, your surgeon
may be able to save much of your breast skin. This
is called a skin-sparing mastectomy. Only the nipple,
areola, and skin near the biopsy site are removed.
Surgery that spares the nipple and areola should only
be done as part of a clinical trial.
There are benefits to having a skin-sparing
mastectomy. The size of the mastectomy scar will be
smaller, your breast will have a more natural shape,
and you will be able to have the reconstruction right
away if you want. To get the best results, your cancer
and plastic surgeons need to work together.
Timing of reconstruction
You can have reconstruction at any time if you have a
total mastectomy. Reconstruction at the same time as
the cancer surgery is called immediate reconstruction.
Delayed reconstruction can occur months or years
after the cancer surgery.
Types of reconstruction
There are three ways to reconstruct breasts after
a mastectomy. All involve having plastic surgery.
Breast reconstruction is generally safe, but with any
surgery, there are risks. Ask your treatment team
for a complete list of side effects. The three ways to
reconstruct breasts are:
Breasts can be reconstructed using breast implants.
Breast implants are small bags filled with salt water,
silicone gel, or both that are placed under the breast
skin and muscle. Implants have a small risk of
breaking and leaking. A balloon-like device, called an
expander, may first be placed under your skin and
inflated to stretch out your muscle and skin. Every
few weeks for two to three months, the expander will
be enlarged until the implant will fit in place. You may
feel pain from the expander stretching your skin and
muscle. Some women will also have pain from the
implant, scar tissue, or tissue death (necrosis).
Another type of reconstruction uses tissue from your
body, known as “flaps.” Tissue is taken from the belly
area, butt, or from under the shoulder blade to form
breasts. Some flaps are completely removed from
your body and then sewn in place. Other flaps stay
attached and then are slid over to the breast area
and are sewn into place. Women who have diabetes
or who smoke are more likely to have problems with
flaps than other women. Some risks of flaps are
tissue death, lumps from death of fat, and muscle
weakness that may cause a hernia.
Implants and flaps
Some breasts are reconstructed with both
implants and flaps. Using both types may give the
reconstructed breast more volume and help match
its shape to the other breast. However, for any
reconstruction, you may need surgery on your real
breast so that the two breasts match in size and
Nipple replacement
Like your breast, you can have your nipple remade,
use a fake nipple, or do nothing. The plastic surgeon
can recreate a nipple mound with the surrounding
tissues or, sometimes, tissue can be moved from
other parts of your body, such as your vulva, thigh, or
other nipple. You may lose feeling in your real nipple
if tissue is removed. Tissue used from other areas of
your body to make a nipple can be darkened in color
with a tattoo.
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