Mastectomy is a traumatic experience for any woman. Breast reconstruction is an alternative for women of any age. There are two basic ways of reconstructing a breast or both breasts: prosthetic implants and using your own tissue (autologous reconstruction).
Your surgeon will discuss with you the risks and benefits of implants versus using your own tissue to reconstruct your breast. Prosthetic implants usually consist of silicone shell implants enclosing saline, or silicone. The implants are usually placed underneath the muscle of the chest wall.
Although implant surgery is usually simpler and shorter than using autologous tissue, have a higher rate of complications if you have had radiation to the chest skin. 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 reforming your own tissue.
After mastectomy, the skin envelope may not be large enough for an implant and skin expansion may be required before the "permanent" implant is inserted. Tissue expansion is done by inserting an expandable silicone "balloon" which is inflated with salt water weekly by your surgeon. When enough skin is available, the implant can be inserted.
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 trans-planted 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 the doctor 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.