The cosmetic outcome post breast reconstruction is an important factor in the overall well-being of the patient who has had a history of breast cancer. Detailed attention is given to the surgical reconstruction in making the reconstruction look, feel and appear as real and natural as possible. It is important that the patient have a realistic expectation with reconstruction, at the same time, it is not unusual that sometimes surgical revisions are performed to improve the overall cosmetic appearance and strive towards the best possible outcome.
In patients who have had same time single-stage breast implant reconstruction at the time of their mastectomy; usually patients who were candidates for skin and nipple areolar sparing total mastectomy, the implants might ripple as the skin envelope stretches through the years. A small out-patient revision of the breast skin envelope might be necessary as a retightening procedure, a “breast lift” procedure or sometimes placement of a new piece of an ADM (acellular dermal matrix) to better support the implant. This is often used in a patient who is thin, or has experienced further thinning of the breast envelope years after the permanent implants are placed.
In patients who were reconstructed as a two-stage expander then implant placement, similar revisions might be necessary as dictated by the changes through the years. In patients who have required radiation treatment in addition to the mastectomy while a tissue expander was placed, there are skin and muscle envelope changes that are attributable to the irradiation. As the radiation effects continue, some patients may need revisions similar to those patients who have had same time implant placement who did not require irradiation. In addition, they might also require fat grafting to areas that have thinned or appear indented due to tissue atrophy with radiation.
Patients who have had autologous breast reconstruction; those who have had free or pedicled TRAM flaps and / or latissimus flap with or without implant reconstruction, also may need future symmetrizing procedures as patients may gain or lose weight or their native breast might further sag while the reconstructed one remains more youthful. Therefore, a breast lift may be required to better match the reconstructed breast or the reconstructed breast might need to be reduced in size to better achieve aesthetic symmetry and overall outcome.
Most breast reconstruction revisions are done as an out-patient, are quicker to recover from and are usually a covered benefit by the patient’s insurance carrier as it is considered part of the breast cancer treatment regimen.