Can you get equally good breast mound reconstruction results with both implant and tissue flap procedures?

I think you can get equally good results with both types, unless you’re dealing with a really droopy breast on the uninvolved side – then decisions have to be made about lifting that breast and the best way to try to match it.

 Why do women lose sensation after a mastectomy?

Because when the breast tissue is removed with the mastectomy, we take all of the breast tissue right at the skin level. So all of the tissue under the skin has been removed all the way - practically up to the collar bone and down to the bottom of the breast, so that cuts all the nerves to the skin.

 So does the sensation ever come back?

Some of it does. To an extent it does, but I think it usually feels different.

 Is it just a matter of the nerves having to heal?

They do regenerate to some extent.

 What determines the size of the mastectomy scars?

I leave that decision to the general surgeons because of the factors they need to consider, such as the aggressiveness of the tumor, how much they think they need to remove, if they’re going into the arm pit, if there’s a pre-existing

scar, if there’s a biopsy scar that needs to be removed. But, if there are minimal scars on the breast and it’s not a particularly aggressive cancer, we can hopefully just remove the nipple and areola, and leave most of the other skin there.
And the scar that’s made is usually like an oval or eye shaped scar?

Yes, usually on an implant reconstruction.

 Because you can’t sew a circle together with a straight line?

Yes.

BREAST IMPLANTS

 Please describe the implant technique that you use in more detail.

I usually use tissue expanders because some skin has been removed during the mastectomy. The nipple’s been removed, and normally the areola’s been removed, so we’ve tightened the skin - and since that skin is also very thin, it’s usually a little bit compromised. For that reason we don’t want to put a big implant in right away because there can be wound healing complications and other problems. So, we put a temporary implant in – an expander - that may be only partially inflated. Then we allow everything to heal and allow the skin to get better circulation to it. Once everything’s healed, we begin to expand the skin, usually every two weeks, until we reach our final volume. Then, after giving it [the breast mound cavity] a little bit of time to take shape, we remove the expander, and place a final, permanent implant in. After we allow that to take shape, the third procedure is the nipple reconstruction.