What is breast reconstruction?

乳房再造术是在切除的乳房(乳房切除术)上再造新的乳房形状的手术。. 乳房丘被创造出来，尽可能接近自然乳房的形状和外观.

手术可以重建单侧乳房或双侧乳房。. 手术的目的是创造一个与对侧乳房相匹配的乳房丘. If both breasts have been removed, 手术的目标是创造出两个乳房丘，大小与女性的自然乳房相仿.

Making a decision about breast reconstruction

The decision to have breast reconstruction is a personal one. It depends on how you think you will feel after a mastectomy. 如果你认为平胸或戴假乳房会让你感到不舒服, you may want to consider breast reconstruction. If you don’t want to have any more surgeries, you may not want to do it.

If you’re thinking of having breast reconstruction, talk with your doctor about it before you have your mastectomy. Your doctor can tell you if reconstruction is an option for you. 他或她会告诉你哪种重建手术最适合你.

你的医生会和你讨论影响手术是否对你有效的因素. These include:

• The size and location of the cancer, 是什么决定了乳房切除术中要切除的皮肤和组织的数量

• The amount of tissue removed from the breast

• If your chest tissue has been damaged by radiation therapy or aging, and is not healthy enough for reconstruction surgery

• Potential for complications

• Your overall health and health history

When is the best time to have breast reconstruction?

Talk with your doctor before your mastectomy. He or she will then talk with you about your options for:

• Immediate reconstruction. This is reconstructive surgery done at the same time as the mastectomy.

• Delayed reconstruction. This is a surgery done after recovery from the mastectomy. If radiation therapy is part of the treatment plan, the surgeon may advise waiting until after the radiation is finished.

这里有一些事情要记住的最佳时间安排:

• Your emotional and psychological well-being. 一些专家认为，从乳房切除术中醒来，重建已经完成，比没有乳房醒来创伤小.

• Any other treatments you are having. 如果你在手术后接受了放疗，你可能需要推迟乳房重建. 对重建的乳房进行放疗会增加出现问题的机会.

• Recovery time. 在乳房切除术的同时进行乳房重建手术可能意味着你会恢复得更快.

• The condition of your skin. 如果你的皮肤还没有准备好在重建过程中进行拉伸, you may need to have the procedure later on. For example, 吸烟或患有糖尿病的女性的皮肤在重建前可能需要额外的愈合时间.

Common risks of breast reconstruction

Any type of surgery has risks. The risks of breast reconstruction include:

• Bleeding

• Fluid collection in the surgical area (called a seroma)

• Infection

• Blood clots

• Excessive scar tissue

• Problems with the sleep medicines (anesthesia) used during surgery

• Bruising and swelling

• Problems with the breast implant

• Problems healing

乳房重建术中最常见的并发症是乳房包膜挛缩. This is when the scar (capsule) around the implant begins to tighten. In some cases, a second surgery is needed to fix this problem.

Reconstruction after Breast Cancer | Pam's Story

- Watch on YouTube

在她被诊断出患有乳腺癌后，她向约翰霍普金斯大学寻求第二意见, Pam Vierra says her reconstruction changed her life, leaving her in better shape than ever.

What are the different types of breast reconstruction?

There are 2 main types of reconstruction surgery:

• Expander-implant. This method uses an expander to create a breast mound. This may be followed by the placement of a filled breast implant.

• Autologous tissue. 这种方法使用你自己的身体组织来重建一个新的乳房丘. 这些重建手术会留下两个手术伤口:胸部和组织被移除的部位.

你也可以决定做其他的手术来改善你的新乳房形状. For example, 你可能会决定对另一个乳房进行重建手术，使它与你的新乳房形状相匹配. Or you may want to have a nipple or areola reconstructed.

Expander-implant surgery

扩张器是放置在胸肌下的空硅胶“信封”. This muscle is between the breast and the chest wall. To enable the skin and soft tissues of the breast to stretch, the expander is filled with saline solution over several weeks. 生理盐水通过位于皮肤下方的扩张器中的阀门或端口注入扩张器. Another option is filling the expander with air over 2 or 3 weeks.

一旦膨胀器被完全填满，它就会被放置几周到几个月. This allows for maximum skin and soft tissue growth. Once the skin has stretched enough, 第二次手术可能会取出组织扩张器，并将永久植入物插入肌肉和皮肤下. Sometimes, the expander is just left in place. 
植入物是一种充满液体的包裹，放在乳房组织下面，用来形成乳房的形状. Implants may be filled with saline or silicone gel. Each type of implant has advantages and disadvantages. 你的医生会和你讨论种植体的类型，并帮助你决定使用哪种类型.

Autologous tissue surgery

There are different ways to do this surgery, such as:

• TRAM (transverse rectus abdominous muscle) flap. This is the most common method. 从腹部取出一块脂肪、皮肤和肌肉，移到胸部. The surgery gives you a tummy tuck. TRAM flaps may change as you gain and lose weight. 重要的是要知道，切除腹部肌肉会增加背部的压力，使你有患疝气的风险. 这种手术会在你的下腹和胸部留下横向疤痕.

• DIEP (deep inferior epigastric perforator) flap. With this method, 外科医生从你的下腹部取出脂肪和皮肤(但不是肌肉)，并将它们移到胸部. This surgery also gives you a tummy tuck.

• Gluteal free flap. The surgeon removes part of the skin, muscle, and fat from your buttocks, and grafts it onto the chest. This is a more complex surgery. It is sometimes done with 2 teams of surgeons. 一队可以移除皮瓣，另一队准备血管.

• Latissimus dorsi flap. 这种方法将肌肉、脂肪、血管和皮肤从你的上背部移动到你的胸部. Sometimes an implant is also needed with this surgery.

• TUG (transverse upper gracilis) flap. 在这种类型中，肌肉和脂肪从大腿内侧的上部移到胸部.

Healing after surgery

即刻重建手术比单纯乳房切除术恢复时间更长. Recovery from delayed reconstruction is much quicker. With autologous tissue surgery, 还有一个手术部位在愈合过程中需要照顾.

重要的是要知道，乳房重建的最终结果可能需要两个月的时间才能看到. Be patient as your body heals.

DIEP Flap | Breast Reconstruction Overview