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Breast

What is breast reconstruction?
Breast reconstruction is achieved through several reconstructive plastic surgery techniques that attempt to restore a breast to near normal shape, appearance and size following mastectomy and may include:

• Flap techniques that reposition a woman's own muscle, fat and skin to create or cover the breast mound
• Tissue expansion that stretches healthy skin to provide coverage for a breast implant
• Surgical placement of a breast implant to create a breast mound
• Grafting and other specialized techniques to create a nipple and areola

While breast reconstruction can effectively rebuild a woman's breast, the results are highly variable. A reconstructed breast will not have the same sensation and feel as the breast it replaces. Visible incision lines will always be present on the breast, whether from reconstruction or mastectomy. In addition, flap techniques will leave incision lines at the donor site, commonly located in less exposed areas of the body such as the back, abdomen or buttocks.

Where only one breast is affected, it alone may be reconstructed. In addition, a breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry in the size and position of both breasts.

Through the advocacy efforts of the American Society of Plastic Surgeons® (ASPS®) and breast cancer support groups, insurance companies are now required by law to provide coverage for breast reconstruction and related procedures to adjust the opposite breast. Pre-certification may be required.

Good candidates for breast reconstruction are women who are:

• Able to cope well with their diagnosis and treatment
• Do not have additional medical conditions or other illnesses that may impair healing
• Non-smokers
• Individuals with a positive outlook and realistic goals for restoring their breast and body image

Flap procedures may not be appropriate for some women with conditions such as obesity, heart disease and diabetes.

What is breast reduction?

Breast reduction is a surgical procedure to reduce the size of large pendulous breasts that are disproportionate to a woman's body and can cause physical pain. Technically called reduction mammaplasty, breast reduction improves breast size, shape and the associated conditions of large breasts that include:

• Back, neck and shoulder pain caused by the weight of excess breast tissue
• Shoulder discomfort and indentation from bra straps that support heavy, pendulous breasts
• Restricted physical activity due to breast size and the associated discomfort
• Skin irritation beneath the breast crease
• Sagging, stretched skin and a low breast profile where, when unsupported, the nipple rests below the breast crease
• An enlarged areola (the dark skin surrounding the nipple) caused by stretched skin

Breast reduction can be performed unilaterally (on one breast) or bilaterally (on both breasts). It is generally considered a reconstructive procedure and may be covered by health insurance when it is performed to relieve medical symptoms. Many insurers define breast reduction surgery as reconstructive based on the amount of tissue that will be removed. However, pre-certification is often required for reimbursement or coverage.

Breast reduction surgery can be performed at any age; however, it is best performed when the breasts are fully developed. Because significant amounts of breast tissue are removed, breast reduction surgery may impair the ability to breast-feed. Changes in the breasts during pregnancy can alter the outcomes of previous breast reduction surgery, as can significant weight fluctuations.

In general, good candidates for breast reduction are women of relatively normal, stable weight whose breast development is complete. Breast reduction is best performed on:

• Healthy individuals who do not have a life-threatening illness or medical conditions that can impair healing
• Non-smokers
• Individuals with a positive outlook and specific goals in mind for improving their physical symptoms, breast size and shape
  

What is a breast augmentation?

Breast augmentation is the surgical placement of breast implants to increase fullness and projection of the breasts or to improve symmetry of the breasts. Clinically referred to as augmentation mammaplasty, the procedure is used cosmetically to:

• • Enlarge a naturally small breast, most commonly the result of heredity
  • Restore breast volume lost following pregnancy, as a result of breast-feeding or due to weight loss
  • Achieve better symmetry when breasts are moderately disproportionate in size and shape

Breast augmentation does not, however, correct sagging breasts. In cases where a woman desires to enhance breast fullness and at the same time improve the position and shape of sagging breasts, a breast lift may be performed in conjunction with breast augmentation.

Breast augmentation is a highly individualized procedure - one that you should choose to undergo to fulfill your own desire for enhanced breast size, not the desire of others. Permanent breast enhancement can only be achieved surgically. There is currently no medical treatment of any kind for breast enhancement with the proven results and satisfaction of breast augmentation.

Adult woman of any age can benefit from breast augmentation to enhance small breast size or restore fullness. However it is recommended that breasts be fully developed prior to breast augmentation. You should also be aware that breast augmentation does not generally interfere with a woman's ability to breastfeed.

A woman who is motivated by her own personal desire to enhance breast contour is most likely to be satisfied with the results of breast augmentation surgery. Good candidates are defined as:

• Healthy individuals who do not have a life-threatening illness or medical conditions that can impair healing
• Non-smokers
• Individuals with a positive outlook and specific goals in mind for improving their body image
  

Where do I begin?
A consultation with your plastic surgeon is the first step to learn how breast reconstruction can restore your breast's appearance. A consultation is designed to fully educate you about your options for breast reconstruction in a supportive, non-pressured environment, and will include:

• A discussion of your goals and an evaluation of your individual case
• The options available in breast reconstruction surgery
• The likely outcomes of breast reconstruction and any risks or potential complications
• The course of treatment recommended by your plastic surgeon, including procedures to achieve breast symmetry

Your plastic surgeon will also answer your questions.

Evaluation
Overall health and personal outlook can greatly impact the outcome of breast reconstruction surgery. These will be carefully evaluated in consultation with your plastic surgeon. The success of your procedure, safety and overall satisfaction requires that you:

• Honestly share your expectations
• Fully disclose health history, current medications, the use of vitamins, herbal supplements, alcohol, tobacco and drugs
• Commit to precisely following all of your plastic surgeon's instructions