Tuesday, October 12, 2010

The reconstruction process

Something I find a lot of my friends don't understand is the reconstruction process.  A lot of people assume it is similar to just getting implants to enlarge your breasts, but it's completely different.

With a breast augmentation, a person still has all of their breast tissue to 'support' their new implant.  A mastectomy patient has had their breast tissue cut out, so the pectoral muscle must be stretched to create a 'house' for the implant.

My tissues expanders look like this....

Right now the plan is, and it will depend on how well my body tolerates the fills to get 60 cc's injected in the expanders every two weeks (possibly every week if I do well with it).  A butterfly needle, like the one shown above, will be inserted through the skin and muscle and into the port (the grey area) and the saline will be injected.  The texture of the expander felt almost rubbery to me.  Under my skin it feels and looks like what most mastectomy patients term their 'turtle shells'.  Their are very hard, and they don't have any give as they are meant to put pressure on the muscles to expand them.  It feels like I have a tight band or a bra that is 3 sizes too tight around my chest.  It's not painful, just uncomfortable.  Below is a picture and description of the two stages of the reconstruction.

Breast reconstruction with Implants

For many patients, breast reconstruction with implants is a great option. The first stage involves placing a tissue expander beneath your chest muscles. This expander is a balloon-like device made from gel. Over time, saline fluid is added in order to inflate the expander and stretch the skin. This expansion takes place over a few weeks to months, with regular office visits. Eventually, the skin and muscle are stretched sufficiently so that there is room for the placement of a more permanent implant.
Stage two involves placing this implant. The balloon expander is removed, and your surgeon will then insert a breast implant. The implant can be saline filled or silicone gel ('gummy bear' style). The choice of implant is between you and your surgeon, but generally speaking, the gel implants give a more natural look and feel.

One thing that I do have to help support the bottom of my breast is AlloDerm.
AlloDerm® is a patented tissue matrix that was originally developed in 1994 by LifeCell as a graft for burn patients. Since that time, AlloDerm®'s remarkable versatility has led to its use in a host of other reconstructive applications, including facial reconstruction, abdominal wall reconstruction, and more recently, breast reconstruction. AlloDerm® allows surgeons to restore many type of tissue damaged through radiation, injury and disease using the regenerative power of their patients' own body.

AlloDerm® is created from donated human skin. LifeCell’s patented process removes all of the cells from the donated skin, while retaining all of the important biochemical and structural components. This makes AlloDerm® an acellular tissue product which will not result in rejection. Since AlloDerm® is derived from human tissue, there may be a concern that it might harbor disease carrying viruses. However, with more than one-million implants and grafts to date, the safety of AlloDerm® has been proven, as there has never been any evidence of viral disease transmission to any patients. Tissue donors are screened and tested for transmissible diseases, and a comprehensive review of each donor is completed by a medical director before allowing the tissue to be processed.

When placed in the human body, AlloDerm® repairs damaged tissue by providing a foundation for new tissue regeneration. Blood will flow into the preserved vascular channels in AlloDerm® allowing it to be incorporated into the body. As cells move into AlloDerm®, the process of tissue regeneration begins. With progression of the healing process, AlloDerm® is transformed into living tissue that not only resembles your own but also functions like your own.

For patients undergoing mastectomy, AlloDerm® is primarily used in the setting of tissue expander and implant breast reconstruction. In the first stage of reconstruction, AlloDerm® helps to provide coverage of a tissue expander and can help to decrease the number of times expansion is needed. The AlloDerm® serves as an extension of the surrounding soft tissue on the chest, allowing for a more immediate breast contour. In fact, for the right patient, direct-to-implant reconstruction, without the need for a tissue expander, may be made possible with the use of AlloDerm®.

In addition to first stage breast reconstruction, AlloDerm® has been used for numerous applications in secondary reconstruction. For example, AlloDerm® may be used in revision reconstruction to help camouflage implant rippling and to help correct implant malposition. Also, AlloDerm® can be utilized to help in nipple reconstruction.

I'm currently at 360 cc's in my expanders.  Ryan will be expanding them to 650-700.  My natural size was 750 cc's, but I asked him if it would be possible to get them smaller.  I certainly think if I have to deal with losing my real ones because of cancer then my reconstructed ones should be my idea of the perfect size.  Turns out it's not quite so easy to go that much smaller, and if we did it would involve removing extra skin, which I really don't want to do.  The smallest he feels we can go without having extra skin is 650. On the bright side, I'm starting out already half-way there, so that means less fills than we initially thought going into surgery.


  1. thanks for educating us!

    and i agree- you deserve whatever size you want :)

  2. Thanks for clearing that up and giving a better mental picture of that. Doesn't look so scary and awful now, though it does still sound a slight bit painful.

    I agree, you deserve whatever size you want to be. I see the point he is saying though with the extra skin and you not going to a certain size. That probably wouldn't be attractive unless you had it taken off/out.

    I am glad that you are halfway there already, so maybe this process will go rather quickly and smoothly.

    Also love that you are comfortable enough with your doctors to be on a first name basis, that is awesome.

  3. my best friend is having a double mastectomy this week. she's not sure when the reconstruction will begin (chemo, then radiation) but this was helpful for me to see - so I can try to talk with her about it.
    thanks for sharing.