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Any time you care for a woman scheduled for a mastectomy (client, patient, or family member), you will want to acquaint her with the possibility of breast reconstruction surgery. Help her determine what the procedure will mean to her in terms of self-confidence, sexuality, and additional expense. Explain that some insurance companies will pay at least part of the expenses, particularly after a radical mastectomy.
Remember that the woman may not be interested in any further surgical procedures and will adapt psychologically to the loss of a breast. But knowing that breast reconstruction is possible may help her cope with an anticipated mastectomy.
Important: Urge the woman to discuss breast reconstruction with her health care provider before her mastectomy. Her health care provider may either modify the surgical technique so that later reconstruction is easier or consult with a plastic surgeon.
UNDERSTANDING RECONSTRUCTION TECHNIQUES
As you probably know, breast reconstruction rebuilds the breast with an implant filled with either silicone gel or a saline solution; in some cases, a tissue graft is used, too. Depending on the type of mastectomy the woman had, she may undergo several surgical procedures before reconstruction's complete.
How does the health care provider reconstruct a breast?
She/He will choose a technique suited to the woman's condition.
For instance, suppose the woman's chest skin is too tight to accommodate an implant that matches the size of her remaining breast. The health care provider may make an incision and place a very small implant in the skin pouch. Later, after the skin has stretched sufficiently, the small implant will be replaced by a larger one that matches the size of her natural breast.
A woman who has undergone an extended radical mastectomy has special problems, because her chest wall is hollow. To rebuild the chest; the health care provider may perform a pedicle graft. To do this, the graft tissue is rolled from the abdomen or thigh to the mastectomy site, the health care provider surgically detaches it from its original site.
In addition to the pedicle graft, the woman's needs an implant to rebuild the breast mound. The health care provider may place the implant under the skin flap when she/he transfers the graft, or the implant may be inserted later in a separate surgery. Note: A pedicle graft may also be used if the woman's skin is very thin.
To reconstruct the nipple, graft tissue may be obtained from the woman's labia or from her remaining nipple. Or, if the nipple on the affected breast is found to be cancer-free, this may be saved and used during reconstruction. The areola may be one of a variety of colors, ranging from pink to brown.
A reconstruction nipple will be less projected than a natural nipple and show evidence of scarring. Also, it will lack normal sensation and probably will not respond to sexual stimulation.
TEACHING ABOUT RECONSTRUCTION
The health care provider needs to be sure to explain to the woman that results of breast reconstruction surgery vary among women. For example, explain that her reconstructed breast may feel soft and natural or become firm. Make sure she understands that the reconstructed breast will have some scars and slight imperfections. But emphasize that it will look nearly normal - especially under clothing.
He/she should also inform the woman that the reconstructed breast may not look exactly like the remaining breast. For example, if little tissue's available to cover the implant and her natural breast is large, the reconstructed breast may be smaller.
To achieve symmetry between the reconstructed breast and the natural breast, the health care provider may surgically adjust the natural one by breast reduction, mastopexy (an uplift operation), or an implant. Or if the remaining breast is likely to develop cancer, a subcutaneous mastectomy and reconstructive surgery may be performed.
If the woman and her health care provider are receptive to breast reconstruction surgery, arrange for an A.F.T.E.R. (Ask a Friend To Explain Reconstruction) volunteer to visit her. This organization puts women who are interested in breast reconstruction in touch with women who have had reconstruction surgery. Check with the hospital's social services department and the community's support services for more information about this organization or other similar support organizations in your region.
Finally, any practitioner caring for the woman as a client/patient should document any teaching, along with the woman's reaction to it, in their care notes.
To request a Reach to Recovery visit ask your health care provider or nurse for a referral, contact REACH TO RECOVERY at 1-800-ACS-2345, or use the "Contact Us" button at www.cancer.org.
MOONDRAGON'S BREAST CANCER LINKS
Learning About Breast Cancer
Learning About Breast Surgery
Understanding Breast Tumor Staging
Familiarizing Yourself With Diagnostic Techniques
Understanding Fibrocystic Breast Disease
Guide To Types of Mastectomies
Patient Preparation For A Mastectomy
Mastectomy Care After Surgery
Learning About Breast Reconstruction
Selecting A Prosthesis
Applying An Arm Sleeve and Gauntlet
Preventing Complications After A Mastectomy
MoonDragon's ObGyn Information: Breast Cancer
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