Breast surgery involves operations on breast tissue for therapeutic, reconstructive, and aesthetic reasons. This field requires the specialized expertise of various medical professionals, including general surgeons, surgical oncologists, and plastic surgeons. The scope of breast surgery ranges from treating diseases to restoring form after trauma or loss, and modifying the breast’s appearance. Understanding the distinct goals of these procedures helps patients navigate options for breast health and body contour.
Procedures for Treating Breast Disease
Surgery to treat or remove cancerous or high-risk abnormal tissue focuses on disease eradication. The two primary therapeutic procedures are lumpectomy and mastectomy. A lumpectomy, or breast-conserving surgery, removes the tumor and a surrounding border of healthy tissue (the surgical margin), while preserving most of the breast. This approach is often followed by radiation therapy.
A mastectomy involves removing all or most of the breast tissue. Traditional methods, like the total mastectomy, remove the entire breast, including the nipple and areola. Modern techniques, such as skin-sparing and nipple-sparing mastectomies, remove the internal glandular tissue while preserving the external skin envelope, which allows for better cosmetic results if immediate reconstruction is planned. The choice between procedures depends on factors like tumor size and location.
A sentinel lymph node biopsy (SLNB) is often performed concurrently with a lumpectomy or mastectomy. This procedure identifies and removes the first one to three lymph nodes in the armpit (sentinel nodes) where cancer cells are most likely to spread. Surgeons locate these nodes by injecting a tracer into the breast. If the sentinel nodes test negative for cancer, it suggests the disease has not spread, often preventing the need for a more extensive axillary lymph node dissection.
Procedures for Restoring Form and Function
Restorative breast surgery rebuilds the breast mound following a mastectomy, trauma, or to correct congenital asymmetry. The goal is to restore natural shape and symmetry to the chest wall, often performed by a plastic surgeon, sometimes immediately after cancer removal. Reconstruction uses either synthetic implants or the patient’s own tissue, known as autologous reconstruction. Implant-based reconstruction typically begins with placing a temporary tissue expander beneath or above the chest muscle. The expander is gradually filled with saline over several weeks to create a pocket for a permanent saline or silicone implant.
Autologous reconstruction, or flap surgery, uses tissue harvested from another part of the body to form the new breast mound. The deep inferior epigastric perforator (DIEP) flap is a common technique using skin, fat, and blood vessels from the lower abdomen. This technique spares the rectus abdominis muscle, minimizing abdominal wall weakness. Another option is the latissimus dorsi (LD) flap, which transfers muscle, fat, and skin from the back to the chest, often combined with an implant for sufficient volume.
The transverse rectus abdominis myocutaneous (TRAM) flap is an older abdominal flap that moves tissue along with a portion of the abdominal muscle. This carries a higher risk of abdominal wall complications compared to the muscle-sparing DIEP flap. Flap procedures create a reconstructed breast that feels softer and more natural because it is composed of living tissue. These complex surgeries require microsurgical techniques to connect the blood vessels of the transferred tissue to vessels in the chest.
Procedures for Modifying Appearance
Elective procedures modify breast appearance by altering the size, shape, or position of healthy breast tissue. Breast augmentation, or augmentation mammaplasty, increases breast size and projection, typically using silicone or saline implants placed under the muscle or behind the glandular tissue. Fat transfer uses liposuction to harvest the patient’s own fat for injection into the breasts, offering a modest size increase using natural body tissue.
Breast reduction, or reduction mammoplasty, removes excess fat, glandular tissue, and skin to achieve a size proportionate to the patient’s body. Although aesthetic considerations are involved, this procedure often provides functional relief from chronic back, neck, and shoulder pain caused by heavy breasts. Surgeons use specialized incision patterns, such as the Wise pattern (anchor-shaped scar) or a vertical scar technique, to remove tissue and reposition the nipple-areola complex.
A mastopexy, or breast lift, reshapes and elevates a sagging breast without significantly changing its volume. The procedure removes excess skin and tightens the surrounding tissue to reposition the nipple-areola complex to a higher position. Incision patterns include a circumareolar approach for minimal sagging, or a vertical incision extending down from the areola for moderate ptosis. A mastopexy is frequently combined with augmentation to restore both volume and position after fullness loss due to factors like pregnancy or weight loss.
Preparing for Surgery and Recovery
Preparation for breast surgery begins with a thorough pre-operative consultation, including blood tests and sometimes a chest X-ray or electrocardiogram, to assess overall health. Patients must stop taking blood-thinning medications, such as aspirin, ibuprofen, and certain supplements, for about ten days before the procedure. Fasting from food and drink after midnight the night before surgery is required to minimize the risk of complications from anesthesia.
Post-operative recovery varies based on the procedure’s complexity, but general guidelines apply to incision and activity care. Patients are advised to wear a specialized surgical bra for support and to minimize swelling during the initial healing phase. Pain is managed with prescribed medications, with discomfort usually highest in the first few days. Activity restrictions are common, often limiting lifting heavy objects for several weeks to prevent strain on the incisions.
Drains, which are small tubes placed under the skin to remove excess fluid, may be necessary for several days or weeks after extensive procedures like a mastectomy or autologous flap reconstruction. Most patients return to non-strenuous daily activities within two to four weeks. Full recovery and the resumption of intense physical exercise can take up to six to eight weeks, especially following flap reconstruction. Following the surgeon’s specific instructions for incision care and movement exercises is important for the best outcome.