What is breast reconstruction surgery?
Breast reconstruction surgery is a medical procedure aimed at restoring the shape, appearance and size of your breasts. If only one breast is affected, it alone may be reconstructed, although a lift, reduction or augmentation of the other breast may be recommended to improve symmetry.
Breast reconstruction is often done after breast cancer surgery. In fact, post-mastectomy breast reconstruction is covered by insurance under the Women’s Health and Cancer Rights Act of 1998.
After a general surgeon removes the cancer via a mastectomy or lumpectomy, a plastic surgeon performs a reconstructive procedure to restore the look and feel of the breasts. The reconstruction may happen at the same time as the mastectomy or be delayed until you’ve recovered from surgery and any additional cancer treatments.
Is breast reconstruction right for me?
Undergoing breast reconstruction is a highly personal choice. Some people desire a more balanced look, want clothes to fit better or aim to improve their self-confidence. Whatever your reason for breast reconstruction, you should do it for yourself — not to fulfill someone else’s desires or to try to fit any sort of ideal image.
It’s also important that you are ready for the emotional adjustment involved in breast reconstruction. It may take some time to accept the results. Breast reconstruction is a good option for you if:
- You’re able to cope well with your diagnosis and treatment.
- You have no other medical conditions or illnesses that could impair healing.
- You have a positive outlook and realistic goals for restoring your body image.
What are types of breast reconstructive surgery?
Our plastic surgeons are experts in both implant-based and flap (tissue-based) reconstructive surgeries. Your surgeon will talk to you about your options and help you make a decision based on your desired results.
Implant reconstruction
Implant reconstruction uses saline or silicone breast implants to replace the tissue that was removed during a mastectomy. The implant is inserted either through your mastectomy incision or an incision underneath your breasts and can be placed either above or below the chest muscle.
Flap reconstruction
Flap reconstruction rebuilds your breasts using tissue from elsewhere in your body. There are many different types of flap surgery — each varies based on the location of the tissue removed.
The most common flap breast reconstructive technique is a DIEP (deep inferior epigastric perforator) flap surgery. In this procedure, tissue is removed from the abdomen — just like in a tummy tuck — and brought up into the chest. Once the tissue is in place, the abdominal blood vessels are connected to those in the chest under a microscope. The DIEP flap procedure is usually less painful than other types of flap reconstruction and has the additional effect of reducing fatty tissue in the midsection.
What should I expect at my breast consultation?
The success and safety of your breast reconstruction procedure depends very much on your complete candidness during your consultation. You’ll be asked a number of questions about your health, desires and lifestyle.
Be prepared to discuss:
- Reasons why you want the surgery
- Expectations and desired outcomes
- Medical history, including conditions, drug allergies and previous medical treatments or surgeries
- Current use of medications, vitamins, herbal supplements, alcohol, tobacco and drugs
- Options available in breast reconstruction surgery
Your surgeon may also:
- Evaluate your general health status, preexisting health conditions and risk factors.
- Examine your breasts and take detailed measurements of their size and shape and skin quality, as well as the placement of nipples and areolas.
- Take photographs for your medical records.
- Discuss your options and recommended course of treatment beyond reconstruction.
- Talk through potential outcomes, risks and potential complications
Where will my breast surgery be performed?
Depending on the procedure, you may undergo breast reconstruction in an outpatient surgery center or in a hospital. Many implant reconstructions can be done on an outpatient basis. Flap reconstruction is performed in a hospital and requires a short hospital stay for recovery.
These decisions are based on the requirements of your specific procedure, your health, your preferences and your doctor’s best judgment.
What happens during breast reconstruction?
Breast reconstruction requires anesthesia for your comfort during the procedure. It may be general anesthesia or administered through an IV. Your doctor will recommend the best choice for your surgery.
Once the anesthesia sets in, your doctor begins the procedure. Some patients require placement of tissue expanders before getting definitive reconstruction with implants or flaps. Tissue expanders are temporary breast implants that help stretch the skin of the breast. They may be placed after a mastectomy if you need radiation, your breast skin is too thin for placement of permanent implants, or you are planning on a flap surgery in the future. Tissue expanders are filled with a small amount of saline when they are inserted. Additional saline is gradually added to the expanders over the course of several weeks using a small needle in clinic.
What is recovery from breast reconstruction like?
Following your surgery, gauze or bandages will be applied to your incisions. An elastic bandage or support bra will minimize swelling and support the reconstructed breast or breasts. You may also have a small, thin tube in place under your skin temporarily to drain excess blood or fluid and a pain pump to reduce the need for narcotics.
Healing continues for several weeks as swelling decreases and breast shape and position improve. For best results, follow your plastic surgeon’s instructions and attend follow-up visits as scheduled.
If you experience shortness of breath, chest pains or unusual heart beats, seek medical attention immediately. Should any of these complications occur, you may require hospitalization and additional treatment.
What are the risks of breast reconstruction?
When breast reconstruction is performed by a qualified plastic surgeon, complications are infrequent and usually minor. But you may experience bleeding, get an infection and have side effects from the anesthesia. Your incisions and surgical wounds may also heal slowly and poorly.
You should also know the risks unique to each procedure. Breast implants carry the risk of breast firmness (capsular contracture) and rupture. Flap surgery includes the risk of partial or complete loss of the flap and a loss of sensation both where tissue was removed, and tissue was placed in the breast.