What is Breast Reconstruction?
Breast reconstruction is achieved through several plastic surgery techniques that attempt to restore a breast to near normal shape, appearance and size following either a lumpectomy or mastectomy. For smaller defects created by a lumpectomy, this may be achieved by reshaping the remaining breast tissue or adding tissue in the form of fat grafting or a small implant. When the entire breast has been removed with a mastectomy, a multi or single stage reconstruction is often performed with the use of tissue expanders, breast implants, and fat grafting. Nipple and areola reconstruction is often required as well, and can be performed as the final stage of the reconstruction or by 3d tattooing. For mastectomy defects, reconstruction begins immediately with placement of tissue expanders or implants at the time of breast removal. Lumpectomy defects are often performed in a delayed fashion once the breast tissue has healed and additional treatments (radiation or chemotherapy) have been completed.
Quick Facts
Stage 1 – Tissue Expander Placement or Single Stage Direct-to-Implant
Tissue expander(s) is/are placed in the breast, following a mastectomy (surgical removal of the breast). A tissue expander is placed to stretch out the skin which will later be replaced with a permanent prosthesis. Direct-to-Implant is a single stage operation done at the time of mastectomy in selected patients.
- LENGTH: 2 to 4 hours including mastectomy
- ANESTHESIA: General – Inpatient Surgery / 1 to 2 days in the hospital
- SIDE EFFECTS: Temporary soreness, swelling, bruising, numbness, burning sensation.
- RISK: Infection. Asymmetry. Tightening & hardening of scar tissue around the implant (“capsular contracture”), or rupture of implant; either may require surgery to release the scar tissue or to remove or replace the implant. Permanent decrease in sensitivity of nipples or breast skin, loss of skin or nipple due to neurosis
- RECOVERY: Tasks of daily living may be resumed immediately. Back to non-strenuous work (no lifting greater than 10 lbs) in 2 to 4 weeks. No strong pushing, pulling or repetitive upper body movements for 3 weeks. Arm restruction will be reviewed.
- EXERCISE: Resume low impact activities at 2 – 3 weeks (1/3 duration of exercise, repetitions, amount of weight and pulse rate). Moderate impact activity @ 4 – 6 weeks. Full intensity including high impact (running, horse back riding, high impact aerobics) @ 8 weeks.
- FADING & SCAR IMPROVEMENT: 6 to 24 months
- BRUISING: 2 to 4 weeks
- SWELLING: Moderate/Significant 4 weeks, Subtle/Mild 2 to 3 months, all of which are dependent upon extent of procedure(s)
- DURATION of RESULTS: Tissue expander will be replaced with permanent prosthesis in 3 to 6 months. Implants may require removal or replacement at some time in the future.
- TIME frame usually years or decades!
- OFFICE VISITS: 1st 5 to 7 days / 2nd Visit 7 to 10 days
Anticipated No. of office visits: 7 to 10 visits the first 3 months, yearly after reconstruction stages completed. - GARMENT WORN: Support as needed for 6 weeks
- PAIN MEDS: Ibuprofen or Narcotics as needed
Stage 2 – Exchange of Tissue Expander for Permanent Prosthesis
May be with or without fat grafting to the breasts or other refining modifications.
- LENGTH: 1.5 to 2 hours
- ANESTHESIA: General – Outpatient Surgery
- SIDE EFFECTS: Temporary soreness, swelling, bruising
- RISK: Infection. Asymmetry. Tightening & hardening of scar tissue around the implants (“capsular contracture”), or rupture of implants; either may require surgery to release the scar tissue, to remove or replace the implant. Decrease in sensitivity of breast skin, usually permanent.
- RECOVERY: Tasks of daily living may be resumed immediately. Back to non-strenuous work (no lifting greater than 10 lbs) in 3 to 5 days. No strong pushing, pulling or repetitive upper body movements for 4 weeks.
- EXERCISE: Resume low impact activities at 2 – 3 weeks (1/3 duration of exercise, repetitions, amount of weight and pulse rate). Moderate impact activity @ 4 – 6 weeks. Full intensity including high impact (running, horse back riding, high impact aerobics) @ 8 weeks.
- FADING & SCAR IMPROVEMENT: 6 to 12 months
- SWELLING: Moderate/Significant 4 weeks, Subtle/Mild 2 to 3 weeks, all of which are dependent upon extent of procedure(s).
- DURATION of RESULTS: Variable. Implants may require removal or replacement at some time in the future.
- OFFICE VISITS: 1st 5 to 7 days / 2nd Visit 7 to 10 days
- PAIN MEDS: Ibuprofen muscle relaer or Narcotics as needed
Stage 3 – Nipple Reconstruction
Two to 3 months after permanent prosthesis placement with or without additional fat grafting
- LENGTH: Office Procedure or Operating room 1 hour, Minimal Downtime
- BRUISING: 2 weeks
- SWELLING: 6 weeks
- REDNESS in SCAR: 6 to 12 months
- OFFICE VISIT: 1st post op visit 5 – 7 days / 2nd Visit 14 days
Considerations
Loss of a breast is a severe physical and emotional event for any woman. Fortunately, procedures are currently available for reconstruction of the female breast following a mastectomy, which helps to correct both the physical and emotional loss associated with a mastectomy.
Most women who have had a mastectomy are candidates for some kind of breast reconstruction. The role of the reconstructive surgeon is to work with the general surgeon, the oncologist, and the radiologist involved in your treatment, to map out a plan for optimum management of your breast cancer. If you desire reconstruction, we make every effort to achieve a fully reconstructed breast as safely and as rapidly as possible.
If chemotherapy or radiation therapy is indicated for you following your mastectomy, reconstructive procedures must be very carefully coordinated with these other therapy methods to insure proper treatment for the cancer. Radiation and/or chemotherapy do not prevent you from having breast reconstruction, however, planned radiation therapy may require delayed, rather than immediate reconstruction following a mastectomy.
Breast Reconstruction Options:
Breast reconstruction can be similar to breast enhancement. It is, however, more extensive and almost always consists of more than one procedure.
BREAST MOUND RECONSTRUCTION: The first stage of breast reconstruction surgery involves recreating the breast mound. This can sometimes be done during the same procedure as the mastectomy, or it can be performed separately. One of the first issues that must be addressed during breast reconstruction is the loss of skin due to the mastectomy. Some women may have sufficient skin available, but for most, the first step involves recreating sufficient skin to cover the reconstructed breast. This is done using either skin expansion or flap reconstruction, both of which are described below.
SKIN EXPANSION: This is the most commonly used technique for breast reconstruction surgery. It involves allowing the skin to slowly regrow using an expandable implant placed under the skin, which is slowly expanded to allow the covering skin to stretch. The expanders will eventually be replaced with a breast implant to create a soft and natural breast mound. Different Techniques include above or below the pectoralis muscle.
FLAP RECONSTRUCTION: Flap reconstruction is an alternative to skin expansion. This technique involves transferring skin and fat from another part of the body – usually the abdomen or the back. Flap reconstruction surgery is far more complicated than skin expansion surgery, requires more recovery time, and leaves more extensive scarring, to both the breast and to the donor site. This option is often used as a backup procedure in our practice.
FOLLOW-UP PROCEDURES: In many cases, the breast mound reconstruction is followed up with procedures to complete reconstruction of the breast. These procedures might include one or more of the following:
- Reconstruction of the nipple and areola.
- Replacement of a tissue expander with a permanent implant.
- Breast lift or enhancement performed on the other breast to create symmetry.
Our surgeons will discuss your options for reconstructive surgery with you in detail so that you will know just what to expect before you begin the process.