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 mastectomy.

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 mastectomy.

Although breast reconstruction can rebuild your breast, the results are highly variable:

  • A reconstructed breast will not have the same sensation and feel as the breast it replaces.
  • Visible incision lines will always be present on the breast, whether from reconstruction or mastectomy.
  • Certain surgical techniques will leave incision lines at the donor site, commonly located in less exposed areas of the body such as the back, abdomen or buttocks.

A note about symmetry: If only one breast is affected, it alone may be reconstructed.  In addition, a breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry of the size and position of both breasts.

Enhancing your appearance with breast reconstruction

Breast reconstruction is a physically and emotionally rewarding procedure for a woman who has lost a breast due to cancer or other condition.

The creation of a new breast can dramatically improve your self-image, self-confidence and quality of life. Although surgery can give you a relatively natural-looking breast, a reconstructed breast will never look or feel exactly the same as the breast that was removed.

Is it right for me?

Breast reconstruction is a highly individualized procedure.  You should do it for yourself, not to fulfill someone else’s desires or to try to fit any sort of ideal image.

Breast reconstruction is a good option for you if:

  • You are able to cope well with your diagnosis and treatment
  • You do not have additional medical conditions or other illnesses that may impair healing
  • You have a positive outlook and realistic goals for restoring your breast and body image

Breast reconstruction typically involves several procedures performed in multiple stages. It can:

  • Begin at the same time as mastectomy, or
  • Be delayed until you heal from mastectomy and recover from any additional cancer treatments

It’s important that you feel ready for the emotional adjustment involved in breast reconstruction. It may take some time to accept the results of breast reconstruction.

 

What to Expect During Your 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:

  • Why you want the surgery, your expectations and desired outcome
  • Medical conditions, drug allergies and medical treatments
  • Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
  • Previous surgeries
  • The options available in breast reconstruction surgery
  • The likely outcomes of breast reconstruction and any risks or potential complications
  • The course of treatment recommended by your plastic surgeon, including procedures to achieve breast symmetry

Your surgeon may also:

  • Evaluate your general health status and any pre-existing health conditions or risk factors
  • Examine your breasts, and take detailed measurements of their size and shape, skin quality, and placement of nipples and areolae
  • Take photographs for your medical record
  • Discuss your options and recommend a course of treatment
  • Discuss likely outcomes of breast reconstruction and any risks or potential complications

 

Preparing for Surgery

Prior to surgery, you may be asked to:

  • Get lab testing or a medical evaluation
  • Take certain medications or adjust your current medications
  • Stop smoking well in advance of surgery
  • Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding

Special instructions you receive will cover:

  • What to do on the day of surgery
  • The use of anesthesia during your breast reconstruction
  • Post-operative care and follow-up
  • Breast implant registry documents (when necessary)

Your plastic surgeon will also discuss where your procedure will be performed. Breast reconstruction surgery may be performed in an accredited office-based surgical center, outpatient/ambulatory surgical center, or a hospital.

You’ll need help

If your breast reconstruction is performed on an outpatient basis, be sure to arrange for someone to drive you to and from surgery and to stay with you for at least the first night following surgery.

Procedural Steps

What happens during breast reconstruction surgery?

Step 1 – Anesthesia

Medications are administered for your comfort during the surgical procedure.  The choices include intravenous sedation and general anesthesia.  Your doctor will recommend the best choice for you.

Step 2 – Flap techniques reposition a woman’s own muscle, fat and skin to create or cover the breast mound.

Sometimes a mastectomy or radiation therapy will leave insufficient tissue on the chest wall to cover and support a breast implant.  The use of a breast implant for reconstruction almost always requires either a flap technique or tissue expansion.

A TRAM flap uses donor muscle, fat and skin from a woman’s abdomen to reconstruct the breast.  The flap may either remain attached to the original blood supply and be tunneled up through the chest wall, or be completely detached, and formed into a breast mound.

Alternatively, your surgeon may choose the DIEP or SGAP flap techniques which do not use muscle but transport tissue to the chest from the abdomen or buttock.

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A latissimus dorsi flap uses muscle, fat and skin from the back tunneled to the mastectomy site and remains attached to its donor site, leaving blood supply intact.

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Occasionally, the flap can reconstruct a complete breast mound, but often provides the muscle and tissue necessary to cover and support a breast implant.

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Step 3 – Tissue expansion stretches healthy skin to provide coverage for a breast implant.

Reconstruction with tissue expansion allows an easier recovery than flap procedures, but it is a more lengthy reconstruction process.

It requires many office visits over 4-6 months after placement of the expander to slowly fill the device through an internal valve to expand the skin.

A second surgical procedure will be needed to replace the expander if it is not designed to serve as a permanent implant.

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Step 4 – Surgical placement of a breast implant creates a breast mound.

A breast implant can be an addition or alternative to flap techniques. Saline and silicone implants are available for reconstruction.

Your surgeon will help you decide what is best for you.  Reconstruction with an implant alone usually requires tissue expansion.

Step 5 – Grafting and other specialized techniques create a nipple and areola.

Breast reconstruction is completed through a variety of techniques that reconstruct the nipple and areola.