Overview
Breast Reconstruction
Breast reconstruction is surgery to rebuild a breast's shape after a mastectomy. It cannot give a woman back her breast - a reconstructed breast does not have natural sensations. However, the surgery offers a result that looks like a breast. Most women who had breast reconstruction are glad they did.Breast reconstruction is achieved through several plastic surgery techniques that attempt to restore a breast to near normal shape, appearance and size following mastectomy.
In breast reconstruction, a surgeon forms a breast mound by using an implant or tissues from the belly, back or buttocks. Implants are silicone sacs filled with salt water or silicone gel. The type of reconstruction you get depends on your body type, age and cancer treatment.
Breast reconstruction takes more than one surgery. Extra steps may include : -
- Adding a nipple
- Changing the shape or size of the reconstructed breast
- Operating on the opposite breast for a better match
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.
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.
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.
Occasionally, the flap can reconstruct a complete breast mound, but often provides the muscle and tissue necessary to cover and support a breast implant.
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.
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
Risks
Risks for any surgery are : -- Blood clots in the legs that may travel to the lungs
- Breathing problems
- Infection, including in the surgical wound, lungs (pneumonia), bladder, or kidney
- Blood loss
- Heart attack or stroke during surgery
- Reactions to medicines
The risks for breast reconstruction with implants are : -
- The implant in 1 out of every 10 women will break or leak in the first 10 years. If this happens, you will need more surgery.
- A scar may form around the implant in your breast. If the scar becomes tight, your breast may feel hard and you may have pain or discomfort. This is called capsular contracture. You will need more surgery if this happens.
- Infection soon after surgery. This would require removal of the expander or the implant.
- Breast implants can shift some. This will cause a change in the shape of your breast.
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