Breast Reconstruction

Breast reconstruction is an emotional experience for a woman who has lost a breast due to cancer or other condition. This surgical procedure can significantly improve your self-image and confidence. It is important to remember this surgery will give you a relatively natural-looking breast, but because it is reconstructed, it will never look or feel exactly the same as the breast that was removed. 

With new technology and advancements, we are pleased to offer an option of fat-grafting to reconstruct breasts. Fat from another area in your body is liposuctioned and then placed into the breast. This procedure is best discussed with our doctors.

About the Procedure

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

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

Consultation

Your consultation is your time to ask the doctor about the procedure you’re considering, how he thinks it will work for you and any concerns you may have. We suggest you come prepared with your questions on paper so you’re sure not to forget to ask the questions that are important to you.

Questions to consider:

  • What is the simplest and safest surgery to help me achieve my goals?
  • How is the surgery performed?
  • What is the expected length of operation?
  • Are other options available?
  • What results can I expect, and how long do the typical results last?
  • Where will scars be located, and how noticeable will they be?
  • Will scars fade over time, and how long will this take?

When you arrive at the office, you will be asked to fill out a few pieces of paperwork. It is very important when asked about medications to put down all medications you take, including any supplements or aspirin-type regimens, since these items can impact your blood clotting and pressure. In addition, you need to be truthful about your use of tobacco and alcohol since this will affect your recovery and incision healing.

Before you see the doctor, a nurse or nurse practitioner will do an initial exam. You may be able to get a number of your questions answered while with the nurse.

Your surgeon will discuss several factors regarding surgery during your initial consultation, including your procedure, location, anesthesia and recovery. In addition, the surgeon will inquire about your concerns, priorities and motivations for pursuing surgery, as well as your fears.

The doctors are sure to address reasonable expectations for the outcome of your desired procedure, and they should explain what is possible and what is not possible.

After your consultation with the physician, you will meet with the practice manager to discuss procedure costs.

Pre-Procedure

There are a number of things to do prior to your procedure that will make your recovery as smooth as possible and ease your pre-procedure anxiety.

Your surgeon will give you instructions on what medications to stop taking and when prior to your surgery to prevent any unwanted side effects. Medications you shouldn’t take up to two weeks prior to your surgery include, but are not limited to, aspirin and products containing aspirin, alcohol and herbal supplements. Your surgeon may advise you to take Arnica Montana, Bromelain or vitamins A or K for swelling, bruising and to promote general healing.

It is important to remember to only take a supplement or herbal remedy if your surgeon advises it.

Your Pre-Op Checklist

  • Take pictures and make notes to discuss with your doctor. You know what you want, and he knows how to make it possible.
  • Make a list of post-op projects and gather what you need.Stop taking blood-thinning medications and supplements two weeks prior to surgery (aspirin, Motrin, fish oils, vitamin E) and don’t take them two weeks after surgery.
    • Books to read
    • Photo projects
    • Journal
    • Sewing
    • Vacation planners
  • Start using anti-bacterial soap in the shower a few days before surgery and following surgery.
  • Remove all fingernail and toenail polish.
  • Fill prescriptions you’ll need, including antibiotics and pain medications.
  • Purchase over-the-counter eye drops and eye gel for overnight (GenTeal seems best and it is found at major drug stores like Walgreens)
  • Pick up Bacitracin for incision areas and Colace to keep your bowels moving during recovery.
  • Clear your calendar for a month post-op
  • Arrange for caretakers: you, kids, plants and pets need to be taken care of during your recovery. You will not be able to lift, reach, bend over or be too active for some time.
  • Prepare your recovery area so your head is elevated. A recliner works wonders for this. Also stock your recovery area with:
    • Blankets
    • Water
    • Phone
    • Lotion
    • Tissues
    • Remote control
    • Reading material
    • Laptop
    • Any other item that will make you feel comfortable during your recovery
  • Make a to-do list of things you want to get done prior to surgery and start! You won’t be able to accomplish as much post-surgery. Some items you may want to get done include:
    • Clean the house
    • Stock up on groceries and easy to prepare meals
    • Catch up on gardening
    • Laundry
    • Give the dog a bath
    • Clean the litter box
    • Wash your car
  • Stock up on ice packs, frozen peas and frozen gel packs. You’ll want to use them early and often on your face, neck and ears. It will definitely feel good and keep the swelling down.
  • Pack a receptacle with a lid and towel in your car for the ride home from the hospital just in case you feel nauseous. You may want to add a pillow and blanket, but be sure to set up on the ride home to help with the nausea and swelling.
  • Get your hair and nails done since it will be a while before you can do either.
  • Prepare Power of Attorney for Medical Care and Advance Directives, just in case. Give copies to your doctor and/or surgical center.
  • Breathe and relax! Stress can adversely affect your recovery. Try to remember that you will heal, the soreness will subside and you will look great.

During Your Procedure

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.

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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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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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 long-lasting implant.

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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.

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.

Results

The final results of breast reconstruction following a mastectomy can help lessen the physical and emotional impact of a mastectomy.

Over time, some breast sensation may return, and scar lines will improve, although they’ll never disappear completely.

There are trade-offs, but most women feel these are small compared to the large improvement in their quality of life and the ability to look and feel whole.

Careful monitoring of breast health through self-exam, mammography and other diagnostic techniques is essential to your long-term health.

Following your surgery for flap techniques and/or the insertion of an implant, gauze or bandages will be applied to your incisions.

An elastic bandage or support bra will minimize swelling and support the reconstructed breast. A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid.

A pain pump may also be used to reduce the need for narcotics.

Recovery is an important part of any surgery, and you must take the doctor’s orders to heart if you want to heal as quickly as possible.

You will be given specific instructions that may include: how to care for the surgical site, medications to apply or take orally to aid healing and reduce the potential for infection, specific concerns to look for at the surgical site or in overall health, and when to follow up with your plastic surgeon.

Be sure to ask your plastic surgeon specific questions about what you can expect during your individual recovery period.

  • Where will I be taken after my surgery is complete?
  • What medication will I be given or prescribed after surgery?
  • Will I have dressings/bandages after surgery? When will they be removed?
  • Are stitches removed? When?
  • When can I resume normal activity and exercise?
  • When do I return for follow-up care?

Risks

 

There are risks involved with any surgery. The possible risks of breast reconstruction include, but are not limited to, bleeding, infection, poor healing of incisions, and anesthesia risks. You should also know that:

  • Flap surgery includes the risk of partial or complete loss of the flap and a loss of sensation at both the donor and reconstruction site.
  • The use of implants carries the risk of breast firmness (capsular contracture) and implant rupture.

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