Breast Reconstruction (Mastectomy)
Many patients diagnosed with breast cancer undergo a breast removal procedure called a mastectomy. Women who have undergone mastectomy can choose to receive breast reconstruction surgery to restore the appearance of the missing breast or breasts. Reconstructive surgery following a mastectomy can help renew a woman’s sense of femininity and beauty by recreating both the size and shape of the natural breast. Below is a general overview of breast reconstruction, for more detailed information we invite you to explore our breast reconstruction section.
The decision to undergo breast reconstruction is not one that should be made with haste. Because the treatment can involve several procedures over the course of many months, it is important for potential breast reconstruction candidates to thoroughly explore whether or not the procedure is right for them. The following guidelines can you a basic overview of the qualities necessary for a successful post-mastectomy breast reconstruction.
Candidates for post-mastectomy breast reconstruction are individuals who have had either one or both breasts removed following breast cancer. The reconstructive process can begin at the same time as mastectomy or can occur after the patient has healed. While no reconstruction can mimic the exact look and feel of the natural breast, reconstructive surgery can go a long way toward helping a patient feel better both emotionally and physically. Unfortunately, not all women who have their breasts removed are good candidates for this procedure. The ideal breast reconstruction candidate is an individual who:
- Wishes to restore the size a shape of their breast
- Is a non-smoker
- Is cancer-free
- Has coped well with previous treatment and diagnosis
- Does not have diabetes or high blood pressure
- Can make the time commitment for several surgeries
- Has realistic expectations regarding the procedure
Individuals who smoke or suffer from diabetes or high blood pressure are not only at an increased risk during surgery, but may also be vulnerable to complications during healing. Because breast reconstruction typically involves several procedures, the amount of healing time in between each treatment is critical.
Flap vs. Implant Reconstruction Candidates
In addition to identifying if breast reconstruction surgery is right for you, it is important for potential candidates to choose the method that will best suit them. Candidates for breast reconstruction using the TRAM, latissimus dorsi, gluteal, or DIEP flap techniques must be free of any health complications that might affect their surgery. This is because these procedures take tissue from other areas of the body and are generally more invasive than implant reconstruction. In addition, flap reconstruction is often preferred for patients undergoing unilateral breast reconstruction (the reconstruction of one breast), because it will be easier to match the size, shape, and feel of the opposite breast when migrating tissue.
Implant reconstruction is recommended for older patients because it is a less-invasive procedure that typically requires less recovery time. Women who are very thin, and therefore do not have a lot of excess tissue may also prefer this procedure over flap reconstruction. Finally, implant-based reconstruction is often preferred for bilateral patients (those having both breasts reconstructed) because it is much easier to achieve symmetrical results.
Breast Reconstruction Surgery
Reconstructive breast surgery is a major surgery that often requires more than one procedure. Patients may choose to receive breast reconstruction at the same time as mastectomy or wait until they have healed. Reconstruction falls into two categories: breast implants or flap reconstructions. The former involves placing silicone or saline breast implants beneath the chest muscle. Flap reconstructions (TRAM flap, DIEP flap, latissimus dorsi flap, and gluteal flap) remove muscle, fat, or skin from another part of the body to reconstruct the breasts. While flap methods generally require more recovery time, they produce breasts that feel and age more naturally than breast implants.
Types of Reconstructive Surgeries
DIEP flap breast reconstruction is one of the most advanced techniques for recreating the breast after mastectomy. DIEP, an acronym for Deep Inferior Epigastric Perforator, has a number of advantages over other breast reconstruction techniques, including the capacity to form a softer, more natural breast. Below are details about the DIEP flap microsurgical breast reconstruction method, including the pros and cons of the procedure for mastectomy patients.
DIEP Flap Reconstructive Surgery
DIEP flap breast reconstruction involves the removal of skin and fat from the patient’s abdominal area to be used in the creation of a new breast mound. This procedure is similar to the TRAM flap procedure, except unlike TRAM, this method does not migrate any muscle from the abdomen. Deep Inferior Epigastric Performation (DIEP) refers to the name of the tissue that is used to create the new breast; it is the main blood vessel found beneath the rectus abdominus (the so-called “six-pack” muscles of the abdomen). The surgeon will detach the skin and fat of the stomach and re-attach it to the breast area. He or she will then connect blood vessels in the tissue to blood vessels in the chest in order to provide proper circulation. In addition, the skin of the stomach will be tightened and closed with stitches. The surgery is complete when the doctor places drains in the breast area to aid with the body’s natural healing process. On average, surgery takes about 5 hours.
The Pros and Cons of DIEP Flap Reconstruction
DIEP flap reconstruction is a unique procedure, and one that is more invasive than implant reconstruction. Not all candidates for breast reconstruction after mastectomy are candidates for the DIEP flap technique. For example, this surgery is not suitable for individuals who lack adequate abdominal tissue, have blood vessel problems, or those who smoke. For those individuals that are able to undergo this type of reconstructive surgery, there are a number of pros and cons.
- Abdominal strength is preserved
- Breasts tissue feels more natural than implants
- Patients generally experience less discomfort than TRAM flap
- Long-lasting solution, will not have to be replaced like implants
- Shorter recovery time than other treatment options
- Permanent scarring on the breast, abdomen, and belly button
- Highly specialized procedure – not all surgeons can perform it
- Newly reconstructed breast will have little sensation
The “Free Flap” Reconstruction
DIEP flap reconstruction is sometimes referred to as a “free” flap reconstruction method because the skin and fat of the abdomen are completely detached from their original blood supply and then reconnected to a new supply in the breast area. The TRAM flap procedure, however, doesn’t actually detach tissue of the belly from its original blood vessels. The other main difference between TRAM and DIEP flap is that DIEP flap does not involve the grafting of any muscle tissue.
One option for flap breast reconstruction surgery after mastectomy is the gluteal technique, also known as the SGAP (superior gluteal artery perforator) or IGAP (inferior gluteal artery perforator). Because the buttocks contains “excess” skin and fat, it is considered by many to be the logical first choice for a tissue transfer. However, SGAP and IGAP procedures are among the most complicated of all microsurgical breast reconstruction techniques. This section discusses the details of gluteal flap reconstruction, as well as the pros and cons of SGAP and IGAP procedures.
What is SGAP and IGAP surgery?
SGAP and IGAP surgeries are techniques that transfer skin and fat from the buttocks to be used in the creation of a new breast mound following a mastectomy. The main difference between SGAP and IGAP is where the tissue is taken from. In SGAP, skin and fat is taken from the top (superior) area of the buttocks. In IGAP surgery, material is used from the lower (inferior) buttocks area, specifically the crease of the buttock, where the thigh and buttock meet.
Both forms of gluteal flap reconstruction are known as “free” flap microsurgeries. This means that the “flap” of skin and fat that is taken from the buttocks is completely detached from the donor site and original blood supply, and then connected to a new supply of blood vessels at the breast area. This is unlike TRAM flap and latissimus dorsi procedures which keep tissue connected to their original blood vessels. During SGAP or IGAP surgery, your surgeon will transfer skin and fat to the breast area, shape a natural-looking breast mound, and connect it to the appropriate blood vessels. Once this is complete, all incisions are closed and the recovery process begins.
Considerations for Gluteal Flap Patients
Gluteal flap surgery is an advanced breast reconstructive surgery technique that can help women regain their sense of beauty and self following breast removal. Some of the benefits of the SGAP and IGAP techniques include:
- No muscle removal- allows for faster healing
- Viable option for patients with little body fat in the abdomen or other areas
- High success rate
- IGAP scars are hidden
- Use of body’s own tissue decreases risk of complications or infection
- Tissue taken from buttocks resembles feel of natural breast
Some downsides to gluteal flap reconstruction include:
- Scarring at two surgical sites
- More recovery time than implant reconstruction
- Constricted blood flow to reconstructed breast
Latissimus Dorsi Technique
Many post-mastectomy patients choose to receive tissue-based reconstruction instead of bbreast reconstruction with implants. While this is considered a more complicated procedure, it has distinct benefits including producing a natural-feeling breast. One of the options for tissue-based breast reconstruction is latissimus dorsi flap reconstruction. This procedure uses skin, muscle and fat from the upper back to create a new breast mound.
What is Latissimus Dorsi Flap Reconstruction?
The latissimus dorsi is the long muscle that runs beneath the armpit and diagonally across the back; when you raise your arm, the muscle can be felt along the side of the rib cage. During latissimus dorsi flap reconstruction, the surgeon uses this area of muscle and skin to build a new breast. Because of this muscle’s proximity to the chest area, utilizing tissue from this region for breast reconstruction after mastectomy is a popular technique among cosmetic surgeons. Additionally, the muscle and skin flap can remain attached to its natural blood supply, making the procedure less complicated than “free flap” procedures such as DIEP flap and gluteal flap reconstruction.
Latissimus Dorsi Flap Procedure
Latissimus dorsi flap breast reconstruction is a unique procedure because the flap is not completely disconnected from its source at any point during surgery. This flap is sometimes referred to as a “pedicle flap.” During latissiumus dorsi flap breast reconstruction, a tunnel is created beneath the skin from the back muscle to the breast area. Through this tunnel, the surgeon transfers the flap to the breast area. In addition, any blood vessels that were cut during the procedure are reconnected with microsurgery.
Once the flap is in place, the surgeon forms the tissue into the desired shape, and sutures it into position. Finally, the back and chest incisions are closed and recovery begins. In some instances, a surgeon may also place a breast implant in order to produce more aesthetic results. Because the musculature of the back is slightly diminished after surgery, some patients are left with minor asymmetry, though back strength and function and minimally affected.
Benefits and Risks of Latissimus Dorsi Flap Reconstruction
Each form of breast reconstruction surgery has its own unique set of advantages, and one type of surgery may be better suited for you than others. It is important to discuss your options for treatment with your doctor in order to decide if latissimus dorsi flap reconstruction is right for you. Some of the benefits of latissimus dorsi flap reconstruction include:
- Use of own tissue creates a more natural feel than breast implant reconstruction
- Muscle and skin remained attached to natural blood supply, improving chances of breast sensation
- No foreign materials are placed in the body
- Results are long-lasting
- Increased self-confidence
Latissimus dorsi flap reconstruction has some risks and disadvantages as well, including:
- Weakened back and shoulder muscle
- Scarring at donor site and breast area
- Two surgical sites results in increased risk of infection, and more recovery time
- Not ideal for patients who are overweight or have other health problems such as diabetes
TRAM Flap Breast Reconstruction Procedure
TRAM breast reconstruction surgery can be accomplished as a pedicle flap procedure, or a free flap procedure. A pedicle flap procedure simply means that the skin and muscle that is being used to create a new breast is left intact with its natural blood supply. During a free flap procedure, however, the skin and muscle are completely detached from their original blood supply and re-attached at the breast area.
Pedicle Flap Reconstruction
Pedicle TRAM flap breast reconstruction is very popular and is generally a quicker surgery than free flap procedures. In this technique, one side of the abdominal muscle is folded upon itself and pressed through a “tunnel” under the skin that connects to the breast site. This allows most of the blood vessels to remain intact and provide blood to the newly created breast.
Free Flap TRAM Reconstruction
During free flap microsurgical breast reconstruction, the surgeon removes the entire section of abdominal tissue and reattaches it at the site of the new breast. The extracted tissue includes an artery and vein, which are preserved and reattached to blood vessels in the chest area. This ensures that a healthy blood supply reaches the transplanted tissue, making it easier to shape the new breast. This specific procedure uses a relatively small amount of abdominal muscle tissue, therefore abdominal strength is not affected as much as with the pedicle flap technique.
Benefits and Risks of TRAM Flap Breast Reconstruction
There are many factors to take into consideration before undergoing any type of breast reconstruction surgery. Understanding the benefits and risks of TRAM flap breast reconstruction can help you form your decision. Some of the benefits of this procedure include:
- Use of own tissue creates natural-feeling breast
- Pedicle flap procedure maintains as much sensation as possible
- No foreign objects placed in the body
- Long-lasting results
- Renewed sense of femininity
The disadvantages and risks associated with TRAM flap reconstructive surgery include:
- Scarring at two surgical sites
- Increased risk of infection over implant reconstruction
- Decreased abdominal muscle strength (especially with pedicle flap technique)
- Risk of hernias
- Extended recovery time required
TRAM Flap Reconstruction Candidates
After a thorough examination, your surgeon can determine if you are a candidate for TRAM flap reconstruction. Ideal candidates for the procedure include individuals who:
- Have sufficient fat and tissue in the abdominal area
- Do not smoke or suffer from diabetes
- Are at a healthy weight
- Have not had prior abdominal surgery
Breast Implants v. Flap reconstruction
Each method of breast reconstructive surgery has its own benefits and risks. Reconstructive surgery using a tissue expander and implant is often appealing, however, because it requires less surgery. Whereas flap reconstruction creates two surgical sites, breast reconstruction using implants is done solely in the breast area. This results in fewer scars, and fewer risks of infection. However, it should be noted that breast reconstruction using implants often does not yield as realistic-looking results as tissue-based reconstruction methods.
Breast Reconstruction Using a Tissue Expander
Following a mastectomy, many women do not have adequate skin in the breast area to support in implant. In this case, a surgeon will place a tissue expander to gradually stretch the skin and make room for an implant. The surgeon will insert a balloon-like tissue expander under the chest muscle. At weekly intervals, usually beginning two weeks after the mastectomy, the surgeon injects saline solution into the tissue expander through a small valve located just below the surface of the patient’s skin. Once the tissue expander has sufficiently stretched, the surgeon replaces it with a breast implant. Adjustments to the tissue expander, and placement of the final implant, typically take about six to eight weeks.
Immediate Implant Breast Reconstruction
In some cases of breast reconstruction, using a tissue expander is not necessary. If the patient has enough skin to adequately cover the implant, it can be placed at the time of mastectomy or at a later date. For patients who qualify, this technique is more convenient than other reconstruction procedures since it does not require multiple appointments.
Whether you are considering breast reconstruction with implants during or after mastectomy surgery, you will want to discuss with your doctor whether the use of a tissue expander will be necessary. In addition, you can discuss your options for further reconstruction including re-creation of the nipple and areola.
- RELATED: Breast Implants Surgery
Risks of Implant Reconstruction
Although implant breast reconstruction is popular, there are some things that all patients should consider prior to surgery.
- Implants typically last about 10 years, and many need to be replaced or enhanced
- Scar tissue can develop around the implant- resulting in a less natural-looking breast
- Natural breast cannot be exactly replicated
Deciding to Undergo Reconstructive Surgery
While advances in medicine have made it possible for women to reconstruct their breasts following mastectomy, the surgery is not necessarily right for everyone. It is important for patients to understand the scope of the procedure, and their reasons for receiving the surgery. If you choose to have breast reconstructive surgery performed, there are a number of important decisions to make, including:
- Choosing a Surgeon. Reconstructive surgery is unlike any other breast surgery. It is important to choose a surgeon who is equipped with the technical and aesthetic skills of this procedure.
- The Procedure Method. There are several different methods for breast reconstruction. Although some of the conditions of your health may dictate which methods you are a viable candidate for, it is important to understand your different treatment options.
- When You Will Undergo Treatment. In some instances patients may opt to receive reconstructive treatment immediately following mastectomy, other patients choose to wait for health or personal reasons.
Speaking to Your Surgeon
Conversations with your surgeon before breast reconstruction surgery are of the utmost importance. Among the important issues to discuss are:
- Treatment options specific to your body and tissue type, health, age, etc. The two major types of surgery are implant reconstruction and flap reconstruction. Flap reconstruction can include TRAM, DIEP, Gluteal, or latissimus dorsi.
- Your expectations regarding the outcome of surgery
- Risks and complications associated with surgery
- The specifics of treatment including anesthesia, procedure time, and recovery details
- The cost of surgery. Speak to your surgeon about financing if the procedure is not covered by your insurance plan.
The Days and Weeks Before Breast Reconstruction
After you have made the decision to undergo breast reconstruction surgery, it is important to prepare yourself both mentally and physically for surgery. Breast reconstruction often involves more than one surgical procedure and can be quite taxing. Following your surgeon’s pre-surgery instructions will help ensure that the entire process runs as smoothly as possible. This will include guidelines about consuming food, beverages, and medications. Patients should:
- Quit Smoking at least 2 weeks prior to surgery. Smoking constricts the blood vessels, depriving the tissues of nutrients and oxygen, and consequently delaying healing time.
- Reduce alcohol consumption, and avoid alcohol completely in the 24 hours prior to surgery
- Do not take vitamins, anti-inflammatory medications, or medications containing acetylsalicylic acid for 2 weeks prior to surgery
- Do not consume solid foods after midnight before surgery
- If you are feeling ill at any point during the week before surgery, contact your surgeon.
Your surgeon will provide more instructions that are specific to your health needs. It is also important to arrange care for yourself for the days after surgery when your activity will be significantly limited.
What to Expect During Surgery
No two breast reconstruction surgeries are alike. Each surgery patient has had a distinct experience with cancer, may be in various stages of remission, and has their own individual health conditions and cosmetic goals. Because of these differences from patient to patient, there are several ways that the surgery can be performed. These various surgery methods accommodate to the specific needs of the patient, and the recommendations of the surgeon. Some women have a mastectomy and breast reconstruction surgery at the same time, while others are advised to wait until after their mastectomy is complete to undergo breast reconstruction surgery. Regardless of the timing, the procedure generally takes place over several stages. The following sections introduce patients to the breast reconstruction process.
Breast reconstruction surgery is a comprehensive procedure that requires the use of general anesthesia. This means that the patient will be unconscious during surgery and will not experience any pain, or be away of what is taking place during surgery. In addition, they will have no recollection of the surgery when they wake up. During a pre-surgery consultation, the surgeon will discuss the use of anesthesia. It is important for your health and safety to disclose any drug allergies or health conditions so your doctor can choose the right anesthetic for you.
Once anesthesia has been administered, surgery begins with incisions. The size and location of the incisions will vary based on which type of breast reconstruction surgery you undergo. Implant reconstruction requires the fewest number of incisions, which are typically made across the center of the breast area. Flap reconstruction techniques, including TRAM flap, DIEP flap, gluteal flap, and latissimus dorsi reconstruction require more incisions because they involve the relocation of tissue from one area of the body to the breast. In both breast reconstruction techniques, the size and number of incisions will affect scarring and healing time.
Creating the new breast
The way the breast mound is created will also vary based on the type of surgery being performed.
Implant reconstruction takes place over several stages. During an initial procedure, a balloon expander is placed beneath the skin and chest muscle in order to stretch the area. In the following weeks and months, liquid will be added to the expander to stretch the skin enough to fit the desired implant size. Once the skin has stretched enough, surgery is performed to place a silicone or saline implant. In some instances, both steps may be performed at the same time. Permanent skin expanders serve as an effective breast implant as well. This eliminates a second surgery to place the implant. Your surgeon will decide if this is a viable treatment option for you.
Flap reconstruction involves taking tissue from one area of the body (the abdomen, buttock, or back), and relocating it to the chest. Blood vessels in the transplanted tissue are re-attached to new ones in the chest area. This new tissue will serve as the breast mound. In some instances, an implant may be placed as well. Due to the additional incisions, flap reconstruction surgery will result in more scarring, and require more healing time than straight forward implant reconstruction.
Sutures and Bandages
After the surgeon has created a symmetrical and natural-looking breast mound, the affected areas will be closed with sutures and bandaged. Your surgeon will provide post-operative instructions to ensure a speedy and complication-free recovery. For many patients, the full recovery period lasts about six weeks. During this time, strenuous activity should be avoided. Just as with surgery, breast reconstruction recovery is unique to each individual. It is important to discuss your specific recovery with your surgeon.
The recovery process from breast reconstruction surgery is both physical and emotional. The amount of time it takes to physically recover from surgery will depend heavily on the procedure technique used. Flap reconstruction requires more recovery time than implant reconstruction because healing must take place in two areas of the body. In general, patients can usually expect to reach full recovery about six weeks after surgery. However, recovery may be prolonged if there are complications or if a patient decides to have another procedure, such as nipple reconstruction. Below are some details of what to expect during breast reconstruction recovery.
Immediately After Surgery
Patients who undergo breast reconstruction should expect to feel tired and sore in the days after surgery. Typically, patients remain in the hospital to be cared for and monitored for two to five days. The surgeon will most likely insert drains in the breast area to remove excess fluid from the surgery site. These drains, along with any stitches, usually remain in place for one to two weeks. Some symptoms that patients can expect to encounter during their recovery period include:
- Soreness at surgical site(s)
- Numbness or loss of sensation at surgical site
A surgeon can prescribe patients medication to deal with mild to moderate discomfort during their breast reconstruction recovery. Following release from the hospital, it is important for patients to strictly follow their surgeon’s instructions for post-operative care. This will ensure a timely, complication-free recovery. Some things that a surgeon may recommend include:
- Avoiding strenuous activity such as lifting objects over the head, participating in sports, and engaging in sexual activity
- Clean all wounds thoroughly
- Change bandages frequently
- Massage the skin and scars after wounds have healed
- Wear a firm, supportive bra (avoid underwires)
Depending on which method of breast reconstruction is utilized, patients can expect to have scars in one, or several, of the following areas: breast, nipple, abdomen, navel, back, buttocks, or another area from where tissue was removed to fashion a breast mound. Flap reconstruction (DIEP, TRAM, latissimus dorsi, or gluteal) leaves more scarring than implant reconstruction, because there are two incision sites. Surgical scars will fade over time, but will never entirely disappear. Most patients find that the benefits of breast reconstruction outweigh drawbacks such as scarring, regardless of the technique used.
Returning to Normal Life
No two breast reconstruction recovery periods are exactly alike, and it is important that patients begin returning to regular activities at their own pace. Patients should consult with their breast surgeon often to determine when they can begin daily routines such as housework, shopping, or driving. Patients who receive flap reconstruction may find that they need more downtime since that technique can weaken the arm or abdominal muscles.
For many women, it may take time to adjust emotionally to having a reconstructed breast. While breast reconstruction can improve a patient’s appearance, the reconstructed breast will never look or feel exactly the same as the natural breast. Many patients find it beneficial to talk with other women who have had the procedure or to a mental health professional. There is no “normal” timeline for patients to come to terms with their breasts following mastectomy and reconstructive surgery. It is important to note, however, that feelings of self-consciousness or depression are not uncommon.
Benefits and Risks
Although many women are hesitant to undergo breast reconstruction surgery following long cancer treatments and mastectomy surgery, the procedure has a number of significant benefits. In fact, many women feel that breast reconstruction benefits outweigh any potential risks associated with the surgery. In addition to improving the contours of the body, breast reconstruction surgery has also helped many patients restore their sense of beauty and femininity. Breast reconstruction benefits women who have lost one or both of their breasts to cancer.
Physical Benefits of Surgery
Mastectomy surgery, whether performed on one or both breasts, significantly impacts a woman’s appearance. While there are prosthetics and special bras available to help improve the look of the chest, many women want a more permanent solution. Breast reconstruction surgery effectively restores the shape of the breast, allowing women to feel more like themselves prior to mastectomy. Rebuilding the breasts can:
- Give women natural, attractive curves
- Allow women to wear form-fitting clothes and bathing suits
- Provide symmetry to the breasts
- Restore the appearance of the nipple
- Improve shape and size of breasts
Emotional Benefits of Breast Reconstruction
While renewed appearances are one reason to undergo breast reconstruction surgery, many women are satisfied with the procedure because of its emotional and psychological value. For many women, their femininity and sexuality are closely associated with their breasts. Having a mastectomy can therefore greatly impact a woman’s emotional well-being. Although the breasts will never be the same following mastectomy, reconstructive surgery is an effective alternative, and a great way for women to begin to feel whole again. Some of the emotional benefits of the surgery include:
- A renewed sense of femininity
- Increased confidence
- Alleviation of anxiety, depression, fear, and low self-esteem
Will Reconstructed Breasts Match My Natural Breasts?
The goal of any reconstructive surgery is to have the breasts resemble your natural breasts as much as possible. A skilled surgeon will pay close attention to aesthetics to give you a natural look. While wearing a bra, bathing suit, or clothing, the reconstructed breast will appear natural to others. However, due to scarring evidence of the reconstructive surgery will most likely be apparent when you are undressed. It is important to discuss the best treatment options with your surgeon in order to minimize scarring, and help you achieve your specific aesthetic goals. Learn more about preparing to undergo breast reconstruction.
For many women, post-mastectomy breast reconstruction is an extremely beneficial procedure, one which allows them to restore both their sense of self and their physical appearance. But while reconstructive surgery has many appealing aspects, it is important for patients to understand that it is a complex surgery. As with all surgeries, breast reconstruction does not come without risks. Patients who are considering surgery should carefully explore all of their options, and consult with a qualified cosmetic surgeon to fully understand potential breast reconstruction complications.
Advances in technology have minimized the impact and severity of breast reconstruction complications both during and after breast reconstruction surgery. However, because complications are possible, patients should still be aware of what they are before undergoing surgery. Some of the short-term risks associated with surgery, include:
Poor Reaction to Anesthesia
Reconstructive surgery is performed under general anesthesia, and does carry some risk. People who have pre-existing medical conditions such as heart, circulation, or nervous system problems are at an increased risk for complications, so patients should provide a complete medical history and be fully forthcoming to the surgeon prior to surgery. It is also important to let your physician know if you have experienced adverse reactions to anesthesia in the past Some complications and side effects of anesthesia can include:
- Nausea and vomiting after surgery
- Dizziness and blurred vision
- Urinary difficulties (less common)
- Chest infection (less common)
Infection is another of the breast reconstruction complications that are possible with any type of surgery. In most cases, antibiotics can be used to treat infections. A persistent infection under a breast implant may require removal of the implant. Signs of infection include:
- A color change or increased redness around the breast incision
- Discharge of fluid or pus from the surgical site
- A fever that exceeds 100 degrees Fahrenheit
Patients on blood thinners or other medications that can affect clotting may be told to stop taking the medicine a week or two prior to surgery to minimize bleeding risks. Those who experience excessive bleeding at the surgical site should contact their physician immediately
In addition to short-term risks that can be common with most breast surgeries, breast reconstruction has a unique set of potential complications. These will vary based on the technique used during the procedure.
Women who chose to have breast reconstruction with breast implants face the same complications as women who choose implants for cosmetic reasons. This can include:
- Capsular Contracture - a condition in which the scar surrounding the implant tightens. The implant or scar tissue may be removed if this occurs.
- Rupture or deflation of the implant – Saline ruptures rapidly while silicone implants can deflate over a long period of time.
- Delayed wound healing
Flap reconstruction involves the removal or tissue from one area of the body to be used in building a new breast mound. This surgical technique creates two surgical sites that need to be monitored following surgery. Some flap breast reconstruction surgeries to be aware of, include:
- Blood clots
- Vascular complications
- Constricted blood flow to the reconstructed breast
- Failure of relocated tissue to “take,” resulting in dead tissue
- Scarring on breast and tissue removal site
- Reduced abdominal strength (TRAM and DIEP flap procedures)
- Weakened arm, shoulder, or back (latissimus dorsi flap)
Breast reconstruction is an individualized procedure, and the outcomes of the surgery will vary based upon a number of factors. Some women will undergo multiple surgeries to achieve a desired look, and may choose to alter their natural breast as well. Fortunately, with advances in surgical techniques, the majority of women are happy with their breast reconstruction results. Below are some details of the results that can be expected following this procedure.
What to Expect After Surgery
Regardless of the type of surgical technique used, the goal of breast reconstruction is to rebuild the breast, helping a woman restore her shape and sense of femininity. Breast reconstruction surgery can result in:
- An improved body contour
- Symmetry among the breasts
- An improved self-esteem
While breast reconstruction has a number of positive results, it should be noted that scarring after surgery is inevitable. The location and number of scars will vary based on the type of reconstructive surgery performed. In all instances, your breast reconstruction surgeon will use techniques to minimize visible scarring.
Flap Reconstruction Results
Flap reconstruction techniques involve the removal of tissue from one area of the body to be used in the creation of a breast mound. Because the newly constructed breast will consist of the patient’s own tissue, this technique produces results that feel the most natural. This technique is typically most beneficial for patients who have smaller breasts, as there must be enough tissue available to construct the breast.
Some patients prefer the breast reconstruction results after implant reconstruction because this technique produces fewer scars. When patients undergo reconstructive surgery with implants, the incisions are contained to the breast area. Patients can choose from saline or silicone breast implants. Silicone implants are recommended for the most natural-looking appearance, however saline implants are often thought to be safer because their material can dissolve naturally into the body if a rupture were to occur.
While implant breast reconstruction results in a faster healing time and fewer scars, it is important to note that many women who receive breast implants eventually have to undergo further enhancement or replace the implants. In fact, according to a 2011 FDA report, about 20 percent of women who receive silicone implants will need to have them replaced within ten years.
Many patients do not feel that breast reconstruction is complete until they have restored the appearance of the nipple. If a patient chooses to undergo nipple reconstruction, this is typically done three to six months after the reconstructive surgery. The two common methods of nipple reconstruction are skin grafting and tattooing. Skin from the remaining nipple or the ear lobe can be used to create a natural-looking nipple. Tattooing the nipple, also known as micropigmentation, is an appealing option because it is a quick and safe outpatient procedure. Nipple reconstruction using skin grafting produces the most realistic results, because both texture and color are accounted for. The tattooing technique, however, simply replicates the look of a nipple.
Choosing a Breast Reconstruction Surgeon
Undergoing a mastectomy due to breast cancer or another medical condition can be a stressful and emotionally draining experience. For many women, reconstructing the breasts can significantly improve their self-esteem as well as their physical appearance. It is important, however, for patients to do their research when choosing a breast reconstruction surgeon. Choosing a surgeon with both experience and compassion can help make the entire reconstructive procedure easier, safer, and more effective. Below are some recommended guideline to follow to ensure your surgery is performed by a reputable breast reconstruction surgeon.
Steps that You Should Take When Choosing a Surgeon
- View Before and After Photos. An experience surgeon should be more than willing to show you the results of their past procedures. Reviewing before and after photos can help you decide if you are pleased with the work of the surgeon
- Listen to Recommendations. A surgeon’s reputation speaks volumes. If possible, speak to previous patients about their experience with the surgeon. You can also reference publications such as The Best Doctors in America, which designates the top doctors in a given region divided by practice area.
- Verify Credentials. When you visit the surgeon’s office, ask to see his certifications and other credentials. Reviewing this information will ensure that the surgeon is trained in the ways they advertise.
- Get Comfortable. Reconstructive surgery is a comprehensive and personal procedure, and it is important to feel comfortable with your surgeon and his or her staff. Pay attention to how you feel during consultations. If you are uncomfortable, if may be best to look for a difference surgeon.
- Shop Around. It is important to know that you are not required to place your health in the hands of the first surgeon you visit. In fact, visiting multiple surgeons before deciding can be beneficial and help you gauge where you feel most comfortable.
- Ask Questions. When it comes to your health, you can never be too certain. Use your office appointments as a time to ask questions that you have about the procedure, the results, the recovery, etc. Being an informed patient is empowering.
Other things to consider include:
One of the most important elements to consider when choosing a surgeon for your reconstructive procedure is past experience. While the majority of plastic surgeons are trained in methods of breast reconstruction that does not guarantee that he or she has extensive experience with the procedure. Because reconstructive surgery is so personal and so delicate, it is beneficial to choose a surgeon who has helped previous cancer patients. Surgeons with experience in this area are not only skilled in the various surgical procedures, but are more apt to provide the support that is necessary during this time. These surgeons are sensitive to the needs and desires of post-cancer patients and can make the entire process more comfortable.
The surgeon you select should be certified by the American Board of Plastic Surgery. In addition, you may want to determine if your surgeon is a member of the American Society of Plastic Surgeons, which requires its members to attend regular medical education courses and follow a strict code of ethics.
It is a good idea to choose a surgeon who not only specializes in reconstructive surgery, but is also trained and experienced in the specific type of surgery you wish to undergo. TRAM flap, latissimus dorsi, gluteal flap, DIEP flap, and implant reconstruction all require specific skills. Choosing a surgeon who is knowledgeable about the exact procedure you will be receiving will help ensure the success of the surgery.
Above all, your surgeon should be honest with you about your expected results, the risks of surgery, and its limitations. If a surgeon paints an overly-simple picture of the breast reconstruction procedure, he or she is probably leaving out some pretty important details. It is also highly desirable that your surgeon works closely with other medical professionals at the hospital or clinic where he or she resides. Most importantly, if you don’t feel comfortable voicing questions or concerns with the breast reconstruction surgeons you have interviewed so far, keep looking.
Have a Question?
DocShop provides an informative breast reconstruction surgery FAQs page that addresses the most common questions patients have about the many aspects of breast reconstruction after a mastectomy. Our FAQs page provides a good starting point for those seeking a concise overview of reconstructive surgery. Contact a plastic surgeon for more information about breast reconstruction.
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