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.
Important facts about the safety and risks of breast
reconstruction
The decision to have breast
reconstruction surgery is extremely personal. You’ll have to decide
if the benefits will achieve your goals and
if the risks and potential complications are acceptable.
Your plastic surgeon and/or staff will explain in detail the risks associated with surgery. You will
be
asked to sign consent forms to ensure that you fully understand the procedures you will
undergo and any risks or potential
complications.
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.
Breast
implants do not impair breast health. Careful review of scientific research conducted by
independent groups such as
the Institute of Medicine has found no proven link between breast
implants and autoimmune or other systemic diseases.
Where will my surgery be performed?
Surgery for your breast reconstruction is most often performed in a hospital setting, possibly
including a short hospital stay, and your doctor will likely use general anesthesia.
Some follow-up procedures may be performed on an outpatient basis, and local anesthesia
with
sedation may be used.
These decisions will be
based on the requirements of your specific procedure and in
consideration of your preferences and your doctor’s
best judgment.
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
My recovery
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.
You
will be given specific instructions that may include: How to care for your surgical site(s)
following
surgery, medications to apply or take orally to aid healing and reduce the risk of infection,
specific concerns
to look for at the surgical site or in your general 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?
•
Will there be drains? For how long?
• When can I bathe
or shower?
• When can I resume normal activity and exercise?
• When do I return
for follow-up care?
Healing
will continue for several weeks as swelling decreases and breast shape and position
improve. Continue to follow your
plastic surgeon’s instructions and attend follow-up visits as
scheduled.
Results and outlook
The
final results of breast reconstruction following mastectomy can help lessen the physical
and emotional impact of 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.
When
you go home
If you experience shortness of
breath, chest pains, or unusual heart beats, seek medical
attention immediately. Should any of these complications occur,
you may require
hospitalization and additional treatment.
The practice of medicine and surgery is not an exact science. Although good results
are expected, there
is no guarantee. In some situations, it may not be possible to
achieve optimal results with a single surgical procedure
and another surgery may
be necessary.
Be
careful
Following your physician’s instructions
is key to the success of your surgery. It is important
that the surgical incisions are not subjected to excessive force,
abrasion, or motion during
the time of healing. Your doctor will give you specific instructions on how to care for yourself.
How much will
breast reconstruction surgery cost?
Cost is
always a consideration in elective surgery. Prices for breast reconstruction can
vary widely. A surgeon’s cost
for breast reconstruction may vary based on his or her
experience as well as geographic location.
Many plastic surgeons offer patient financing plans, so be sure
to ask.
Cost may include:
•
Surgeon’s fee
• Hospital or
surgical facility costs
• Anesthesia fees
•
Prescriptions for medication
• Post-surgery
garments, and
• Medical tests and x-rays
Breast reconstruction surgery after breast cancer is considered a reconstructive procedure
and
should be covered by health insurance. However, your coverage may only provide a
small part of the total fee.
Your satisfaction involves more than a fee
When choosing a plastic surgeon for breast reconstruction, remember
that the surgeon’s
experience and your comfort with him or her are just as important as the final cost of the
surgery.
