Breast Reconstruction

What is Breast Reconstruction?
Breast Reconstruction is a surgical procedure designed to create a breast that matches the appearance of a natural breast. Although Breast Reconstruction is most often associated with surgery related to breast cancer, patients with congenital or acquired deformities of the breast may also require Breast Reconstruction. Such reconstructive procedures, designed to restore normal function and appearance, are often considered medically necessary. Insurance will generally cover these reconstructive procedures.

How many surgeries are necessary?
Most Breast Reconstruction procedures involve at least two stages. The first stage surgery creates the breast mound with a patient’s own tissue, an implant, or a combination of the two. Most reconstruction will require one or two smaller procedures to complete the breast.

How does the treatment work?
There are several approaches to Breast Reconstruction. Your medical history, body type, breast shape and aesthetic goals will determine which is best for you. There are three basic types of reconstruction.

Breast Implants
One advantage of implant reconstruction is that it limits your surgery to the breast and does not require a donor site, such as the abdomen or back. Some patients may be candidates for immediate placement of a permanent implant. Most patients require a staged procedure in which a temporary implant is first used to expand the skin and is later replaced with a saline or silicone gel implant.

Flap Reconstruction
The advantage of autologous tissue reconstruction is that it provides the natural feel and warmth of your own tissue and avoids potential problems with implants. A procedure such as the TRAM flap, in which the lower abdominal fat and skin is used to recreate the breast, provides the patient with the benefit of a tummy tuck.

Flap Reconstruction with Implant
Some patients may not have enough tissue to reconstruct the breast. If autologous tissue is necessary or desired, but volume is not adequate, an implant may be combined with fat and skin from the abdomen or the back.

Who are candidates for Breast Reconstruction?
Many women undergoing mastectomy are candidates for immediate reconstruction. However, some women may be advised to delay reconstruction until the nature and treatment of their disease is clear. Women with congenital abnormalities, such as an absent or malformed breast, or acquired deformities from breast surgery or radiation, are also candidates.

Can Breast Reconstruction affect healing after breast cancer?
There is no evidence that Breast Reconstruction has any effect on recurrence or detection of cancer. Some types of reconstruction can be adversely affected by radiation, and may require additional reconstructive surgery.

Will there be any downtime?
Yes, you will need to stay in the hospital for two to five days, and you may need to rest for a couple of weeks following surgery. Reconstruction using abdominal or back tissue will require four to six weeks for complete recovery.

What are the results?
Though results vary, many patients are able to achieve good to excellent symmetry.

What can be expected post-surgery?
You may experience some soreness and lethargy. Medication will be prescribed to control any pain.

How does the treatment feel?
Surgery is performed under general anesthesia. Some procedures, such as the TRAM flap, can be associated with significant discomfort, and may require the use of intravenous pain medication for a few days.

How long do the results last?
Breast Reconstruction performed with your own tissue is permanent. Patients with implant reconstructions may need replacement of the implant in the future if the implant leaks or if excessive scar tissue develops.

Is Breast Reconstruction safe?
Yes, but, like any surgery, it has associated risks. There is a slight risk of infection, bleeding, fluid collection, excessive scarring and complications from anesthesia. If the breast is reconstructed using an implant, there is the risk of firmness due to scar tissue developing around the implant, as well as some risk of rippling, shifting, loss of sensation and implant rupture. These problems may need to be corrected with additional surgery.

Instructions prior to surgery:
Avoid ibuprofen and aspirin for two weeks prior to surgery, as they are blood thinners and may increase bleeding. You should also avoid smoking during that time. Leave your fingernails unpainted for monitoring purposes during surgery. If you will not have assistance during your recovery, make preparations. Take items you will need down from high shelves, and set out clothing that is easy to change in and out of.

Instructions for after surgery:
Your doctor will give you specific instructions and advise you of what to expect, depending on the type and extent of your reconstruction surgery. If you develop any signs of infection, such as fever or bleeding, you should see your doctor.