Breast reconstruction is achieved through several plastic surgery techniques that attempt to restore a breast to near normal shape, appearance, and size following mastectomy.
Enhancing your appearance with breast reconstruction
Breast reconstruction is a physically and emotionally rewarding procedure for a woman who has lost a breast due to cancer or other condition.
The creation of a new breast can dramatically improve your self-image, self-confidence and quality of life. Although surgery can give you a relatively natural-looking breast, a reconstructed breast will never look or feel exactly the same as the breast that was removed.
Is it right for me?
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:
Breast reconstruction typically involves several procedures performed in multiple stages. It can:
It’s important that you feel ready for the emotional adjustment involved in breast reconstruction. It may take some time to accept the results of breast reconstruction.
The success and safety of your breast reconstruction procedure depends very much on your complete candidness during your consultation. You’ll be asked a number of questions about your health, desires and lifestyle.
Be prepared to discuss:
Your surgeon may also:
Prior to surgery, you may be asked to:
Special instructions you receive will cover:
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.
You’ll need help
If your breast reconstruction is performed on an outpatient basis, be sure to arrange for someone to drive you to and from surgery and to stay with you for at least the first night following surgery.
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 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.
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:
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.
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
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.
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.
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.
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:
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.