What is Breast Reconstruction?
Breast reconstruction includes a variety of procedures performed to restore the form and shape of the breast, following mastectomy or lumpectomy surgery.
Factors such as individual anatomy, aesthetic goals and the need for any postsurgical chemotherapy or radiation will determine your options.
Discussing your cancer surgery with your plastic surgeon before undergoing mastectomy is crucial, because the proposed cancer removal surgery may significantly affect the choices and the results of any type of breast reconstruction.
The three basic options for breast reconstruction:
- Using breast implants (saline or silicone).
- Reconstructing the breast using your own skin, fat and muscle.
- A combination of these methods.
Who is it for?
The following are some common reasons why you may want to consider breast reconstruction:
- If you think reconstruction will give you a sense of psychological well being or a feeling of “wholeness”
- To help restore your feelings of femininity and confidence in your appearance
- To improve symmetry if only one of your breasts is affected
- To allow you to wear low-cut necklines and normal swimwear
- Follow the instructions given to at your preoperative appointment. These will likely include having blood tests, a chest x-ray and an electrocardiogram (ECG).
- Stop smoking at least six weeks before undergoing surgery to promote better healing.
- Avoid taking aspirin, certain anti-inflammatory drugs and some herbal medications that can cause increased bleeding.
- Regardless of the type of surgery to be performed, hydration is very important before and after surgery for safe recovery and good outcomes.
What to expect during surgery
Implant reconstruction procedures
This is usually a two-or three-step process.
- In the initial procedure, your surgeon inserts a tissue expander beneath the skin and chest muscle, forming a skin-muscle envelope. The tissue expander is a modified saline implant with a valve, allowing more saline to be added after the first surgery. Serial injections of saline through the skin into the valve slowly fill the implant and will subsequently expand your breast mound. During office visits over two to six months, the skin-muscle envelope is slowly stretched until it reaches the size you want for the final implant.
- In the next stage, you will undergo outpatient surgery during which the expander is removed and replaced with a softer breast implant (saline or silicone).
- Sometimes, with saline implants, the expander is kept in place for a longer period, allowing the size of the reconstructed breast to be changed (by increasing or decreasing the amount of saline) without implant removal. With a silicone implant, your breast size cannot be changed without another surgery.
- It is rare for a woman to have an implant (saline or silicone) inserted directly without first having tissue expansion. In this situation, the size of the skin-muscle envelope at the time of mastectomy is large enough to cover the desired final implant.
Breast reconstruction with implants using acellular dermal matrix
Acellular dermal matrix (ADM) is a sheet of tissue that has had its cells removed leaving a framework of collagen and elastin for support and cover. This tissue is specifically prepared to allow your body tissues to gradually grow into this material, ultimately replacing it with your own collagen and blood vessels.
In the case of breast reconstruction:
- The acellular dermal matrix acts like a hammock under the mastectomy skin-muscle envelope that supports the tissue expander and can also improve implant placement. This framework of molecules allows your body’s cells to grow into the matrix, promoting the regenerative process that takes place during tissue expansion. ADM is usually combined with your chest muscle to cover the expander and maintain its position, and subsequently the position of the implant.
- The ADM procedure can be less invasive than other techniques, permitting a larger breast mound to be created at the time of the mastectomy and decreasing the number of office visits needed to reach the desired implant volume. When ADM is used, the expander can often be replaced with the final implant sooner than with other tissue-expansion techniques. In rare circumstances, an expander is not needed and the final implant can be placed into the created hammock at the time of the mastectomy with no further surgery required.
- The use of ADM products has enabled plastic surgeons to offer immediate breast reconstruction to more patients and to improve the overall results of breast reconstruction. Whether or not you’re a candidate for this technique depends on the quality of your mastectomy skin envelope.
- ADM has been available since 1994 and has become popular in breast reconstruction within the past ten years. Different ADM products have different properties and your surgeon may recommend one over the other, depending on your situation.
Natural grafts/tissue flap surgery
In certain circumstances, especially if you have radiation-damaged tissues, your surgeon may recommend the use of a flap of your own tissue, which can provide coverage or replacement of the damaged tissues with healthy, nonirradiated tissue.
- Reconstruction using skin and tissue flaps from your own body (autologous tissue) can look and feel more like a natural breast than reconstruction with implants. However, these procedures are more complex and invasive, usually prolong the hospital stay and leave scars in the areas from which the tissue was taken.
- The most common natural flap procedures use tissue from the back, abdomen or buttocks. In some procedures an entire muscle needs to be moved to reconstruct the breast, causing weakness in that area of the body.
- Autologous fat grafting or fat transfer is another option for treating radiation-damaged tissues or small areas of contour irregularities. Fat transfer has pros and cons, including graft loss and fatty cysts and may require multiple surgical sessions. Your surgeon can discuss the advantages and limitations of this surgery with you after he or she has evaluated you. Surgeons sometimes use autologous fat grafts to improve the results from implant reconstruction or to correct contour irregularities.
Your surgeon will prepare you for the experience, but here are a few things you can expect:
- You may wake up from surgery feeling groggy and/or very tired.
- You may have compression sleeves on your legs to help with circulation.
- Although you may be receiving pain medication, you may still feel sore.
- You may have drains coming out of your underarms to assist in healing (and from your stomach if you had an autologous reconstruction using tissue from your abdominal area).
If you have an autologous flap breast reconstruction:
- You may have a catheter in your bladder, which will be removed after surgery.
- The area from which tissue was taken to form your new breast(s) may also be sore.
- It may be difficult for you to get out of bed alone.
If you have a breast implant reconstruction:
- Your armpit region may be a little sore following surgery, but it is important to move your arms and maintain the range of motion in your shoulders. Certain exercises can help with this, and your doctor will discuss this with you.
- Your surgeon will encourage you to get out of bed with assistance; early ambulation is very important to prevent the formation of clots in your legs.
- You will be able to use the bathroom by yourself but may need assistance during the first week following certain types of reconstructive procedures.
When the anesthesia wears off, you may have some pain. If the pain is extreme or long-lasting, contact us immediately. You will also have some redness and swelling after the surgery. Contact us to find out if your pain, redness and swelling are normal or are signs of a problem.
Limitations and Risks
All surgical procedures have some degree of risk. Some of the potential complications of all surgeries are:
- Adverse reaction to anesthesia
- Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
- Infection and bleeding
- Changes in skin sensation
- Allergic reactions
- Damage to underlying structures
- Fat necrosis and/or fatty cysts
- Blood clots in the legs or lungs
- Partial or complete loss of the flap
- Loss of sensation at both the donor and reconstruction site.
- Unsatisfactory results that may necessitate additional procedures