Breast Reconstruction Basics

Breast Reconstruction Basics: What You Should Know About Post Mastectomy Breast Reconstruction

Written By: Christine G. Adamo
Reviewed by: Dr. Richard Baxter

When you first receive a diagnosis of breast cancer, making a decision about treatment can seem overwhelming. In most cases, though, there is no urgency. You have time to find out what options are available to you and should begin discussing breast reconstruction with your surgeon right away (since breast reconstruction affects other decisions related to having a mastectomy).

If after consulting with your doctor a mastectomy makes sense for you, you’re likely to wonder what’s next. Here, we’ll take you from wondering to feeling wonderful – with information, pointers and tips to help you get from before and during (to after) breast reconstruction surgery with dignity, confidence and grace.

About Breast Reconstruction

Breast reconstruction surgery can restore the size, shape and appearance of your breast(s) after a mastectomy. It can also restore your sense of body confidence. Breast reconstruction post-mastectomy is often referred to as delayed surgery (versus immediate, which is performed during a mastectomy). The Susan G. Komen Foundation points out that the timing of your own breast reconstruction surgery will depend upon your unique situation. Surgery for women who face future radiation or other treatments is typically delayed.

Before jumping into the specifics of breast reconstruction surgery, we’d like to share a few tips for quickly checking “find the best plastic surgeon available” off your to do list.

Tips for Selecting a Breast Reconstruction Surgeon:

• Choose a plastic surgeon who specializes in breast reconstruction surgery
• Choose a plastic surgeon who’s American Board of Plastic Surgery certified
• Choose a plastic surgeon who offers thorough consultations & follow up care
• Choose a plastic surgeon with great breast reconstruction before & after photos
• Choose a plastic surgeon who discusses your likely outcomes in realistic terms
• Choose a plastic surgeon whose client testimonials are upbeat & genuine

Breast Reconstruction Surgery Basics

As with all surgeries, your best and most reliable source of information will be a plastic surgeon of your choosing who is board-certified, highly knowledgeable and familiar with the latest breast reconstruction techniques. The following basics are adapted from information provided by the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery. While breast reconstruction surgery helps rebuild your body and self-confidence while it improves your quality of life, results vary and risks exist. Always consult with a plastic surgeon.

Set realistic expectations early on by keeping the following in mind:

• Reconstructed breasts do not hinder proper mammography examination
• Reconstructed breasts are not typically as sensitive as natural breasts
• Reconstructed breasts do not generally feel the same as natural breasts
• Reconstructed breasts are often accompanied by visible incision lines
• Reconstructed breasts require follow up care as prescribed by your doctor

Surgery is typically performed in a hospital setting under general anesthesia. A short hospital stay may be recommended. Follow up procedures are typically performed on an outpatient basis. Potential risks of breast reconstruction may include: Bleeding, infection, slow-healing incisions, loss of sensitivity, the potential for firmness or rupture (if implants are used) and/or complications associated with anesthesia.

Breast Reconstruction Surgery Options

Surgery options have expanded beyond implants to include methods which use of your body’s own natural tissues in breast reconstruction. Your best option will be decided in consultation with a plastic surgeon, but we can help you understand the alternatives. Grafting and/or other specialized techniques will be used to reconstruct the nipple and areola – the final step in your breast reconstruction surgery process.

Breast Reconstruction Using Your Body’s Own Tissue

Repositioning your muscle, fat or skin to create and/or cover your reconstructed breast is known as the flap technique. At times, flaps are used to fully reconstruct breast mounds. When a mastectomy or radiation therapy leaves insufficient tissue on your chest wall to cover and support a breast implant, either flap or tissue expansion techniques are used (see “Breast Reconstruction Using Implants”). Let’s talk about TRAM, DIEP and SGAP flap techniques.

TRAM, DIEP and SGAP are acronyms identifying the part of your body tissue may be recovered from. TRAM (transverse rectus abdominis myocutaneous) flaps are created using tissue from your abdomen. Unlike TRAM flaps, DIEP (deep inferior epigastric perforators) and SGAP (superior gluteal artery perforator) flaps are not created from muscle; they are created from fat and skin transferred from your abdomen and/or buttocks.

Alternately, a latissimus dorsi flap may be created by repositioning muscle, fat and skin from your back to the mastectomy site. In this way, it remains attached to its donor location so that blood supplies remain intact. Flaps may either remain attached to their original blood supply and repositioned in the chest wall or be completely detached and formed into a breast mound.

In general, flap procedures require longer hospital stays than breast reconstruction with implants.

Breast Reconstruction Using Breast Implants

Once the decision to use breast implants is made, your surgeon will determine if tissue expansion is necessary. During tissue expansion, your skin is stretched (over time) so that it can be used to cover your implant. The process may last up to six months but can produce great results and may shorten recovery time – with expanders sometimes used to hold permanent breast implants in place. Reconstruction with an implant alone usually requires tissue expansion.

If using the flap technique to create a breast mound isn’t an option, your plastic surgeon will suggest a breast implant though implants can be used both alongside and in place of flaps. The size and type of breast implant used should be based on your goals, body type, breast tissue and other topics discussed with your plastic surgeon. Breast implants are filled with either saline or silicone, though all are housed in a lumen (a rubber outer shell made of silicone).

• Saline breast implants – are filled with sterile salt water, may be placed pre-filled or placed through a smaller incision and then filled (to allow for size adjustments)
• Silicone gel breast implants – are filled with a soft elastic gel, are pre-filled to a standard size and sometimes require larger incisions to achieve proper placement

Incisions & the Placement of Your Breast Implants:

Incisions for placement of implants in breast reconstruction are often made through the existing mastectomy scar (if delayed) or at the time of mastectomy (if immediate). After incision, your surgeon will create a pocket in which to place your implant – with implants usually placed below the pectoral muscle. When implants are used in breast reconstruction, the pectoral muscle is used to cover the upper portion of the implant.

A material called “acellular dermal matrix”, or ADM, can be used to create a sort of living internal bra to support the implant along the bottom and side of the breast. One way this is achieved is with AlloDerm® (developed in 1994 by LifeCell as a graft technique used to treat burn patients). In breast reconstruction, products like AlloDerm® restore body tissue damaged through radiation, injury and/or disease. Products like AlloDerm® are generally less prone to rejection, but there are risks.

With the use of ADMs (such as AlloDerm®) it may be possible to achieve faster expansion or even “direct to implant” reconstruction in a single operation. Ask your plastic surgeon for information about this option.

Recovering from Breast Reconstruction Surgery

Whichever technique is used your goal should be to heal quickly, get great results, reduce your recovery time and minimize your risk for infection. Closely follow your surgeon’s instructions when caring for yourself, your breasts and your incisions – taking medications as prescribed.

Post-Surgery Questions to Ask Your Doctor PRIOR to Surgery:

• Which medications will I need to take – and when and how should I take them?
• If I require dressings or bandages, when will they be removed and by who?
• Will there be drainage? For how long and how can I tell if it’s “normal”?
• How long before I go back to my normal routine? Shower? Take a bath?
• How soon should I schedule a follow up visit after my surgery?

Important Note: If at any time during the recovery process you experience shortness of breath, chest pain or an irregular heart beat, seek immediate medical attention.

Things You Should Know About Your Recovery:

Good results come with preparation and follow up. There’s no guarantee that you’ll get perfect results from one procedure, but there are things you can do to encourage the best results possible. It is normal for your breasts to feel tight or sensitive or for your skin to itch or feel warm. Here are other things to be aware of:

• Be Mindful – Don’t subject incisions to force, abrasion or motion while you’re healing
• Get Support – Use elastic bandages and support bras, as directed, to minimize swelling
• Give Yourself Time – You may see discoloration and/or swelling for up to 1 month
• Simply Relax – Raising your arms may hurt; don’t lift, push, twist or pull anything
• Expect Soreness – Your chest area will probably feel stiff or sore for 2 to 5 days

Your body will continue to heal for many weeks. Over time, your swelling will decrease and the shape and position of your reconstructed breast will improve. Remember to follow your plastic surgeon’s instructions closely – and follow through with your follow up visit!