Patients with breast cancer who have undergone a mastectomy may also choose to undergo breast reconstruction to restore bilateral breast symmetry by reconstructing the skin, breast tissue, and removed nipples. The amount of breast reconstruction needed depends on the width, size, and location of the mastectomy and resected tumor.
Is breast reconstruction right for you?
Long-term absence of one breast or part of a breast affects each woman differently. One person’s choice is not necessarily right for others either; it is a personal decision and not an easy one to make.
Patients may choose not to have reconstructive surgery, may wear a prosthesis or breast patch, or may not try to change the appearance.
However, the continued evolution of reconstructive surgery means that the results of the procedure are getting better. Patients can choose to have breast reconstruction using breast implants or autologous tissue.
Surgery not only changes appearance, but also has psychological benefits that can increase the well-being of the patient and family.
Is it a cosmetic procedure?
Is reconstructive breast surgery a cosmetic procedure?
Reconstructive breast surgery is not cosmetic surgery; it is reconstructive surgery and is part of the treatment of the disease.
When is the best time to reconstruct the breast?
When is the best time to reconstruct the breast?
The timing can be determined based on your needs, your medical condition, and your cancer treatment. It may be done at the same time as the mastectomy or several months or years after the mastectomy.
If chemotherapy or radiation therapy has been started, reconstructive surgery is usually delayed until these treatments are completed. The doctor can help the patient determine the most appropriate time.
What reconstructive options are available?
Before deciding on surgery, discuss your needs, medical condition, and prior surgical history with your doctor.
- In
- implant surgery, the skin is expanded with a tissue expander implanted in the patient and the tissue expander is then replaced with a breast implant. The tissue expander usually needs to be expanded with a moderate amount of saline once a week for a period of time. During this time, many patients experience pain, but are usually satisfied with the end result. The prosthesis may rupture causing pain and infection. Patients may require surgical removal or replacement.
- Breast flap reconstruction surgery uses autologous tissue from a woman’s abdomen or back (or sometimes even her thighs and buttocks) to reconstruct the breast. A transverse rectus abdominis muscle (TRAM) flap may be used for abdominal tissue, and a latissimus dorsi flap for back tissue. Sometimes the excised tissue will have blood vessels remaining attached, and sometimes the vessels will be disconnected and then reconnected to other vessels after transfer to a new location.
- Patients may also want reconstructed nipples. Usually, the nipple and areola are removed during a mastectomy to reduce the chance of cancer recurrence. Nipple reconstruction can usually be done on an outpatient basis through local anesthesia. Patients may undergo nipple reconstruction after breast reconstruction is complete, which needs to be done after the new breast tissue is healed and secured. When reconstructing the nipple and areola, the breast can be resized and repositioned.
- The surgeon may reconstruct the nipple using back or abdominal flap tissue and then tattoo it to mimic nipple color.
- Another option is a prosthetic nipple. A plastic surgeon can replicate a natural nipple and color the areola area, then glue it to the breast and re-glue it every 1 week or so.
How long does breast reconstruction take?
After the procedure begins, it usually takes 1 to 6 hours.
Reconstruction usually takes 1 to 6 hours after the procedure begins.
Patients need 2 to 3 hours of recovery time after surgery and then are sent back to their rooms.
What can I expect to experience during my hospital stay?
Patients may feel uncomfortable for the first few days after surgery. Pain medication may be given if needed. Patients will be monitored closely by staff during their hospital stay.
Patients will be encouraged to move their arms after surgery, but will not be allowed to do strenuous activities such as standing on their own, getting out of bed, or lifting heavy objects. The nurse will help the patient get in and out of bed. You can sit in a bedside chair on postoperative day 2, and most patients can walk independently.
Patients may need fluids for several days and may need a catheter until they can go to the toilet. The incision site will need to be drained, and the surgeon will provide instructions for care if the patient goes home without a drain.
The length of hospital stay depends on the type of surgery and how well the patient is recovering. If a prosthesis is placed, the length of stay is usually 1 to 2 days, and flap surgery may require a 5- to 6-day stay.
What are the possible experiences after going home?
After going home, patients usually experience some pain, swelling, and bruising that lasts 2 to 3 weeks. Patients may need to change dressings or bandages at home. The physician will provide advice related to showering, bathing, and wound care.
Most patients can return to normal activity 6 to 8 weeks after surgery, and should avoid strenuous exercise for several weeks after surgery.
After mastectomy and breast reconstruction, the surgical site may feel numb. The donor area providing the flap will not feel pain, but rather numbness and tightness. After a period of time, sensation will return to both areas. Most scarring will fade with time.
The shape of the reconstructed breast will gradually improve over several months.
Adherence to regular postoperative follow-up
Initially, patients will need to return for regular checkups. If dilators are implanted, saline fill will be performed on average 1 time per week until the desired size is achieved.
Breast self-exams are performed once a month and mammograms are performed once a year.
Breast reconstruction does not change the chances of cancer recurrence and usually does not interfere with treatment. If the disease comes back, it will still be treated with surgery, radiation, chemotherapy, and targeted therapy.