Breast reconstruction is most often recommended for patients who have undergone a mastectomy (surgical removal of a breast) due to cancer or a pre-cancerous condition , but these techniques are also used to correct breast deformities.
Using a number of different techniques, surgeons can create a breast that closely matches the shape, size and feel of the breast that was removed. There are two alternatives to consider: immediate breast reconstruction and delayed breast reconstruction. Immediate breast reconstruction is performed at the same time as the mastectomy, while delayed breast reconstruction is postponed until a later post-surgery date. There are risks and benefits to both immediate and delayed reconstruction, so it is important that you talk with your doctor before your mastectomy to decide which method is best for you.
Many women feel insecure about breast abnormalities, or the condition of the breasts after a mastectomy, and in restoring a normal appearance; breast reconstruction often helps women to feel more confident and feminine, so that they can continue their lives normally.
Immediate Breast Reconstruction
During immediate reconstruction the general surgeon, who removes the breast, teams up with a plastic surgeon, who creates the new breast. Immediate reconstruction has several potential emotional and aesthetic advantages. Some patients find that waking up from a mastectomy with two normal breasts helps to alleviate the grief caused by losing a breast. Immediate reconstruction can also preserve a greater amount of skin and reduce scarring. Scars are easier to conceal when less skin is removed during the mastectomy. And, of course, when the reconstruction is performed immediately following the surgery, there is only one recovery to deal with.
Delayed Breast Reconstruction
Though immediate reconstruction offers many benefits, it is not for everyone. Some patients do not want the added stress of researching different reconstruction techniques while they are coping with a cancer diagnosis. Since breast reconstruction can be performed weeks or even years after having a mastectomy, choosing a delayed reconstruction allows patients to take their time exploring their choices. Delayed reconstructions also allow patients to complete other treatments such as chemotherapy or radiation before thinking about breast reconstruction.
If you are considering breast reconstruction, the following information will provide you with a good introduction to the procedure. For more detailed information about how this procedure may help you, we recommend that you consult a plastic surgeon who is board certified or who has completed a residency program that includes instruction in this procedure.
* 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.
Some women have breast reconstruction right after a mastectomy, where the plastic surgeon uses the remaining skin from surgery to construct the new breast.
Breast Reconstruction is a surgical procedure with Long-lasting results. In most cases this procedure is covered by insurance.
- What are some of the most common benefits of breast reconstruction?
- How is breast reconstruction performed?
- How long does the surgery take?
- Will I need to stay in a hospital?
- How much pain is there?
- What can I expect after breast reconstruction?
- What is the recovery period like?
- What is the long-term outcome like for most people?
- Ideal candidate:
- Other important information:
- Risks and limitations:
What are some of the most common benefits of breast reconstruction?
Having a breast removed can cause great emotional strain. For patients whose mastectomy was due to cancer, the absence of a breast can be a daily reminder of their struggle with a serious disease. Breast reconstruction can give patients a physical appearance similar to that before their mastectomy, or, when it is used to correct deformity, it can create symmetry that in the body that was lacking before the surgery. Breast reconstruction can help restore women's self-confidence, femininity and sense of wholeness, so that they can go on with their lives.
How is breast reconstruction performed?
There are two major types of breast reconstruction: breast implants and flap reconstruction:
The most common breast reconstruction technique, implants are rubber shells filled with either silicone gel or a saline solution. Breast implants are typically inserted through the use of a tissue expander. In this technique, a silicone balloon or bag is surgically placed beneath the chest muscle. Through a valve buried under the skin, the surgeon injects a sterile saline solution into the bag, expanding it. The "expander" stays in place for several weeks or months, during which time weekly or twice-weekly injections are administered. Once the skin has expanded sufficiently, the bag is replaced with a permanent implant during a second surgery.
A third surgery may be recommended to reconstruct the nipple and areola. In order to ensure proper placement of the nipple, this operation is normally performed at least three weeks after implant surgery, giving time for the new breast to settle into its permanent position. The nipple is usually fashioned from a small piece of skin drawn from the breast mound. A separate skin graft forms the areola. About six weeks later, the nipple and areola will be colored to match the other side using a medical tattoo technique.
This technique creates a new breast using a section of muscle, skin, and fat taken from another area of the body. It requires a longer hospital stay and more recovery time than implant reconstruction, and it also leaves scars at both the breast site and the donor site. But because the new breast is made of natural tissue, it looks, feels, and ages more like a normal breast -- which many patients prefer. In addition, the use of natural tissue eliminates the complications that can arise when foreign objects such as implants when inserted into the body. Flap reconstruction may also be recommended when the skin won't expand enough to cover an implant.
Flap reconstruction may be performed using a pedicle flap or a free flap. The pedicle flap allows the tissue used in reconstruction to remain attached to its original blood source. The tissue is moved to the breast area through a tunnel under the skin. In the free flap technique, the flap tissue is completely removed and reattached to the breast area, where its blood vessels are connected to those in the chest area through microsurgical techniques.
Types of flap reconstruction:
- Transverse abdominus musculocutaneous flap
The TRAM procedure can be performed as either a pedicle flap or a free flap. A section of muscle, fat, and skin is surgically removed from the abdomen and used to form the new breast. Sometimes referred to as "tummy-tuck" reconstruction, this procedure flattens the stomach and reconstructs the breast simultaneously. After the surgery, the abdominal muscles are temporarily weakened, and in rare cases, this weakness becomes permanent. If you are considering future pregnancy, be sure to tell your doctor because this sort of abdominal weakness can affect future pregnancy.
- Latissimus Flap
In this technique, a section of the latissimus dorsi (the back muscle arising from the top of the hip to the arm just below the shoulder) is removed to form a new breast. This tissue is often quite thin, so a small implant may be required as well.
- Other flaps
If the abdominal or latissimus tissue is unsatisfactory, a flap can be taken from the upper, middle or lower part of the buttock. However, this technique tends to weaken the gluteal muscle, restricting an athletic patient's activities. It also requires the surgical removal of a vein from one leg, since the gluteal blood vessels often aren't long enough to stretch from the chest area to the armpit where they must be reattached. If all other methods are unsatisfactory, tissue can be taken from the upper hip or "love handle" area. This technique is usually a last resort, since this tissue does not lend itself well to shaping a breast. Taking a flap from this area can also leave the hips uneven.
How long does the surgery take?
Normally, each of the surgeries in the implant process takes from one to two hours. Flap reconstruction surgeries take longer, from two to four hours, and the TRAM flap operation could take as long as six hours. Free flap procedures are often longer than pedicle flap procedures because of the careful microsurgery needed to reconnect the blood vessels.
Will I need to stay in a hospital?
Tissue expansion and implants are often done on an outpatient basis, allowing the patient to return home and rest after surgery. On rare occasions patients may be slow to recover from anesthesia or have other complications that require them to stay overnight in the hospital. Patients having flap reconstructions should expect to stay in the hospital from two to five days.
How much pain is there?
All of the initial reconstruction procedures are done under general anesthesia, so you'll sleep through the entire surgery.
What can I expect after breast reconstruction?
After surgery you will be tired and sore for one to two weeks. Your doctor can prescribe pain medication to relieve any discomfort. You should also expect some swelling and bruising, which could last for several weeks. Some procedures require the insertion of a drain for at least a week to remove excess fluid from the surgical site. Your stitches will either dissolve or be removed within 10 days of surgery.
For the first 24 to 48 hours after surgery, you can apply ice to the area every 15 minutes to reduce pain and swelling. After a tissue expansion or implant procedure, you'll be allowed to bathe again beginning 24 hours after the surgery. After flap surgeries, sponge baths are advised for about a week.
What is the recovery period like?
Recovery time varies depending on the type of procedure, but usually takes between four and six weeks. Recovery from flap procedures generally takes longer than recovery from implant procedures. You should be able to engage in light activities by the end of the first week, including taking short walks to reduce the risk of blood clots in the legs. Refrain from heavy lifting, sexual activity and rigorous sports for three to six weeks. Patients who have had the TRAM flap procedure should refrain from heavy lifting for at least three months, since the abdominal wall is weaken by the procedure and further strain could result in a hernia.
What is the long-term outcome like for most people?
Most patients report that breast reconstruction enhances their appearance and contributes to their quality of life. Scars will never completely disappear, but they do fade with time. You should also be aware that a reconstructed breast may not duplicate the other breast exactly; it may seem firmer and have a slightly different shape. For most patients, these factors do not detract from their overall satisfaction with the replacement of a lost breast.
In general, the best candidates for breast reconstruction are:
- In good physical health
- Psychologically stable
- Wanting to improve the appearance of their chest
- Well informed about the procedure
- Realistic about the outcome
The above is only a partial list of the criteria that your surgeon will consider in determining whether or not this procedure is appropriate for you. Be sure to ask your surgeon if he/she considers you an ideal candidate for breast reconstruction.
Other important information:
Breast reconstruction is often performed in combination with breast reduction or a breast lift in order to match the shape of the breasts. An alternative to breast reconstruction is an external breast prosthesis that can restore the outward appearance of the breast without the pain and cost of undergoing surgery.
Breast Reconstruction Risks and limitations:
The most common problem following implant surgery is capsular contraction, a tightening of the scars around the implant. In this situation, a second surgery can be performed to loosen the scar tissue. Other complications associated with implants include infection around the implant, necessitating its removal, and leaking, hardening, or shifting of the implant. You should know that implants deteriorate over time and may eventually need to be replaced. With all free flap procedures there is a risk that the blood vessels will not reattach sufficiently, constricting blood flow and causing the death of the flap tissue. Flaps taken from the buttocks can result in a weakened gluteal muscle, and flaps taken from the hips can result in noticeable asymmetry. TRAM flap procedures can result in abdominal hernia, loss of feeling in the skin below the navel, and a permanent weakening of the abdominal muscles. As with any surgery, breast reconstruction incurs the risk of swelling, bleeding, infection, fluid collection, drug reactions, keloid scarring, and numbness.
The information on this web site is only intended as an introduction to this procedure and should not be used to determine whether you will have the procedure performed nor as a guarantee of the result. The best method of determining your options is to consult qualified surgeons who are able to answer specific questions related to your situation.
*Disclaimer: Source: According to the American Society of Plastic Surgery (ASPS), nationally in 2010. Most surgeons offer convenient payments plans for this procedure. Cost does not include anesthesia, operating room facility, hospital stay, and other related expenses. Costs may vary depending the extensiveness of the procedure, location, and other factors. Costs are provided solely for research purposes. For specific estimates, please contact a qualified plastic surgeon.