What is Breast Reconstruction?

Breast reconstruction is a type of surgery for women who have had a breast removed (mastectomy). The surgery rebuilds the breast so that it is about the same size and shape as it was before. The nipple and areola (the darker area around the nipple) can also be added. Most women who have had a mastectomy can have reconstruction. Women who have had a lumpectomy may not need reconstruction. Breast reconstruction is done by a plastic surgeon.

Here are some facts to help you better understand the process and the words used when talking about breast reconstruction.

The choice to have breast reconstruction is yours to make. We hope this information will help you with this decision. Try to learn as much as you can before you decide what to do. No one source of information can give you every fact or give you all the answers. You and those close to you should talk to your health care team about any questions and concerns you have about this type of surgery.

If you are thinking about having reconstructive surgery, it is a good idea to talk about it with your surgeon and a plastic surgeon experienced in breast reconstruction before your mastectomy. This lets the surgical teams plan the treatment that is best for you, even if you decide to wait and have reconstructive surgery later.

Why have Breast Reconstruction?
Women choose breast reconstruction for many reasons:

• to make their breasts look balanced when they are wearing a bra
• to permanently regain their breast contour
• to avoid using an external prosthesis (form that fits into the bra)

There are often many options to think about as you and your doctors talk about what is best for you. The reconstruction process may require one or more operations. You should talk about the benefits and risks of reconstruction with your doctors before the surgery is planned. Give yourself plenty of time to make the best decision for you. You should decide to have breast reconstruction only after you are fully informed.

Immediate or Delayed Breast Reconstruction

Immediate reconstruction is done at the same time as the mastectomy. An advantage to having immediate reconstruction is that the chest tissues are undamaged by radiation therapy or scarring. This often means that the final result looks better. Also, immediate reconstruction means one less surgery.

Delayed reconstruction means that the rebuilding is started later. For some women, this may be advised if they need radiation to the chest area after the mastectomy. Radiation therapy given after breast reconstruction surgery can cause complications.

Decisions about reconstructive surgery depend on many personal factors, all of which should be discussed with your doctor prior to the mastectomy.

Types of Breast Reconstruction

Several types of operations can be done to reconstruct your breast. You can have a newly shaped breast with the use of a breast implant, your own tissue flap, or a combination of the two. A tissue flap is a section of your own skin, fat, and muscle which is moved from your tummy, back, or other area of your body to the chest area.

Implant Procedures

The most common implant is a saline-filled implant. It is a silicone shell filled with sterile saline (salt water). Silicone gel-filled implants are another option for breast reconstruction. They are not used as often as they were in the past because of concerns that silicone leakage might cause immune system diseases. But most of the recent studies show that implants do not increase the risk of immune system problems.

One-stage immediate breast reconstruction may be done at the same time as your mastectomy. After the general surgeon removes the breast tissue, a plastic surgeon places a breast implant where the breast tissue was removed to form the breast contour.

Two-stage reconstruction or two-stage delayed reconstruction is done if your skin and chest wall tissues are tight and flat. An implanted tissue expander, like a balloon, is placed beneath the skin and chest muscle. Through a tiny valve beneath the skin, the surgeon injects a salt-water solution at regular intervals to fill the expander over time. After the skin over the breast area has stretched enough, a second surgery is done to remove the expander and put in the permanent implant. Some expanders are left in place as the final implant.

The two-stage reconstruction is sometimes called delayed-immediate reconstruction because it allows options. If the surgical biopsies show that radiation is needed, the next steps may be delayed until after radiation treatment is complete. If radiation is not needed, the surgeon can start right away with the tissue expansion and second surgery.

There are some important factors for you to think about if you are thinking about having implants:
 

• Implants may not last a lifetime, and you may need more surgery to replace them later.
• You can have local complications with breast implants such as rupture, pain, capsular contracture (scar tissue forms around the implant), infection, or an unpleasing cosmetic result. This means that implants may become less attractive over time.

Nipple and Areola Reconstruction

You can decide if you want to have your nipple and areola (the dark area around the nipple) reconstructed. Nipple and areola reconstructions are optional and usually the final phase of breast reconstruction. This is a separate surgery that is done to make the reconstructed breast look more like the original breast. It can be done as an outpatient under local anesthesia (drugs are used to make the area numb). It is usually done after the new breast has had time to heal (about 3 to 4 months after surgery).

Possible Risks

Almost any woman who must have her breast removed because of cancer can have reconstructive surgery. Certain risks go along with any surgery, and reconstruction may have certain unique problems for some people.
Some risks of reconstruction surgery are:

• bleeding
• fluid build-up with swelling and pain
• growth of scar tissue
• infection
• tissue death (necrosis) of all or part of the flap, skin, or fat
• problems at the donor site (this can happen right away and later on)
• loss of or changes in nipple and breast sensation
• fatigue
• the need for more surgery to correct problems
• changes in the affected arm
• problems with anesthesia

Risks of Smoking

Using tobacco causes the blood vessels to tighten (constrict) and reduces the supply of nutrients and oxygen to tissues. As with any surgery, smoking can delay healing. This can result in more noticeable scars and a longer recovery time. Sometimes these complications are severe enough to require a second operation. You may be asked to quit smoking before surgery to reduce these risks.

Risks of Infection

Infection can develop with any surgery, usually in the first 2 weeks after surgery. If an implant has been used, it may have to be removed until the infection clears. A new implant can be put in later. If you have a tissue flap, surgery may be needed to clean the wound.

Risks of Capsular Contracture

The most common problem with breast implants is capsular contracture. This happens when the scar or capsule around the implant tightens and starts to squeeze down on the soft implant. It can make the breast feel very hard. Capsular contracture can be treated in several ways. Sometimes surgery can remove the scar tissue,or the implant may be removed or replaced.

What to expect after Breast Reconstruction Surgery

You are likely to feel tired and sore for a week or two after implants, and longer after flap procedures. Your doctor can give you medicines to control pain and other discomfort.
Depending on the type of surgery, you should go home from the hospital in 1 to 6 days. You may be discharged with a surgical drain in place. The drain is an open tube that is left in place to remove extra fluid from the site while it heals. Follow your doctor’s instructions on wound and drain care. If you have any concerns or questions, call your doctor.

Getting back to normal

You should be up and around in 6 to 8 weeks. If implants are used without flaps, your recovery time may be shorter.