The purpose of breast reconstruction is to restore one or both breasts to their normal appearance, size, shape, and symmetry after mastectomy or lumpectomy. Breast reconstruction may involve several cosmetic procedures performed over several months.
Breast reconstruction can begin when the mastectomy or other surgery is performed or may be delayed until a later date. Some patients need breast reconstruction to be postponed until all cancer treatments are complete.
Breast construction usually involves implants or flap reconstruction. Implant reconstruction uses silicone or saline breast implants to create new breasts. The flap procedure uses your tissue from another body area to create a new breast.
Some of the factors that your surgeon will consider when choosing a breast reconstruction option include the type of mastectomy you had, cancer treatments, and your body type.
Breast Reconstruction Procedure
Steps for the breast reconstruction procedure usually include:
Your surgeon will administer general anesthesia for your comfort during the procedure. Dr. Smita will use IV sedation or general anesthesia, depending on what is best for you.
Mastectomy or radiation therapy may not leave enough tissue on your chest wall to cover and support breast implants. In this situation, your surgeon will use the flap method or tissue expansion.
The TRAM flap technique uses donor skin, fat, and muscle from your lower abdomen to rebuild the breast. The flap may be left attached to the blood supply from the donor area or could be connected through the chest wall.
Or, your surgeon may use the DIEP flap method, which doesn’t use abdominal muscle but transfers only fat and skin to your chest from the abdomen. If you don’t have enough tissue in your lower abdomen, Dr. Smita may take tissue from your thighs or buttocks.
Breast implant reconstruction may be a good choice for patients who don’t need breast radiation and avoid using a donor site. Reconstruction with tissue expansion may allow you to recover easier than with flap procedures, but the reconstruction may take longer.
Tissue expansion usually requires you to visit the surgeon several times over one or two months after Dr. Smita places the expander. The expander slowly fills the device with a solution through a valve to expand the skin.
Another surgery is required to replace the expander with a permanent breast implant.
Placement Of Breast Implant
A breast implant can be used in addition or as an alternative to the flap method. Your surgeon may also use a breast implant as a placeholder for other cancer treatments until your body is ready for the flap technique.
Dr. Smita will help you choose the best method for your situation. For example, breast reconstruction with only a breast implant usually requires the use of a tissue expander. But a direct implant breast reconstruction method may work for some women having mastectomy depending on the tumor type and breast shape.
Reconstruction Of Nipple And Areola
For patients who aren’t candidates for mastectomy that spares the nipple, breast reconstruction is finished with various methods that rebuild the nipple and areola.
Popular techniques include folding skin the create a nipple, which is then tattooed for a realistic appearance. In addition, 3-D nipple-areolar tattooing may be used by itself to create the look of a nipple with a projection illusion.
Breast reconstruction may be enhanced with revision procedures that enhance symmetry by liposuction and fat grafting to improve donor site appearance.
Breast Reconstruction Benefits
Whether to have breast reconstruction is a personal decision, and the benefits vary from one person to another. However, some of the most common advantages of breast reconstruction are:
- Restores balance and proportions: After mastectomy, your clothing may not look or feel the same. It affects your sense of balance, so breast reconstruction can return your physical proportions to how they were before surgery.
- Enhances confidence and self-esteem: The fact that you’re alive after a significant health problem is more important than anything. But losing the breasts can affect a woman’s self-confidence and her sense of femininity. Having breast reconstruction can offer a tremendous boost of self-confidence.
- Return to normalcy: If you have survived a battle with cancer, your life has probably focused on beating the disease for months or years. Restoring your breasts to how they looked before can return you to a sense of normalcy.
Ideal Candidates For Breast Reconstruction
Breast reconstruction is a highly personalized procedure. You should have this surgery because you want it for yourself and not to please someone else.
If the following apply, you could be an ideal candidate for this procedure:
- You are coping well with your diagnosis and treatment, so you enter the breast reconstruction procedure with a positive mindset.
- You don’t have other medical problems that can delay healing.
- You have realistic goals to restore your body and breast image.
As you are weighing breast reconstruction, you should remember:
- The reconstructed breast will not have the same feel or sensation as the original breast.
- You will always have visible incision lines on your breast, either from mastectomy or reconstruction.
- Some surgical methods leave scars at the donor site, usually on the abdomen, buttocks, or back.
Surgery Preparation For Breast Reconstruction
Dr. Smita will give you instructions a few weeks before your surgery to ensure the procedure goes as well as possible. If you smoke, she will provide you with the resources and tools you need to quit; smoking interferes with the healing process, so you need to not smoke for several weeks before and after surgery.
She also will tell you what you should eat and drink before surgery to improve healing. Dr. Smita also will advise you on any medications, vitamins, or supplements you shouldn’t take before surgery.
You’ll need a friend or family member to take you home after surgery, and it’s recommended to have them stay with you overnight.
Breast Reconstruction Risks And Complications
Most breast reconstruction surgeries go well, but some patients may have issues with excessive bleeding, infection, and poor incision healing. Also, remember:
- Flap surgery has a risk of a partial or total loss of the flap and sensation at the reconstruction and donor site.
- Breast implants carry a risk of excessive breast firmness, implant rupture, and capsular contracture (hardening of scar tissue around the implant that distorts the breast shape).
- You risk developing a rare cancer of the immune system that is generally associated with textured breast implants.
- Breast implants increase the risk of breast implant illness, which may include ‘brain fog,’ fatigue, rash, and joint pain.
- If you have a breast implant, note that they usually last between 10 and 20 years, so you may eventually need revision surgery.
If you feel like something isn’t right with your breast implant or flap during your recovery, call Dr. Smita right away. Most problems can be resolved, but the sooner she knows, the better.
Breast Reconstruction Recovery
After your procedure, the surgeon will place bandages or gauze on the incisions. She may give you a support bra to reduce swelling and support the breast. Drains also may be placed under your skin to remove extra fluid or blood.
The surgeon will give you instructions for your recovery, including how to clean the surgical site, medications to take to encourage healing and reduce chances of infection, and what to watch for as your breast heals.
Some of the questions you should ask the surgeon about your recovery include:
- Where will you take me after my breast reconstruction is complete?
- What medications will I take after surgery?
- Will you put dressings and bandages on my breast after surgery? When will I take them off?
- Will you put in drains?
- When can I take a shower or bath?
- When can I go back to work and my regular workout routine?
- When should I come back for a follow-up?
Healing will take several months as the swelling goes down and the breast position and shape improve. Remember to follow Dr. Smita’s instructions and go to your follow-up appointments as scheduled.
Patients undergoing breast reconstruction surgery may be interested in other procedures, as well. Having more than one procedure at a time is more cost-effective and allows you to complete all of your recoveries at one time.
Dr. Smita will do a medical evaluation before scheduling your breast reconstruction procedure to discuss other cosmetic procedures.
Breast Reconstruction FAQ
Common breast reconstruction questions include:
What Does Breast Reconstruction Involve?
Breast reconstruction is usually implant-based or flap-based. Implant reconstruction uses saline or silicone breast implants to form a new breast.
The flap technique uses your tissue from another body area to make a new breast.
Is This A Major Surgery?
Yes, breast reconstruction is major surgery. You will probably spend several days at the hospital after flap or implant reconstruction. Remember, you may need more than one surgery to rebuild the breast, and flap surgery requires a longer recovery than breast implants.
How Can Breast Reconstruction Go Wrong?
The most common risks associated with this procedure are bleeding, infection, poor incision healing, and anesthesia problems. Also, if you have skin flap surgery, there is a risk the flap may not survive, and revision surgery may be needed.
How Painful Is Breast Reconstruction?
After surgery, you will be tired and weak and may have mild or moderate pain for two or three weeks. You also may feel a pulling sensation in your breast. But you will feel better day every day, and Dr. Smita will prescribe pain medication if you need it.
Will My Insurance Cover Breast Reconstruction?
Yes. The 1998 Federal Women’s Health and Cancer Rights Act requires medical insurance policies in the US to cover all phases of breast reconstruction.
How Does The Breast Feel After Reconstruction?
The rebuilt breast will feel natural after you recover, but you may lose some sensation when it is touched.
Can I Keep My Nipples After Mastectomy?
In many mastectomies, the nipple is removed with the breast, but some women may have surgery that spares the nipple. Fortunately, there are several options to rebuild the nipple during breast reconstruction, including 3-D tattooing.
What Happens If I Lose Weight After Breast Reconstruction?
Losing a few pounds after your reconstruction won’t affect your new breast. You would need to lose a lot of weight to have any effect on the new breast.
Will My Implant Drop After Reconstruction?
Yes. Breast implants usually drop a few days after surgery and settle into their final position after two or three months.
Will The Implant Feel Better Than The Tissue Expander?
After Dr. Smita places the breast implant, you’ll feel more comfortable than you did with the tissue expander. In addition, the feeling of tightness will fade as your breast implant adjusts and settles in over a few weeks.
What Is The Most Common Type Of Breast Reconstruction?
Most women who have mastectomies have breast reconstruction with silicone or saline implants. If you don’t want or can’t have implants, Dr. Smita will use the skin flap to rebuild your breast.
How Long Do I Need To Have A Tissue Expander?
When using breast implants for breast reconstruction, Dr. Smita will first place a tissue expander at the surgical site. You need to have the tissue expander in place for at least two months before having a breast implant.
Why Do Some Breast Reconstructions Fail?
The most common problems with breast reconstruction are capsular contracture that causes implant deformity or pain. Other patients have severe infections or are unhappy with how the breast looks.
Breast reconstruction is an important procedure that can help you regain a feeling of confidence and well-being after a severe illness. Talk to Dr. Smita today to decide if you want to explore breast reconstruction surgery.
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