Breast reconstruction is plastic surgery to rebuild a breast. It is usually done after a
mastectomy
(removal of the breast) has been performed to treat cancer. Reconstruction is often done in several stages. The first stage may be done at the time of mastectomy (immediate reconstruction) or at some point after mastectomy (delayed reconstruction).
A breast implant is the simplest form of reconstruction. It can be done at the time of mastectomy if there is enough skin left on the chest wall. The one-stage immediate breast reconstruction procedure involves inserting a breast implant where the breast tissue was taken out.
The implant is most often a silicone shell filled with sterile saline.
Two-stage immediate, or two-stage delayed, reconstruction is done if your skin and chest wall tissues are tight and flat. A small pouch is slipped under the skin, and the skin is closed. The pouch can then be filled with a saline (salt water) solution. Over weeks, more saline is gradually put into the pouch with a needle. This apparatus is called a tissue expander. The skin overlying the pouch slowly expands as the pouch grows in size. Some surgeons leave this expander in place as the actual prosthesis. Others will replace the tissue expander with a saline breast implant. This replacement requires surgery.
If you want the size, shape, and color of your nipple and areola reconstructed, another surgery may be necessary to add tissue. The skin for this purpose is usually removed from the inner thigh. Proper coloring is achieved through tattooing.
Tissue Flap Procedures
More complicated types of breast reconstruction involve using muscle and skin flaps from the abdomen, back, or other parts of your body.
The
transverse rectus abdominus
muscle (TRAM) flap procedure takes tissue and muscle from the lower abdomen and creates a breast shape. It is then moved to the chest area. Skin, fat, blood vessels, and abdominal muscles are removed, resulting in a
tummy tuck
. Two types of TRAM flaps exist:
A pedicle flap remains attached to the original blood supply under the skin.
A free flap is completely cut away from its original location and reattached to the chest area using microsurgery.
The gluteal-free flap procedure is similar to the TRAM flap procedure except that tissue and muscle are taken from the buttocks and reconstructed to form a breast shape.
The
latissimus dorsi
flap procedure involves taking skin and muscle from your upper back and tunneling it under the skin to the front of your chest.
After Procedure
If you have a tissue expander, you'll need to have additional saline added gradually. Your surgeon will set the schedule.
How Long Will It Take?
Breast reconstruction can take two to six hours after mastectomy.
Will It Hurt?
Anesthesia prevents pain during surgery. You will experience pain after the surgery and during the healing process. You will be given pain medication to help relieve this pain.
Possible Complications
Bleeding
Infection
Implant may harden
Abnormal scarring
Painful and/or restricted arm and shoulder motion
Uneven appearance to breasts, either due to position or size
If silicone implants are used, the implant may harden, rupture, or leak
Presence of an implant may make cancer detection (through mammogram and/or self-exam) more difficult
Newly reconstructed breast will not have nerve sensation
Average Hospital Stay
The surgery typically requires about a week stay when performed in conjunction with mastectomy.
Postoperative Care
Managing pain and nausea—You might require anti-nausea and pain medications. You may be nauseated for a few hours after surgery, and may not be able to eat normally. Therefore, you may continue to receive fluids and sugar through an IV. For several days after surgery, you may need to eat a lighter, blander diet than usual.
Preventing blood clots—You may be given special compression stockings to wear after surgery. These help to decrease the possibility of blood clots forming in your legs.
Improving lung function—You may be asked to use an incentive spirometer, to breathe deeply, and to cough frequently, to improve lung function after general anesthesia.
Outcome
The reconstructed breast will appear somewhat normal. Although there may be some asymmetry between the newly reconstructed breast and the other, natural breast. Some women want improved symmetry, and therefore undergo further surgery on one or both breasts to achieve this.
Call Your Doctor If Any of the Following Occurs
Signs of infection including fever and chills, redness, swelling, increasing pain, excessive bleeding, or discharge at the incision site
Nausea and/or vomiting that you can't control with the medications you were given after surgery, or which persist for more than two days after discharge from the hospital
Your implants grow hard, or you believe that they are leaking
Joint pain, fatigue, stiffness, rash, or other new symptoms
Pain and/or swelling in your feet, calves, or legs, sudden shortness of breath or chest pain
RESOURCES:
American Cancer Society http://www.cancer.org
Breastcancer.org http://www.breastcancer.org
CANADIAN RESOURCES:
Canadian Breast Cancer Foundation http://www.cbcf.org/
The Canadian Society of Plastic Surgeons http://www.plasticsurgery.ca/
References:
Reconstruction. Breastcancer.org website. Available at:
http://www.breastcancer.org/bey_tre_recon_idx.html
. Accessed October 14, 2005.
Sabiston DC Jr.
Textbook of Surgery
. 15th ed. Philadelphia, PA: WB Saunders Co.; 1997.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
