Breast Reconstruction

Breast Reconstruction Candidates

Breast reconstruction is a good option for you if:

• You are able to cope well with your diagnosis and treatment.
• You do not have additional medical conditions or other illnesses that may impair healing.
• You have a positive outlook and realistic goals for restoring your breast and body image.

Although breast reconstruction can rebuild your breast, the results are highly variable:

• A reconstructed breast will not have the same sensation and feel as the breast it replaces.
• Visible incision lines will always be present on the breast, whether from reconstruction or mastectomy.
• Certain surgical techniques will leave incision lines at the donor site, commonly located in less exposed areas of the body such as the back, abdomen or buttocks.

Breast reconstruction typically involves several procedures performed in multiple stages. It can begin at the same time as mastectomy or be delayed until you heal from mastectomy and recover from any additional cancer treatments.

It is important that you feel ready for the emotional adjustment involved in breast reconstruction. It may take some time to accept the results. Breast reconstruction is a physically and emotionally rewarding procedure for a woman who has lost a breast due to cancer or other condition.

Your Breast Reconstruction Consultation

By choosing a member of the American Society of Plastic Surgeons (ASPS) for your breast reconstruction procedure, you can be assured that you are choosing a highly-trained, board-certified plastic surgeon. ASPS Member Surgeons must meet rigorous standards for training, ethics, physician practice and research in plastic surgery.

The success and safety of your breast reconstruction procedure depends very much on your complete candidness during your consultation. Your surgeon will help you decide what is best for you. You will be asked a number of questions about your health, desires and lifestyle. Be prepared to discuss:

• Why you want the surgery, your expectations and desired outcome.
• Medical conditions, drug allergies and medical treatments.
• Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs.
• Previous surgeries.
• The available breast reconstruction options.
• The likely outcomes of breast reconstruction and any risks or potential complications.
• The course of treatment recommended by your plastic surgeon, including procedures to achieve breast symmetry.

Your breast reconstruction surgeon may also:

• Evaluate your general health and any pre-existing health conditions or risk factors.
• Examine your breasts and take detailed measurements of their size and shape, skin quality and placement of nipples and areolae.
• Take photographs for your medical record.
• Discuss your options and recommend a course of treatment.
• Discuss the likely outcomes of breast reconstruction and any risks or potential complications.

Breast Reconstruction Risks and Safety Information

Your plastic surgeon and/or staff will explain in detail the relevant risks associated with your specific surgery. You may be asked to sign consent forms to ensure that you fully understand the procedures you will undergo and any risks or potential complications. The decision to pursue breast reconstruction does not change your risk of breast cancer recurrence.

The possible risks of breast reconstruction include, but are not limited to, bleeding, infection, poor healing of incisions and anesthesia risks. You should also know that:

• Flap surgery includes the risk of partial or complete loss of the flap and a loss of sensation at both the donor and reconstruction site.
• The use of implants carries the risk of breast firmness (capsular contracture) and implant rupture.
• The development of a type of cancer of the immune system called breast implant- associated anaplastic large cell lymphoma (BIA-ALCL), primarily associated with textured implants.
• Breast implants may be associated with systemic symptoms commonly referred to as breast implant illness (BII), which can include fatigue, "brain fog," muscle or joint pain and rash.
• Acellular dermal matrix products may have a higher chance for complications or problems.

You should feel free to ask any questions to help you understand the risks.

Breast Implant Safety

FDA-approved breast implants undergo extensive testing to demonstrate reasonable assurance of safety and effectiveness. The vast majority of people with breast implants experience no serious complications. However, there are risks associated with breast implants, including breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and systemic symptoms commonly referred to as breast implant illness (BII) that some patients attribute to their implants, which can include fatigue, "brain fog," muscle or joint pain and rash. In the event any complication develops, patients should consult a board-certified plastic surgeon to address it in a timely manner. Likewise, if a patient desires to have breast implants removed for any reason, she should consult her plastic surgeon.

Preparing for Breast Reconstruction

Prior to breast reconstruction surgery, you may be asked to:

• Get lab testing or a medical evaluation.
• Take certain medications or adjust your current medications.
• Stop smoking well in advance of surgery.
• Avoid taking aspirin, anti-inflammatory drugs and herbal supplements, as they can increase bleeding.

Special instructions you receive will cover:

• What to do on the day of surgery.
• The use of anesthesia during your breast reconstruction.
• Post-operative care and follow-up.
• Breast implant registry documents (when necessary).

Your plastic surgeon will also discuss where your procedure will be performed. Breast reconstruction surgery may be performed in an accredited office-based surgical center, outpatient/ambulatory surgical center or hospital (possibly including a short hospital stay). If your breast reconstruction is performed as an outpatient procedure, be sure to arrange for someone to drive you to and from surgery and stay with you for at least the first night.

Some follow-up procedures may be performed as outpatient procedures. Local anesthesia with sedation may be used. These decisions will be based on the requirements of your specific procedure and considering your preferences and your doctor's best judgment.

Breast Reconstruction Procedures

Anesthesia choices for breast reconstruction surgery include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.

Flap Techniques

Flap techniques reposition a woman's own muscle, fat and skin to create or cover the breast mound.

A mastectomy or radiation therapy will sometimes leave insufficient tissue on the chest wall to cover and support a breast implant. The use of a breast implant for reconstruction almost always requires either a flap technique or tissue expansion.

TRAM Flap

A TRAM flap uses donor muscle, fat and skin from the abdomen to reconstruct the breast. The flap may either remain attached to the original blood supply and be tunneled up through the chest wall or be completely detached and formed into a breast mound.

Alternatively, your surgeon may choose the DIEP or SGAP flap techniques, which do not use muscle but transport tissue to the chest from the abdomen or buttock.

Latissimus Dorsi Flap

A uses muscle, fat and skin from the back tunneled to the mastectomy site and remains attached to its donor site, leaving the blood supply intact.

Latissimus Dorsi Flap for Breast Implant

Occasionally, the flap can reconstruct a complete breast mound, but often provides the muscle and tissue necessary to cover and support a breast implant.

Tissue Expansion

Tissue expansion stretches healthy skin to provide coverage for a breast implant. Reconstruction with Tissue Expansion allows an easier recovery than flap procedures, but it is a more lengthy reconstruction process. Tissue expansion requires many office visits over 4 to 6 months after placement of the expander to slowly fill the device through an internal valve to expand the skin.

A second surgical procedure will be needed to replace the expander if it is not designed to serve as a permanent implant.

Breast Implants

Surgical placement of a Breast Implant creates a breast mound. A breast implant can be an addition or alternative to flap techniques. Saline and silicone implants are available for reconstruction. Reconstruction with an implant alone usually requires tissue expansion.

Nipple Reconstruction

Breast reconstruction is completed through grafting and other specialized techniques that reconstruct the nipple and areola.

Breast Reconstruction Recovery

Following your physician's instructions is key to the success of your breast reconstruction surgery and recovery. Your doctor will give you specific instructions on how to care for yourself. These instruction may include:

• How to care for your surgical site(s) following surgery.
• Medications to apply or take orally to aid healing and reduce the risk of infection.
• Specific concerns to look for at the surgical site or in your general health.
• When to follow-up with your plastic surgeon.

Following breast reconstruction surgery, gauze or bandages will be applied to your incisions. An elastic bandage or support bra will minimize swelling and support the reconstructed breast. A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluids. A pain pump may be used to reduce the need for narcotics.

After you go home, seek medical attention immediately if you experience shortness of breath, chest pains or unusual heart beats. Should any of these complications occur, you may require hospitalization and additional treatment.

It's important that the surgical incisions are not subjected to excessive force, abrasion or motion during the time of healing.

Be sure to ask your plastic surgeon specific questions about what you can expect during your breast reconstruction recovery period.

• Where will I be taken after my surgery is complete?
• What medication will I be given or prescribed after surgery?
• Will I have dressings/bandages after surgery, and when will they be removed?
• Will there be drains, and for how long?
• When can I bathe or shower?
• When can I resume normal activity and exercise?
• When do I return for follow-up care?

Breast Reconstruction Results

Healing will continue for several weeks as swelling decreases and breast shape and position improve. Continue to follow your plastic surgeon's instructions and attend follow-up visits as scheduled. The final results of breast reconstruction following mastectomy can help lessen the physical and emotional impact of mastectomy.

Though surgery can give you a relatively natural-looking breast, a reconstructed breast will never look or feel exactly the same as the breast that was removed. There are trade-offs, but most women feel these are small compared to the large improvement in their quality of life and the ability to look and feel whole.

Over time, some breast sensation may return and scar lines will improve, although they will never completely disappear.

Careful monitoring of breast health through self-examinations, mammography and other diagnostic techniques is essential to your long-term health.

The practice of medicine and surgery is not an exact science. Although good results are expected from your breast reconstruction, there is no guarantee. In some situations it may not be possible to achieve optimal results with a single procedure and another surgery may be necessary.

Breast Reconstruction Words to Know

• Areola: Pigmented skin surrounding the nipple.
• Breast augmentation: Also known as augmentation mammaplasty, breast enlargement by surgery.
• Breast lift: Also known as mastopexy, surgery to lift the breasts.
• Breast reduction: Reduction of breast size and breast lift by surgery.
• Capsular contracture: A complication of breast implant surgery which occurs when scar tissue that normally forms around the implant tightens and squeezes the implant and becomes firm.
• DIEP flap: Deep Inferior Epigastric perforator flap, which takes tissue from the abdomen.
• Donor site: An area of your body where the surgeon harvests skin, muscle and fat to reconstruct your breast. Commonly located in less exposed areas of the body such as the back, abdomen or buttocks.
• Flap techniques: Surgical techniques used to reposition your own skin, muscle and fat to reconstruct or cover your breast.
• General anesthesia: Drugs and/or gases used during an operation to relieve pain and alter consciousness.
• Grafting: A surgical technique to recreate your nipple and areola.
• Hematoma: Blood pooling beneath the skin.
• Intravenous sedation: Sedatives administered by injection to help you relax.
• Latissimus dorsi flap technique: A surgical technique that uses muscle, fat and skin tunneled under the skin and tissue of a woman's back to the reconstructed breast and remains attached to its donor site, leaving blood supply intact.
• Local anesthesia: A drug injected directly to the site of an incision to relieve pain during an operation.
• Mastectomy: The removal of the whole breast, typically to rid the body of cancer.
• SGAP flap: Superior Gluteal Artery perforator flap, which takes tissue from the buttock.
• Tissue expansion: A surgical technique to stretch your own healthy tissue and create new skin to provide coverage for a breast implant.
• TRAM flap: Also known as transverse rectus abdominus musculocutaneous flap, a surgical technique that uses muscle, fat and skin from your own abdomen to reconstruct the breast.
• Transaxillary incision: An incision made in the underarm area.