Breast Reconstruction

If you’ve have a mastectomy because of breast cancer, you may choose to have reconstructive plastic surgery. It can restore symmetry between the two breasts by replacing skin, breast tissue, and the removed nipple.

The amount of reconstruction will depend on the mastectomy, and the width, size, and location of the removed tumor.

The long-term prospects of living without a breast or part of one affects every woman differently. The choice for one woman won’t necessarily be right for another. It’s a personal decision, and it’s often not easy to make.

You can choose to skip reconstruction. You can wear external breast forms or pads, or make no attempt to change your appearance.

Improvements in plastic surgery mean better results now than ever before, though. You can choose breast reconstruction using either breast implants or your own tissue.

The operation changes your appearance, but it can have psychological benefits as well. It can add to a sense of wellness for you and your family.

Restoring the breast isn’t considered a cosmetic procedure. It’s reconstructive surgery. Since it’s considered part of the treatment of a disease, the law says insurance providers must provide coverage.

The timing is based on your desires, medical conditions, and cancer treatment. You can choose to have it done during the same operation to remove the breast, or months or years after a mastectomy.

If you’ve started any chemotherapy or radiation treatments, reconstruction is usually postponed until you complete those treatments. Your surgeon can help you decide the right timing for you.

You and your doctor will need to talk about your wants and needs, your medical condition, and any previous surgery before you decide.

Implants involve stretching the skin with a tissue expander that goes inside you, and then inserting a silicone-gel or saline (salt water) implant weeks later. The tissue expander is filled to a desired volume by adding saline, usually once a week for a few sessions. Many women find these sessions painful, but they’re often pleased with the final result. 

Implants can rupture, causing pain and infection. You may need surgery to remove or replace them.

Tissue flap procedures use a woman’s own tissue taken from the abdomen or back (or sometimes the thighs and bottom) to create a mound to reconstruct the breast. Taking abdominal tissue is called a TRAM flap. Taking tissue from the back is called a latissimus dorsi flap. Sometimes the tissue being moved is kept attached to its blood supply. Other times it’s disconnected and then reconnected to a blood supply near the new location.

You may want to consider nipple reconstruction, too. Usually, the nipple and areola (the dark area around the nipple) are removed during the mastectomy to lower the chance of cancer returning.

Nipple reconstruction is typically an outpatient procedure done with local anesthesia. You may have it after breast reconstruction is complete. This allows the new tissue to heal and settle into place. Minor adjustments in size and position of the breast can be carried out when the nipple and areola are rebuilt.

Surgeons can make a nipple from tissue taken from the back or abdominal flap. It’s then tattooed to resemble the color of a nipple.

In rare cases, the nipple from the original breast can be reattached, but only if the surgeon is convinced the tissue is cancer-free. Because of a lack of nerve connections, the nipple will not rise or flatten in response to touch or temperature.

A prosthetic nipple is another option. The plastic surgeon makes a copy of your natural nipple and colors the areola. It can be glued to the breast and re-glued every week or so.

Preparation for the procedure, including getting anesthesia, may take 2 hours. Once it begins, the reconstruction will take anywhere from 1 to 6 hours.

After the surgery, you’ll spend about 2 to 3 hours in recovery before being transferred to a hospital room.

You may have some discomfort for the first few days afterward. You’ll be given pain medication as needed. Throughout your hospital stay, the staff will closely watch you.

Soon after surgery you’ll be encouraged to move your arms, but not for any forceful activity like pulling yourself up, getting out of bed, or lifting heavy objects. Nurses will help you in and out of bed. The day after surgery, you may be able to sit in a chair beside the bed. On the second day, most patients are walking without help.

You’ll likely get IV fluids for a day or two. You may have a urinary catheter in overnight or until you can walk to the bathroom. You’ll also have drains at the incision sites. If you go home with these drains in place, you’ll get instructions on how to care for them.

The length of your hospital stay depends on the type of operation and how your recovery goes. If you got implants, the average hospital stay is 1 to 2 days. Flap procedures may require a stay of 5 to 6 days.

After you go home, you can expect some soreness, swelling, and bruising for 2 to 3 weeks. You may be asked to apply medications to the suture area or change bandages at home. Your plastic surgeon will advise you about showering, bathing, and wound care.

Most women return to normal activities within 6 to 8 weeks after surgery. It may be several weeks before you can do strenuous exercise.

The mastectomy and breast reconstruction will leave areas of numbness where the surgery was performed. Instead of feeling pain where the tissue was taken, you may feel numbness and tightness. In time, some feeling may return in your breasts. Most scars will fade over time.

The shape of your reconstructed breast will gradually improve over the months.

You’ll be asked to return for regular checkups at first. If you have a temporary expander implanted, it will be expanded with saline once a week, on average, until the desired size is reached (usually within six to 10 office visits).

Keep doing self-exams of your breasts every month, and have an annual mammogram.

Breast reconstruction doesn’t change the chance of cancer coming back, and it generally doesn’t interfere with treatment. If the disease does come back, your medical team can still treat you with surgery, radiation, chemotherapy, and targeted therapy.

SOURCES:

American Cancer Society: “Types of breast reconstruction,” ”Breast Reconstruction After Mastectomy.”

American Society for Plastic and Reconstructive Surgeons: “Breast Reconstruction.”

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