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Definition

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).

Breast Reconstruction With Implant

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Parts of the Body Involved

  • Breast
  • Sometimes muscles and/or skin flaps from abdomen, chest, back, or buttocks
  • Sometimes skin grafts from inner thigh and/or armpit

Reasons for Procedure

To rebuild a natural-appearing breast after a breast has been removed.

Risk Factors for Complications During the Procedure

  • Obesity
  • Smoking
  • Bleeding disorder
  • Malnutrition
  • Chronic illness or debilitation
  • Prior radiation therapy to the chest wall (which may impede healing)

What to Expect

Prior to Procedure

Your doctor will likely do the following:

In the days leading up to your procedure:

  • Arrange for a ride to and from the procedure
  • Arrange for help at home after the procedure
  • The night before, eat a light meal and do not eat or drink anything after midnight
  • You may be asked to shower the morning of your procedure. You may be given special antibacterial soap to use.

During Procedure

You will be given IV fluids, sedation, and anesthesia.

Anesthesia

General anesthesia is used for this procedure.

Description of the Procedure

Implant Procedures

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