Breast Reconstruction

The goal of breast reconstruction is to restore one or both breasts to near normal shape, appearance, symmetry and size following mastectomy, lumpectomy or congenital deformities. Breast reconstruction often involves multiple procedures performed in stages and can either begin at the time of mastectomy or be delayed until a later date.

Who are Good Candidates:

• Good Health
• Nonsmoker
• If you need chemotherapy or radiation therapy as part of your treatment, you may need to delay reconstructive surgery until after your treatment 6 months after chemo and one year after radiotherapy.
• Within normal range of your weight
• Scarring from earlier operations may limit the type of reconstruction you can have.
• Have realistic expectations
• Consultation:
• During the consultation your plastic surgeon will:
• Evaluate your general health status and any pre-existing health conditions or risk factors
• Examine your breasts and take measurements of their size and shape, skin quality and placement of nipples and areolae
• Take photographs
• Discuss your options and recommend a course of treatment
• Discuss likely outcomes of breast reconstruction and any risks or potential complications

Procedure

• Implant reconstruction: For women who do not require breast radiation and would like to avoid a separate donor site, implant-based reconstruction is an option. Reconstruction with tissue expansion allows an easier recovery than flap procedures, but it can be more lengthy reconstruction process. Implant reconstruction involves placing an expandable balloon under the muscles of your breast area after breast surgery. This balloon is gradually filled with salt water. It expands to form a breast mound. A few months after this initial surgery, you can have another procedure to replace the balloon with a longer-lasting implant.
• Autologous tissue reconstruction: Uses your own skin, fat, muscle, and blood vessels to create a breast mound. This tissue may come from your belly area or from your back . This option may mean a longer operating time and longer recovery time from surgery. You may not need to go back for a second procedure though.
• Surgical Placement of breast implant: A breast implant can be an addition or alternative to flap techniques. Surgeons may also use an implant as a temporary placeholder during other breast cancer treatments until you are ready for more involved flap reconstruction techniques. Saline and silicone implants are available for reconstruction. A biological mesh can be added to the implant to avoid complication specially if a radiotherapy is required after breast reconstruction.
• Reconstruction of nipple and areola: For women who are candidates for nipple-sparing mastectomy, breast reconstruction is completed through a variety of techniques that reconstruct the nipple and areola. Techniques usually involve folding skin to create the shape of a nipple followed by tattooing. Three-dimensional nipple-areolar tattooing may be used alone to create the appearance of a realistic nipple with the illusion of projection.

Risks of Breast Reconstruction

Is it safe?

Breast reconstruction may have several complications and risks such as :

• Bleeding
• Problems with anesthesia
• Infection in the area of the surgery
• Wound healing problems like hematoma (blood collecting in a surgical wound) or seroma (clear fluid collecting in a surgical wound)
• Unexpected scarring
• Implant rupture
• Implant displacement
• Capsular contracture
• Breast implant illness

Is Breast Reconstruction Painful?

Right after the surgery, you will probably feel weak, and you may feel pain for 2 to 3 weeks. You may have a pulling or stretching feeling in your breast area. You can expect to feel better and stronger each day, although you may need pain medicine for a week or two.

Recovery after Breast Reconstruction

Most patients can start to get back to normal activities within 6 to 8 weeks. If implants are used without flaps, your recovery time may be shorter. Some things to keep in mind:

• It may take up to about 8 weeks for bruising and swelling to go away. Try to be patient as you wait to see the final result. As well it might take as long as 1 to 2 years for tissues to heal fully and scars to fade (the scars never go away completely).Ask when you can go back to wearing regular bras. Talk with your surgeon about the type of bra to wear – sometimes it will depend on the type of surgery you had. After you heal, underwires and lace in your bra might feel uncomfortable if they press on scars or rub your skin.
• Follow your surgeon’s advice on when to begin stretching exercises and normal activities, because it’s different with different types of reconstruction. As a basic rule, you’ll want to avoid overhead lifting, strenuous sports, and some sexual activities for 4 to 6 weeks after reconstruction. Check with your surgeon for specific guidance.

Breast Reconstruction Results

The final results of breast reconstruction following surgery can help lessen the physical and emotional impact of mastectomy. Over time, some breast skin sensation may return, and scar lines will improve, although they will never disappear completely.

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.

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

It’s hard to match the natural droop of your original breast. A breast reconstructed with an autologous procedure may develop some sag with time and gravity, but a breast reconstructed with an implant rarely sags. Over time, your other breast may sag while the reconstructed breast remains higher and firmer.

Things to keep in mind

• Often breast reconstruction can be done at the time of your breast cancer surgery. Sometimes, it is better to have the reconstruction done after you have recovered from the cancer surgery and any other breast cancer treatment. Chemotherapy and radiation therapy, for example, may affect the timing and the type of reconstructive surgery you can have. This is called delayed reconstruction. Talk to your surgeon about the best timing for you.
• Reconstruction does not restore normal feeling to your breast, but some feeling may return over a period of years.
• Breast reconstruction required many surgery and retouch like a fat grafting is required to improve the result you should be patient to achieve a good result.