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Breast Cancer: Breast Reconstruction After Breast Surgery

What is breast reconstruction?

Breast reconstruction is surgery to create a new breast in place of a breast that has been removed (mastectomy). A breast mound is created that comes as close as possible to the shape and look of a natural breast.

The surgery may be done to reconstruct either 1 breast (unilateral) or both breasts (bilateral). The goal of the surgery is to create a breast mound that matches the opposite breast. If both breasts have been removed, the goal of the surgery is to create both breast mounds about the size of the woman’s natural breasts. 

Making a decision about breast reconstruction

The decision to have breast reconstruction is a personal one. It depends on how you think you will feel after a mastectomy. If you think you would feel uncomfortable with a flat chest or wearing a false breast (prosthesis), you may want to consider breast reconstruction. If you don’t want to have any more surgeries, you may not want to do it.

If you’re thinking of having breast reconstruction, talk with your doctor about it before you have your mastectomy. Your doctor can tell you whether reconstruction is an option for you. And he or she can tell you what type of reconstructive surgery might work best for you.  

Your doctor will talk with you about factors that can affect whether the surgery will work for you. These include:

  • The size and location of the cancer, which determines the amount of skin and tissue to be removed in the mastectomy

  • The amount of tissue removed from the breast

  • If your chest tissue has been damaged by radiation therapy or aging, and is not healthy enough for reconstruction surgery

  • Potential for complications

  • Your overall health and medical history

Dr. Justin Sacks

Restoring Wholeness Through Reconstructive Surgery

Surgeons use advances in clinical research, patient safety and breast reconstruction techniques to match patients with a reconstruction option that fits their life circumstances and recovery expectations.

Learn more.

When is the best time to have breast reconstruction?

Talk with your doctor before your mastectomy. He or she will then talk with you about your options for:

  • Immediate reconstruction. This is reconstructive surgery done at the same time as the mastectomy.

  • Delayed reconstruction. This is a surgery done after recovery from the mastectomy. If radiation therapy is part of the treatment protocol, the surgeon may advise waiting until after the radiation is finished.

Here are some things to keep in mind about the best time to schedule it:

  • Your emotional and psychological well-being. Some experts think that waking up from a mastectomy with the reconstruction already done is less traumatic than waking up without a breast.

  • Any other treatments you are having. If you’re getting radiation after your surgery, you may need to postpone breast reconstruction. Radiation to the reconstructed breast can increase the chance of problems. 

  • Recovery time. Having reconstruction surgery at the same time as your mastectomy may mean you’ll recover faster.

  • The condition of your skin. If your skin isn’t ready for the stretching that goes on during reconstruction, you may need to have the procedure later on. For example, the skin of women who smoke or who have diabetes may need extra healing time before reconstruction.

Common risks of breast reconstruction

Any type of surgery has risks. The risks of breast reconstruction include:

  • Bleeding

  • Fluid collection in the surgical area

  • Infection

  • Excessive scar tissue

  • Problems with the sleep medicines (anesthesia) used during surgery 

  • Bruising and swelling

  • Problems with the breast implant

The most common complication of breast reconstruction done with implants is capsular contracture. This is when the scar (capsule) around the implant begins to tighten. In some cases, a second surgery is needed to fix this problem.

What are the different types of breast reconstruction?

There are 2 main types of reconstruction surgery: 

  • Expander/implant. This is the use of an expander to create a breast mound, which may be followed by the placement of a filled breast implant.

  • Autologous tissue. The use of the person’s own body tissues to reconstruct a new breast mound. These reconstruction surgeries leave you with 2 surgical wounds: the chest and the site where tissue was removed.

You may also decide to have other procedures to improve how your new breast shape looks. For example, you might decide to have reconstructive surgery on your other breast so that it matches your new breast shape. Or you may want to have a nipple reconstructed. 

Expander/implant surgery

Breast tissue expanders are empty silicone "envelopes" placed under or over the pectoralis muscle, which is located between the breast and the chest wall. They are designed to stretch the skin and make room for a future, more permanent implant.

Implants are envelopes filled with liquid that are put under the breast tissue or pectoralis muscle and form the shape of the breast. Implants may be filled with saline or silicone gel.

Process:To enable the skin and soft tissues of the breast to grow, the expander is filled with saline solution over a period of several weeks. The saline is injected into the expander through a valve or port in the expander that lies just under the skin. Once the expander has been completely filled, it is left in for several more weeks or months. This allows for maximum skin and soft tissue growth. Once the skin has stretched enough, a second surgery is done to remove the tissue expander and insert the permanent implant beneath your muscle and skin.

Expander/implant Placement:

  • Submuscular Breast Reconstruction. The expander or implant is placed under the pectoralis muscle. The muscle slowly stretches to form a pocket for the implant. This method, while having a longer healing time, often reduces instances of rippling, sagging and other cosmetic deformities caused by the implant. However, because of placement under the muscle, there can be movement and animation of the implant while exercising.

  • Prepectoral breast reconstruction. The expander or implant is placed over the muscle instead of under. With this method there is less pain and a quicker healing time since the muscle does not have to be cut and stretched. Since the implant is placed above the muscle there is a small chance of the implant may rotate or cause other cosmetic deformities. Following a prepectoral tissue expander, the patient can also have a free tissue transfer such as a DIEP flap.

Each type of implant and reconstruction procedure has advantages and disadvantages. Your doctor will discuss the types of implants with you and help you decide which type to use.

What is a Tissue Expander | Breast Reconstruction Overview

A breast tissue expander is an inflatable breast implant designed to stretch the skin and muscle to make room for a future, more permanent implant.

Autologous tissue surgery

There are different ways to do this surgery, such as: 

  • Transverse rectus abdominous muscle (TRAM) flap. This is the most common method. An area of fat, skin, and muscle is removed from the belly (abdomen) and moved to the chest. The surgery gives you a tummy tuck. TRAM flaps may change as you gain and lose weight. It’s important to know that removing stomach muscle can increase stress on the back. This type of surgery leaves a horizontal scar across the lower abdomen plus a scar on your chest.

  • Deep inferior epigastric perforator (DIEP) flap. This is is a method in which the surgeon takes fat and skin but not muscle from your lower belly and moves them to the chest. This surgery also gives you a tummy tuck.  

  • Gluteal free flap. The surgeon removes part of the skin, muscle, and fat from your buttocks, and grafts it onto the chest. This is a more complex surgery. It is sometimes done with 2 teams of surgeons. One team may remove the flap, and the second prepares the blood vessels.

  • Latissimus dorsi flap. This method moves muscle, fat, blood vessels, and skin from your upper back to your chest. Sometimes an implant is also needed with this surgery.  

DIEP Flap | Breast Reconstruction Overview

The deep inferior epigastric artery perforator (DIEP) flap is a common technique where skin and tissue (no muscle) is taken from a person’s abdomen to recreate their breast. Lillie Shockney, administrative director of the Johns Hopkins Breast Center, further explains.

Healing after surgery

Immediate reconstruction surgery has a longer recovery time than for mastectomy alone. Recovery from delayed reconstruction is much quicker. With autologous tissue surgery, there's a second surgery site that will need to be cared for as it heals. 

It's important to know that it can take up to 2 months before the final results of breast reconstruction can be seen. Be patient as your body heals.

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