Breast Procedures Breast Reconstruction

Breast Reconstruction

  • Best Candidates:
    Women who are seeking to restore the normal appearance of their breasts
  • Length of Procedure:
    1 to 4 hours
  • Inpatient/Outpatient:
    Usually inpatient — follow-up procedures may be outpatient
  • Anesthesia:
    General or local with sedation
  • Results:
    Permanent — possible future implant replacement
  • Procedures in 2015:
    106,338 (source: American Society of Plastic Surgeons)

Breast Reconstruction

Each year, more than 200,000 American women are diagnosed with breast cancer. Many of these women undergo a mastectomy, or breast removal, to eliminate the cancerous tissue. Mastectomies save many lives, but the prospect of losing a breast can take an emotional toll.

Today, great strides have been made in breast reconstruction techniques for mastectomy patients. A breast implant, a woman's own tissues or a combination of both can be used to create a breast closely resembling a natural breast. Many women feel more self-confident and feminine with their physical appearance permanently restored.

The procedure information contained in this article will give you a good introduction to breast reconstruction. Schedule a consultation with a Top Plastic Surgeon to receive a medical examination and discuss your breast reconstruction options.

Breast Reconstruction Overview

Breast reconstruction is a surgical procedure to rebuild the breast after a mastectomy (surgery to remove a breast) or to correct a breast deformity. Mastectomies are usually performed to treat breast cancer but can also be necessitated by other conditions. Using the latest advances and a number of different techniques, plastic surgeons can create a breast that closely matches the size, shape and feel of a natural breast.

Breast reconstruction can be performed immediately following a mastectomy or delayed for weeks or even years. With immediate reconstruction, your plastic surgeon teams with the surgeon who removes the breast and builds the new breast immediately following the mastectomy. Patients have one less surgery to deal with, and awakening from surgery with the new breast mound in place can help to alleviate the shock of losing a breast. However, delayed reconstruction may be advised for some patients, especially if the breast will be rebuilt using a more complicated tissue flap technique. The procedure may also be delayed because of the emotional stress caused by cancer, to allow chemotherapy or other treatments to be completed or because of other health conditions, such as high blood pressure.

How Breast Reconstruction is Performed

Breast reconstruction usually involves a series of procedures during which breast implants, a tissue flap, or a combination of both are used to create the new breast. The tissue flap — consisting of skin, fat and muscle — is moved from another part of the body, usually the abdomen or upper back. As a final step in the procedure, the nipple and areola may be reconstructed from skin grafts.

Breast Implant Reconstruction

The most common breast reconstruction technique uses a breast implant to build the new breast. Breast implants consist of a silicone elastomer shell filled with saline or silicone gel, and come in a variety of sizes, shapes and textures. The implant is placed either over, partially under or completely under the chest muscle in a manner similar to breast augmentation.

Most women have to undergo an expansion of the remaining breast tissues before the permanent implant can be inserted. A balloon expander is implanted and gradually filled with saline solution through a tiny valve. The expander remains in place for several weeks or months until the skin has stretched enough to accommodate the permanent implant. Some tissue expanders are designed to remain in place as the permanent implant.

The surgeries to insert the tissue expander and to insert the permanent implant each normally take 1 to 2 hours. The first surgery is usually performed at a hospital if done immediately after a mastectomy. If delayed, it can be performed at a hospital or as an outpatient procedure. General anesthesia is administered to put you to sleep throughout the surgery.

Tissue Flap Reconstruction

Tissue flap reconstruction is an option for women whose skin will not expand enough to allow for the use of a breast implant. A tissue flap is taken from the abdomen, upper back or other part of the body and used to create the new breast mound. Breasts made from a woman's own tissues can be more natural in feel and appearance.

Tissue flap procedures are more complex than implant reconstruction and take longer, normally 2 to 4 hours. The surgery is usually performed in a hospital under general anesthesia. Patients should expect to stay in the hospital for several days.

Several different tissue flap reconstruction techniques are used:

TRAM Flap — The TRAM (transverse rectus abdominis myocutaneous) Flap procedure uses tissue from the lower abdomen to form the new breast. This method carries the added benefit of a tummy tuck for women with excess abdominal tissue.

The TRAM Flap procedure can be performed in two different ways:

  • With a Pedicle Flap, the abdominal tissue is moved to the breast through a tunnel under the skin and remains attached to its blood supply.
  • With a Free Flap, the tissue is surgically removed from the abdomen and reattached to the chest. The blood vessels are attached to those in the breast area using microvascular surgery.

DIEP Flap — The DIEP (deep interior epigastric perforator) Flap is a newer procedure that uses skin and fat from the abdomen, but not muscle, to form the new breast. As with the TRAM Flap, this procedure also gives the patient a tummy tuck. The DIEP Flap is performed as a free flap procedure, so microsurgery is required to connect the blood vessels.

Latissimus Dorsi Flap — The Latissimus Dorsi Flap procedure uses tissue from the upper back that is tunneled under the skin, remaining attached to its blood supply, and shaped to form the new breast mound. A breast implant is usually necessary as well.

Gluteal Flap — The Gluteal Flap procedure uses a free flap of tissue from the buttocks to form the new breast. This newer technique is an option for women who are too thin to use tissue from the abdomen, though it can result in weakening of the gluteal muscle.

Nipple and Areola Reconstruction

Reconstruction of the nipple and areola (the darker skin surrounding the nipple) is an optional procedure that is considered to be the final stage of breast reconstruction. It is usually performed several months after the new breast is created to give it time to heal and settle into shape.

The nipple and areola are created from separate skin grafts from the new breast or another area of the body, such as the inner thigh. Tattooing may be used to match the color of the new nipple and areola to the other breast.

Nipple and areola reconstruction can usually be performed as an outpatient procedure under local anesthesia.

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Best Candidates

The best candidates for breast reconstruction are women who want to restore the normal appearance of their breasts after a mastectomy (surgery to remove a breast) because of breast cancer or to correct a breast abnormality.

Knowing about their options for breast reconstruction helps many women with the emotional strain of preparing for their mastectomy. Breast reconstruction can be performed immediately following a mastectomy, so that the patient wakes up from surgery with the new breast in place, or it may be delayed if the patient is not ready to consider reconstruction while coping with breast cancer.

Make sure that you are realistic about the outcome and understand that improvement, not perfection, is the desired result. Breast reconstruction successfully creates a normal breast contour, improves symmetry and eliminates the need for an external prosthesis. Many women who might otherwise be insecure about their appearance also experience a boost in self-esteem and a sense of completeness. However, breast reconstruction will not make your breasts look exactly alike or restore normal feeling to the new breast.

A qualified plastic surgeon can evaluate your circumstances, explain the different techniques that are available, answer all of your questions and help you decide if breast reconstruction is right for you.

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Breast Reconstruction Risks

Breast reconstruction carries the same risks as any surgery, which include infection, excessive bleeding and complications from the anesthesia. To reduce your risk, carefully follow all of your plastic surgeon's instructions, both before and after the procedure. Contact your surgeon's office immediately if you have any symptoms you believe may indicate a complication.

Breast reconstruction usually involves a series of procedures, and additional surgeries may be necessary to correct problems. If breast implants are used, the most common risk is capsular contracture. This problem occurs when the scar capsule surrounding the implant contracts and compresses the implant into a hard shape. Breast implants are not lifetime devices and may need to be replaced at some point, requiring additional surgery.

Tissue flap reconstruction is a major procedure with a longer time in surgery and an extended recovery period. If a free flap procedure is used, the flap tissue can die from lack of blood flow if the blood vessels are not sufficiently reattached. Problems at the donor site can also occur. TRAM Flap procedures can result in weakening of the abdominal muscles, though most patients eventually regain their full strength. The Gluteal Flap, where a free flap is taken from the buttocks, can result in weakening of the gluteal muscle.

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Breast Reconstruction Costs

You should be provided with complete information on costs and financing options at the initial consultation with your plastic surgeon. The total fee for breast reconstruction can vary depending on the region of the country, the extent of the procedure and your specific needs as a patient.

Most or all of the cost of breast reconstruction is usually covered by health insurance. Be sure to check with your insurance company to ensure that you are covered and to find out if there are any limitations on your coverage.

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Breast Reconstruction Consultation

If you decide that you might benefit from a breast reconstruction, the first step is to locate a qualified plastic surgeon and schedule a consultation. During this meeting, you will be examined by the doctor and discuss your options in detail. Be sure to ask any questions that you have and openly discuss your expectations and concerns.

The surgeon should fully address all of your questions and offer advice on how to achieve your desired results. He or she will explain the types of breast reconstruction that are possible based on your medical history, overall health, physical characteristics and aesthetic goals and help you decide on the specific technique that is most appropriate.

The surgeon should give you the full details of the recommended procedure, including the benefits, limitations, how many surgeries will be required and whether the initial surgery will be immediate or delayed after mastectomy. He or she will also cover costs and insurance coverage, where the surgery will be performed, anesthesia and recovery time. Be sure to ask to see before and after photos of the surgeon's recent breast reconstruction patients.

As the consultation concludes, you may wish to schedule your procedure, take some time to think or seek a second opinion. If you decide to proceed with breast reconstruction, your plastic surgeon and the surgeon performing the mastectomy will work together to develop an overall treatment strategy. You will be given specific instructions on how to prepare for breast reconstruction, including guidelines for eating, drinking, and medications and vitamins to take or avoid before and after surgery.

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Breast Reconstruction Recovery

Depending on the type of procedure, recovery from breast reconstruction can take up to 6 weeks or more. The recovery time for breast implant reconstruction may be less if it is not performed as the same time as the mastectomy. Tissue flap reconstruction patients usually have to stay in the hospital for a few days and face a longer recovery period than implant reconstruction patients.

Normal symptoms experienced after breast reconstruction include soreness, fatigue, swelling and bruising. Any pain should subside within a week or two and be controlled by your prescribed pain medication. Swelling or bruising can last for several weeks.

A surgical drainage tube may be inserted to remove excess fluids that collect in the breast area before being removed within a week or so. Your stitches will dissolve or be removed in 1 to 2 weeks. The remaining scars may be red and bumpy for a month or so but should eventually fade to thin lines. Breast reconstruction cannot restore normal feeling to the new breast, but some feeling may return over time.

For the first few days after surgery, take it easy, get plenty of rest and follow all of your post-operative instructions. You should be up and around within a week and able to perform stretching exercises and light activities, such as a short walk. More vigorous physical activity, overhead lifting and sexual activity should be avoided for 3 to 6 weeks. Patients whose reconstruction was performed using the TRAM Flap technique should avoid heavy lifting or any activities that strain the abdominal muscles for 3 months or more.

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