What is Breast Reconstruction?
Dr. Mary Gingrass and Dr. Melinda Haws
Breast reconstruction is available to most women who have undergone a mastectomy due to breast cancer or another disease. Breast reconstruction is often possible immediately following the removal of the breast, offering additional advantages to the patient. The best candidates for breast reconstruction are those whose cancer seems to have been eliminated by mastectomy.
Breast Reconstruction Surgery
Following a mastectomy, our cosmetic surgery practice in Nashville, Tennessee will select the breast reconstruction surgery option that is right for you.
One breast reconstruction option involves a balloon expander inserted beneath the skin and under the chest muscle. A salt-water solution is gradually injected into the balloon through a valve mechanism. The solution will expand the balloon, thus stretching the skin over a period of several weeks or months. Once the skin over the breast area has been adequately stretched, the expander is replaced by a more permanent breast implant. Some expanders may be left in place as the final implant. The nipple and the areola are reconstructed in a later procedure.
Another approach our plastic surgery practice in Nashville, Tennessee used for breast reconstruction involves the creation of a skin flap made from tissue from other parts of a patient's body. In one type of skin flap breast reconstruction surgery, the tissue - which consists of skin, muscle, and fat - is placed beneath the skin of the chest in order to create a space for a breast implant. Sometimes, during this breast reconstruction procedure, the tissue can form the breast mound itself without any need for a breast implant. The two most common flap breast reconstruction surgeries involve using the soft tissue of the lower abdomen (TRAM flap) or the soft tissue from the back (latissimus flap).
A majority of breast reconstruction surgeries involve a series of periodic procedures. In most cases the initial operation is the most complex. Some follow-up surgeries may be required to replace a tissue expander with a breast implant or to reconstruct the nipple and the areola.
When deciding which option is best for you at our Nashville, Tennessee practice, the breast reconstruction surgeon will determine which procedure will come closest to achieving your goals and which option your body will best support. Not all women are candidates for all surgical options. This will be discussed during your initial consultation.
After Breast Reconstruction Surgery
You will likely be sore for a week or two after breast reconstruction surgery, but this can be controlled by medication. You will probably be released from the hospital in two to five days. Often a surgical drain is required to extract excess fluids from surgical sites immediately following breast reconstruction surgery, but is removed within the first week or two after surgery. Most of the stitches are placed under the skin and will dissolve over time.
The expander/implant type of breast reconstruction typically results in a faster initial recovery. However, it takes longer and more visits to the office for expansion. This means it will be several weeks before you will have an appreciable breast mound. In contrast, the flap breast reconstruction procedure requires a longer initial recovery with discomfort in more than just the breast area of your body. In many cases, a reasonable breast mound is present immediately after this form of breast reconstruction surgery.
As stated above, at least one, if not more, follow-up surgeries will be required for nipple/areolar reconstruction, touchups, and to ensure the restored breast matches the opposite breast. Our practice in Nashville, Tennessee will time these breast reconstruction follow-up surgeries according to your rate of healing and corresponding with any other therapy related to breast cancer.
Generally, it can take up to six weeks to recover from a mastectomy combined with breast reconstruction surgery. It may take up to six weeks just to recover from a flap breast reconstruction procedure alone. Recovery time may be less, however, if breast implants are used without the skin flap technique and the breast reconstruction surgery is not performed following the mastectomy.
In time, some feeling may return to the reconstructed breast, but not all. Most scars will fade significantly in one to two years, but the scars will never disappear entirely. You should refrain from sports, overhead lifting, and sexual activity for three to six weeks after breast reconstruction surgery.
As with most surgery, bleeding, excess fluids, excessive scar tissue, or anesthesia complications can occur during breast reconstruction. If a breast implant is used, there is a remote possibility of infection. In some cases, the breast implant may need to be removed for several months until the infection clears. A new implant is then inserted later.
The most common problem following breast surgery involving implants, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. However, capsular contracture can be treated, usually with surgery.
Breast reconstruction has no known effect on the recurrence of disease in the breast, nor does it generally interfere with chemotherapy or radiation treatment should cancer recur.