The goal of breast reconstruction is to restore one or both breasts to near-normal shape, appearance, symmetry and size following mastectomy, lumpectomy or other trauma.
How is the breast reconstruction surgery performed?
Breast reconstruction generally falls into two categories: implant-based reconstruction or flap reconstruction. Implant reconstruction relies on breast implants to help form a new breast mound. Flap reconstruction uses the patient's own tissue from another part of the body to form a new breast. There are a number of factors that should be taken into consideration when choosing which option is best, including:
Types of implant reconstruction:
First, a temporary device known as a tissue expander is placed inside the breast cavity to create the soft pocket that will contain the permanent implant. Some surgeons may also use an acellular dermal matrix to assist with reconstruction. Once expansion is complete, the expander will be exchanged for the permanent implant during an outpatient procedure.
This approach allows for a breast implant to be implanted immediately following mastectomy, foregoing the need for a tissue expander. Some patients may still require a secondary procedure.
What implant choices are there for breast reconstruction?
Saline implants are filled with sterile salt water. They can be filled with varying amounts of saline, which can affect the shapes, firmness and feel of the breast. Should the implant shell leak, a saline implant will collapse and the saline will be absorbed and naturally expelled by the body. Saline implants can feel or look wrinklier in thin patients.
Silicone implants are filled with an elastic gel that feels and moves much like natural breast tissue. If the implant leaks, the gel may remain within the implant shell, or it may escape into the breast implant pocket. A leaking implant filled with silicone gel may not collapse. If you choose these implants, you may need to visit your plastic surgeon regularly to make sure the implants are functioning properly. An ultrasound or MRI screening can assess the condition of your breast implants.
Form stable implants mimic the natural shape of the breast and are shaped like a tear drop. They are thicker at the bottom and tapered toward the top. They are usually filled with cohesive gel. If they rotate, they may lead to a strange appearance. It usually also is necessary to have a longer incision with these implants.
Round implants have a tendency to make reconstructed breasts appear fuller than form stable implants. They also often will make the breast project out further away from the body. New high-profile options can lead to even more projection, if that is a concern for you. Because they are the same shape all over, there is less concern about them rotating out of place.
Texture breast implants allow the scare tissue to stick to the implant, making them less likely to move around inside of the breast and become repositioned.
Smooth breast implants move around freely inside of the breast, which may provide a more natural movement. These implants also have an increased risk of rippling.
Will the breast reconstruction surgery result in permanent scarring?
Over time, 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.
How long is the recovery time for breast reconstruction?
Recovery time depends on the type of procedure you undergo.
An expander/implant reconstruction requires two surgeries – a mastectomy, during which the expander is inserted, and a second surgery during which the expander is removed and replaced with the implant. After the first surgery, you will need to stay overnight in the medical center for one or two days to recover, followed by a four- to six-week recovery time at home. The second surgery is an outpatient procedure that has a shorter recovery time of one to two weeks.
As a direct-to-implant reconstruction requires only one surgery, recovery time is much shorter. You will need to stay in the medical center for one to two days, after which you will recover at home for another four to six weeks.
Will I need anesthesia for breast reconstruction?
Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anesthesia.
Am I a good candidate for breast reconstruction?
Breast reconstruction is a highly individualized procedure. You should do it for yourself, not to fulfill someone else's desires or to try to fit any sort of ideal image.
You may be a candidate for breast reconstruction if:
Although breast reconstruction can rebuild your breast, the results are highly variable:
During your breast reconstruction consultation, be prepared to discuss:
Your surgeon also will:
Prior to surgery, you may be asked to:
Following your breast reconstruction surgery, gauze or bandages will be applied to your incisions.
An elastic bandage or support bra will minimize swelling and support the reconstructed breast. A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid. A pain pump also may be used to reduce the need for narcotics.
You will be given specific instructions that may include how to care for your surgical site(s) following surgery, medications to apply or take orally to aid healing and reduce the risk of infection, specific concerns to look for at the surgical site or in your general health, and when to follow up with your plastic surgeon.
Healing will continue for several weeks while swelling decreases and breast shape/position improve.
Continue to follow your plastic surgeon's instructions and attend follow-up visits as scheduled.