Customize your experience, We go an extra mile for you.
Sign in / Join
Media News Medical Professionals Partners
Search

Breast Reconstruction

Home / Procedures / Breast / Breast Reconstruction
What is breast reconstruction?

Breast reconstruction is surgery performed to recreate or reshape a breast (or breasts) that have been removed due to mastectomy, lumpectomy, or congenital deformity.

Reasons for Breast Reconstruction:

  • Following Mastectomy: Mastectomy, the surgical removal of all or part of the breast tissue, is often performed as part of breast cancer treatment. Reconstruction can help women regain a sense of balance and normalcy in their appearance after mastectomy.
  • After Lumpectomy: Lumpectomy involves removing only the cancerous lump and a margin of healthy tissue around it. Reconstruction can help achieve a more symmetrical appearance after lumpectomy, especially if a significant amount of breast tissue was removed.
  • Congenital Deformities: Reconstruction can be an option for women with congenital breast abnormalities, such as Poland Syndrome (underdeveloped chest wall muscles on one side).

Types of Breast Reconstruction:

There are two main types of breast reconstruction, each with its own advantages and considerations:

  1. Implant-based Reconstruction:
  • This technique uses silicone or saline breast implants to recreate the shape and volume of the breast mound.
  • Implants can be inserted either immediately following mastectomy (immediate reconstruction) or at a later date (delayed reconstruction).
  • Advantages: Less invasive procedure, shorter surgery time.
  • Disadvantages: Potential for implant complications (rupture, leakage, capsular contracture). May not achieve the same look and feel as natural breast tissue.
  1. Autologous Tissue Flap Reconstruction:
  • This technique uses the patient’s own tissue from another part of the body, such as the abdomen, buttocks, or back, to create the new breast mound.
  • The tissue is carefully transferred (flaped) to the chest area and sculpted to create a natural-looking breast.
  • Advantages: Provides a more natural look and feel compared to implants. Less risk of implant complications.
  • Disadvantages: More complex surgery, longer procedure time, potential scarring at the donor site.

Choosing the Right Type of Reconstruction:

The best type of reconstruction for you will depend on several factors, including:

  • The extent of breast tissue removed during mastectomy or lumpectomy
  • Your skin quality and tissue laxity
  • Your desired outcome (appearance, feel)
  • Overall health and medical history
  • Your personal preferences
How is breast reconstruction performed?

Breast reconstruction can be performed using two main techniques: implant-based reconstruction and autologous tissue flap reconstruction. The specific surgical approach will vary depending on your individual case, desired outcome, and surgeon’s expertise. Here’s a general overview of each:

Implant-Based Reconstruction:

  1. Pre-operative Consultation and Planning: Similar to breast augmentation, a thorough consultation with your plastic surgeon is crucial. They will assess your anatomy, remaining breast tissue (if any), and discuss your desired outcome. Imaging tests might be done to evaluate your suitability for implants.

  2. Surgical Procedure: Performed under general anesthesia. Here’s a simplified breakdown:

    • An incision is made, typically in the inframammary fold (breast crease) or around the areola (nipple area).
    • A pocket is created behind the chest wall muscles or beneath the pectoralis major muscle (large chest muscle) to accommodate the implant.
    • The chosen implant (silicone gel or saline fill) is inserted and meticulously positioned for optimal appearance and symmetry. Depending on your situation, the surgeon might also use a tissue expander (temporary inflatable device) before implant placement to gradually stretch the skin and create space for the final implant.
    • The incision is closed with sutures, and a drainage tube might be placed temporarily to drain excess fluids.

  3. Post-Surgical Care: You’ll experience some swelling, bruising, and discomfort after surgery. Pain medication will be prescribed to manage these. Wearing a surgical bra for support and compression is essential during healing as instructed by your doctor. Recovery can take several weeks, with gradual improvement in swelling and discomfort.

Autologous Tissue Flap Reconstruction:

  1. Pre-operative Consultation and Planning: Similar to implant-based reconstruction, a thorough consultation is essential. The surgeon will discuss the donor site options (abdomen, buttocks, back) and plan the flap design based on the amount of tissue needed for breast reconstruction.

How can I select a trustworthy surgeon?

When choosing an aesthetic plastic surgeon, it’s essential to consider the following factors:

  1. Qualifications: Does the surgeon possess the necessary education, training, and certification?

  2. Experience: Does the surgeon have extensive experience performing ear surgery?

  3. Pediatric Experience: If the patient is a child, does the surgeon have experience operating on pediatric patients?

  4. Results: Do you find the surgeon’s before-and-after photos satisfactory?

  5. Comfort Level: Are you comfortable with the surgeon and their approach to your procedure?

  6. Membership: Is the surgeon a member of The Aesthetic Society?

After finding a board-certified plastic surgeon with significant experience in ear surgery, you’ll need to schedule a consultation.

What to expect during a consultation?

Typically, there may be a consultation fee due to the comprehensive nature of the appointment. During the consultation, you’ll have the opportunity to discuss your aesthetic goals. The surgeon will assess your suitability for ear surgery and evaluate the shape, size, and position of your ears. They may also take photographs for further analysis. Be prepared to provide your complete medical history, including past surgeries, medical conditions, allergies, and current medications.

Questions to ask your surgeon: It’s crucial to be proactive during your consultation. Here are some questions to consider asking:

  • Am I a suitable candidate for ear surgery?
  • Are my desired outcomes realistic?
  • Can I see before-and-after photos of previous ear surgeries?
  • How many ear surgeries have you performed?
  • Which surgical approach is best suited to my needs?
  • Where will the incisions be made, and will they be visible?
  • What type of anesthesia do you recommend?
  • What is the expected cost of the procedure?
  • What can I do to ensure optimal results?
  • What is the anticipated recovery period?
  • What are the potential risks and complications?

After the consultation: Following the consultation, your surgeon will provide personalized recommendations and information, including:

  • Proposed surgical approach
  • Expected outcomes
  • Financial considerations
  • Risks and complications
  • Anesthesia options
  • Preoperative preparation
  • Postoperative care instructions
  • Similar case studies
  • Answers to any additional questions

With thorough research and consultation, you’ll be equipped to make an informed decision regarding your surgery and surgeon. If uncertainties persist, don’t hesitate to seek further clarification or explore consultations with other surgeons.

How do I prepare for breast reconstruction?

Pre-Operative Instructions:

  • Once you decide to proceed, the surgeon will provide specific instructions to prepare your body for surgery. These might include:

    • Healthy Diet: Maintaining a balanced diet rich in fruits, vegetables, and lean protein in the weeks leading up to surgery is recommended. This ensures your body has the necessary nutrients to heal effectively.
    • Smoking Cessation: Stopping smoking ideally weeks or months before surgery is crucial. Smoking hinders healing and increases complication risks.
    • Medication Management: You might need to stop taking certain medications or supplements that could increase bleeding risk. Discuss any medications with your doctor for specific guidance.
    • Weight Management: Maintaining a stable weight within a healthy range is recommended. Significant weight fluctuations can affect the long-term results of breast reconstruction.
    • Logistics: Arrange transportation to and from the surgical facility, as you’ll likely be unable to drive yourself after anesthesia. Prepare comfortable post-surgical garments as instructed by your doctor (surgical bra for implant-based reconstruction, loose clothing for flap reconstruction).
How long does it take to recover from breast reconstruction?

Implant-Based Reconstruction:

  • Immediately After Surgery: You’ll experience some swelling, bruising, and discomfort in the chest area. Pain medication will be prescribed to manage these. Depending on the extent of the surgery, you might stay overnight at the surgical facility or recover at home on the same day.
  • First Weeks (1-2): Discomfort gradually lessens. Swelling and bruising will be most prominent during this initial phase. Wearing a surgical bra for support and compression is crucial throughout the day and night as instructed by your doctor. Limited movement and activity, especially those that strain the chest muscles (lifting objects, strenuous exercise), are recommended for the initial recovery phase.
  • Weeks 3-6: Swelling and bruising progressively subside. You can gradually increase activity levels, but strenuous exercise should still be avoided. Sutures might be removed during follow-up appointments with your doctor.
  • Months 3-12: Daily activities can be resumed with minimal discomfort in the breasts. Light exercise that doesn’t strain the chest muscles might be gradually incorporated as approved by your doctor. The final results of the breast reconstruction become progressively more evident during this period. Up to a year: By 6 months to a year after surgery, significant improvement in the appearance of the breasts should be evident. Most swelling will have resolved, and the implants will feel more settled in their final position.

Autologous Tissue Flap Reconstruction:

  • Immediately After Surgery: Expect more extensive swelling, bruising, and discomfort compared to implant-based reconstruction due to the complexity of the surgery. Pain medication will be provided for management. You’ll likely stay in the hospital for several days for monitoring and initial recovery.
  • First Weeks (1-4): Discomfort gradually lessens, but it might be more pronounced than with implant reconstruction due to the flap healing process. Swelling and bruising will be significant initially. Following a meticulous post-operative care plan, including proper wound care, drainage tube management (if used), and physical therapy exercises (if recommended) is crucial for optimal healing and reducing complications.
  • Weeks 4-8: You’ll gradually transition to outpatient care with regular follow-up appointments. Swelling and bruising begin to subside, but it might take longer than with implant reconstruction.
  • Months 2-12: Gradual improvement in discomfort and mobility. Daily activities can be resumed with caution, and light exercise might be gradually incorporated as approved by your doctor and physical therapist. Recovery continues as the flap tissue heals and integrates with the surrounding tissues.
  • Up to 18 Months: It can take up to 18 months for full healing and for the final appearance of the reconstructed breast to stabilize.
How long will my breast reconstruction results last?

Implant-Based Reconstruction:

  • With a healthy lifestyle, you can expect to enjoy significant improvements in the appearance of your breasts for 5 to 10 years after implant-based reconstruction.

Autologous Tissue Flap Reconstruction:

  • Flap reconstruction results are generally considered more durable than implants. You can expect them to last for many years, often a lifetime with proper care.
Will I have any scars after my breast reconstruction?

Yes, you will likely have some scarring after breast reconstruction surgery, regardless of the type (implant-based or autologous tissue flap). Here’s a breakdown of what to expect:

Scars are inevitable:

  • Any surgical procedure will inevitably leave some degree of scarring. The surgeon’s skill and technique minimize scarring as much as possible, but it’s a natural part of the healing process.

Scarring Variations:

  • The appearance of scars can vary depending on several factors, including your individual healing response, genetics, and the type of reconstruction performed.
  • Scars typically appear red and raised initially, gradually fading and flattening over time, often taking up to a year or more to mature to their final appearance.

Implant-Based Reconstruction:

  • Scars typically occur in the following locations:
    • Inframammary fold (breast crease) incision – most common for implant placement.
    • Around the areola (nipple) incision – less common, used for smaller implants or with a breast lift.
  • These incisions are strategically placed to minimize visibility and blend in with the natural contours of the breast.

Autologous Tissue Flap Reconstruction:

  • Scars will occur at the following locations:
    • Recipient site on the chest wall where the flap is placed.
    • Donor site where tissue was harvested (abdomen, buttocks, back).
  • The size and location of donor site scars depend on the specific flap technique used.

Minimizing Scars:

  • While you can’t prevent scarring entirely, there are ways to promote optimal healing and potentially improve scar appearance:
    • Silicone gel sheets: Applying these on the scar during the healing phase can help flatten and soften scars.
    • Scar massage: Gentle massage techniques can improve blood flow to the area and promote scar softening.
    • Sun protection: Consistent use of sunscreen with SPF 30 or higher is crucial to prevent scars from darkening with sun exposure.
 
What are the risks associated with breast reconstruction?

General Surgical Risks:

  • Anesthesia Reactions: Reactions to anesthesia can occur, though uncommon with modern medicine.
  • Bleeding: Bleeding is a potential risk during and after surgery, but controlled with surgical techniques and medications.
  • Infection: Infection is a risk after any surgery, but proper sterile technique and antibiotics help minimize this risk.

Potential Complications Specific to Breast Reconstruction:

  • Scarring: As discussed previously, scarring is inevitable, but techniques minimize its appearance. Scars typically fade over time with proper care.
  • Swelling and Bruising: Swelling and bruising are common after surgery and resolve gradually over weeks.
  • Fluid Accumulation (Seromas): Fluid pockets can form under the skin after surgery, typically addressed with aspiration by your doctor.
  • Numbness or Changes in Skin Sensation: Temporary numbness or altered sensation around the incision sites can occur, usually improving over time.
  • Asymmetry: Minor asymmetry in appearance between the two breasts is possible, but a skilled surgeon works to minimize this risk.

Serious but Rare Risks:

  • Deep Vein Thrombosis (DVT): Blood clots can develop in the deep veins of the legs, potentially leading to serious complications. Preventive measures like compression garments and blood thinners help mitigate this risk.
  • Fat Necrosis: Fat cells can die after liposuction, sometimes leading to firm, tender lumps under the skin. This risk is less common in breast reconstruction if liposuction isn’t part of the procedure.
  • Implant Rupture or Leakage (Implant-based only): Implants can rupture or leak over time, potentially requiring additional surgery. Silicone gel implants can rupture silently, while saline implants feel deflation when ruptured.
  • Capsular Contracture (Implant-based only): Scar tissue tightens around the implant, causing the breast to feel firm and distorted. This can necessitate revision surgery.

Source: Information adapted from theaestheticsociety.org