Reconstructive Breast Surgery

Overview

When some or all of the breast is removed, surgery may be needed to rebuild the breast. This operation is known as breast reconstruction. This is often done after a partial or complete mastectomy. You should talk to a plastic surgeon before having a mastectomy. This can improve the results of rebuilding the breast later on.

It is important that your cancer surgeon and plastic surgeon work together. Doing so, they can save skin and tissue. This can help when the breast is rebuilt.

Most breast reconstruction can be done either at the time of the mastectomy or later. In either case, more than one operation may be needed to have the best result.

Modern treatment may include:

• Reconstruction immediately after the mastectomy
• Using your own tissue (autologous)
• Implants
• Nipple reconstruction and tattooing (if the nipple was removed at the time of mastectomy)

There are a number of ways to rebuild the breast:

• Temporary expander. This temporary implant can be placed under the skin and muscle at the time of mastectomy. The expander is inflated over time. The expander is removed once the correct size is reached. A permanent silicone or saline implant then replaces the expander.
• Breast implants. These are placed in the area that once held the breast tissue. These implants can be made of silicone or saline. In general, using an implant is easier than using your own tissue. These operations require less time in the hospital and carry less risk. However, complications are possible. These include risks of the implant:
  • Hardening
  • Breaking
  • Leaking
  • Moving out of place
  • Rippling and wrinkling
  • Becoming infected

Implants usually need to be replaced after 10-15 years.

• Tissue flap. Breasts can also be rebuilt using your own tissue (muscle, fat, skin). The tissue can come from the stomach, back muscles or buttocks. These are different "flaps" of tissue. Sometimes both a flap and an implant are used. Using tissue rather than an implant is more difficult. You will be in the hospital four to seven days, and the operation lasts four to eight hours. There is also higher risk of tissue loss and scars. The advantage of the flap procedure is that it feels very natural.
• Nipple-Areola Reconstruction. Complete breast reconstruction includes rebuilding the nipple-areola area. It is the final touch to make the breast look natural. Tattooing makes the color match the natural look of the nipple and areola. Rebuilding the nipple-areola is usually an outpatient operation or office procedure. While it is not necessary, it is the step that brings you closest to your natural form.

You should meet with a plastic surgeon to determine which type of reconstruction is best for you.

The general events on the day of operation will be:

1. When you get to the hospital, you'll change into a hospital gown and remove any jewelry or valuables.
2. The surgical team will explain the procedure and answer any of your questions.
3. You will be taken to the operating room and given general anesthesia.
4. Once you are asleep, the plastic surgeon will begin reconstructing one or both breasts as needed. The method used to reconstruct the breasts will determine how the operation is performed.
5. The incision will be sewn closed. One or more plastic tubes may be sewn to the incision site to allow the area to drain. These tubes will be attached to plastic drainage bags outside of the body.
6. You'll be taken to a recovery room, where the medical team will watch over you as the general anesthesia wears off.

Breast reconstruction procedures can also correct pre-existing problems such as breast droopiness and poor shape.

Following surgery, patients are likely to feel tired, some pain and discomfort. Risks associated with this surgery are:

• Bleeding
• Infection
• Pain
• Swelling in the arm, known as lymphedema
• Hard scar tissue at the surgery site
• Shoulder pain and stiffness
• Numbness
• Buildup of blood in the surgery site (hematoma)

Surgeons prescribe medication or use other methods to resolve these issues.

Sometimes, radiation therapy is used after a mastectomy if there is a high risk of cancer returning to the area. Radiation therapy can affect the choice and timing of reconstructive surgery.

Radiation has effects on implants as well as tissue reconstruction. This includes:

• Increased risk of implant hardening
• Shrinkage of flap tissue
• Poor or delayed healing
• Loss of skin
• Damage to tiny blood vessels in the soft tissue (reduced vascularization)

Damage to the tiny blood vessels in the soft tissue can limit the options to use your own tissue to rebuild the breast. Surgery on the tissue after radiation treatment is also more risky.

We recommend scheduling an appointment with one or more plastic surgeons to discuss your options. You should also talk with women who have had the procedures you are considering. You may want to know what it feels like to live with the results of the surgery.

The Center for Plastic and Reconstructive Surgery offers comprehensive surgery breast reconstruction performed by experienced surgeons using leading-edge technology.

Get general information about your surgery and procedure.