Breast reconstruction is a surgery used to restore breast shape following a mastectomy (removal of breast to treat/prevent breast cancer). Some women undergoing breast reconstruction require breast implants, which are made of silicone, silicone gel, or saline water. Breast reconstruction with implants is a complex surgery requiring the skill of a plastic surgeon. Most patients require two or more surgeries.
Factors to Consider
Before having breast reconstruction surgery, some factors to consider include:
Breast reconstruction is done to re-create natural-looking breasts, but the exact feel and look will be somewhat different than natural breasts.
Your body type, cancer treatment, and health status all factor into what type of breast reconstruction you will have.
The Initial Consultation
Before the mastectomy, you will meet with the plastic surgeon for a consult. During the initial consultation, the plastic surgeon will describe your options and discuss the procedure risks and benefits.
Before the Procedure
You must hold all medicines that can thin the blood, such as aspirin, ibuprofen, over-the-counter herbal supplements/vitamins, Plavix, and Coumadin. Smoking is prohibited, as it delays wound healing, and should be stopped 6 weeks before surgery. Arrange to have help at home for a few days, and you will need to have someone drive you home from the surgical center.
During the Procedure
Breast reconstruction surgery is performed under general anesthesia, so you will not experience any pain or have memory of the procedure. A temporary tissue expander is usually placed in the breast pocket at the time of the mastectomy, under the pectoral muscle. This device stretches skin and soft tissues to prepare for the implant. After all surgical changes and corrections are made, drains are placed, incisions are closed, and bandages are applied. The expander is exchanged for the permanent implant in a second stage (usually a couple months afterwards depending on healing).
After the Procedure
After surgery, a nurse monitors you in the recovery room for 30-60 minutes. Once vital signs are stable, you will be discharged home or moved to a room. Expect to have drainage tubes that remove fluids from the breast region. Soreness, bruising, and drainage is expected, but this gradually improves over the next few days. You must avoid overhead stretching, lifting, and rigorous activities for 4-6 weeks, and you should wear the compression garment during this time as well.
Scarring and Nipple Reconstruction
After breast reconstruction surgery, scars are quite noticeable. However, with time, scarring fades. Breast reconstruction usually involves removal of the nipples, but you can have local mini-flaps or tattooing to restore the nipple color and shape.
Benefits of Breast Reconstruction
Breast reconstruction can:
Give you a breast contour.
Enhance self-esteem and confidence.
Provide symmetry to the breasts.
Avoid the need for external prosthesis.
Partially erase the physical reminders of your condition.
Require additional surgery.
Breast cancer is the leading malignancy among women, with as many as 50% of patients having some type of breast reconstruction. According to studies, 80-90% of patients are happy with their results. There is increased likelihood of requiring corrective surgery after a mastectomy, immediate reconstruction, and/or radiation therapy. In a study involving 62 patients, researchers found that patients who undergo immediate reconstruction after mastectomy have a high rate of subsequent reconstruction procedures.
Lim J, Low SC, & Hoe M (2001). Breast reconstruction after mastectomy: a survey of general surgeons in Singapore. ANZ J Surg, 71(4), 207-211.
Wong JS, Ho AY, & Kaelin CM (2008). Incidence of major corrective surgery after post-mastectomy breast reconstruction and radiation therapy. Breast Journal, 14(1), 49-54.