Would you like to remain comfortable with your breasts after mastectomy? Would you like to retain a confident body image and an alternative to wearing external pads or forms?
If so, breast reconstruction after a mastectomy is perfect for you.
Breast reconstruction is the surgical procedure to rebuild the shape and appearance of the breasts after the surgical treatment of breast cancer. The surgery can begin at the time of mastectomy, but can also be delayed to a more convenient time.
During the reconstruction, a breast mound is shaped and positioned using either an implant or natural tissue to recreate a natural-looking breast. Since the resulting breast mound does not usually have a nipple and an areola, a new nipple and areola may be recreated after the reconstructed breast has healed and settled.
Also called reconstructive mammoplasty, the breast reconstruction:
- Reshapes and repositions breasts after mastectomy
- Acts as an alternative to external breast pads and forms
- Improves symmetry if only one breast is affected
- Gives a confident appearance after mastectomy
- Enables wearing normal swimwear and low-cut necklines
- Boosts psychological wellbeing after breast cancer surgery
When should you consider breast reconstruction?
A mastectomy will have a huge impact on your breasts, so it is advisable to discuss the possible impact of the procedure on your breasts and body with your oncologist, breast surgeon, and plastic surgeon. They will look at your surgical history, coexisting illnesses, and past medical history to assess your suitability for breast reconstruction.
Breast reconstruction may be inappropriate if you have conditions such as heart disease, high blood pressure, diabetes and autoimmune diseases. These conditions increase the risk of infections and delay wound healing. Since chemotherapy and radiation therapy also reduce wound healing and can cause tightening of the skin, breast reconstruction is usually delayed if these treatments are administered after mastectomy.
Being overweight or having a body mass index of more than 30 reduces the efficacy of reconstruction surgery. Therefore, you are required to attain a recommended weight before the procedure. You will also be directed to stop smoking for at least 6 weeks before and after the surgery. You should avoid aspirin, anti-inflammatory drugs, and herbal supplements that may increase bleeding after reconstruction surgery.
At Politis Plastic Surgery, we will engage you in candid discussions about your suitability for breast reconstruction long before the scheduled mastectomy. We will also conduct a detailed medical history, do a physical exam, and assess your attitude and aesthetic goals before we recommend the procedure.
How is breast reconstruction done?
Breast reconstruction is done using either breast implants or autologous flaps. The breast implant procedure is preferred in most cases because it requires a few short, outpatient procedures. But since implants are only effective if the mastectomy leaves sufficient tissue on the chest wall, the flap technique is a valuable alternative when there is extensive damage to breast tissue.
1. Implant-based breast reconstruction
This is typically an outpatient procedure recommended when you want a short, straightforward reconstruction. It is also ideal if you have smaller breasts. Performed either as a one-stage or a two-stage procedure, implant-based reconstruction mammoplasty involves inserting a silicone breast implant beneath the skin and muscle of the chest wall.
For the one-stage procedure, the plastic surgeon inserts the breast implant at the time of mastectomy. Adequate skin and muscle is preserved during the mastectomy to envelope and cover the implant which is placed under the pectoral muscle and supported by a dermal matrix.
The dermal matrix enhances the thickness and strength of the mastectomy skin flaps and acts as supportive scaffolding to hold the implant in place. And with time, the dermal matrix integrates into the surrounding tissue and becomes part of the reconstructed breast.
For the two-step process, a tissue expander is partially filled with saline and inserted at the time of mastectomy. Your reconstruction surgery takes place when you are healed from the initial surgery.
Once the breast heals, your plastic surgeon injects more fluid into the expander to gradually increase its volume and stretch the skin and muscle. This is done for several weeks, creating a pocket big enough to hold a permanent implant matching the size of the other breast.
The expander is left in place for several months to allow your skin to adapt to it. And finally, it is replaced with a cohesive silicone gel implant during a second operation.
2. Autologous flap reconstruction
When breast tissue is seriously damaged during mastectomy or radiotherapy, autologous flap reconstruction is the right option. This surgery is a little more complex, requiring a hospital stay and longer recovery time.
During autologous flap reconstruction, your plastic surgeon repositions body muscle, skin and fat to create or cover a breast mound. Flap tissue—a healthy non-irradiated tissue commonly obtained from the abdomen, buttocks, and back—replaces or covers the damaged tissues.
The plastic surgeon can either use pedicled or free flaps for the reconstruction. Pedicled flap reconstruction involves the transfer of skin, fat, and muscle to the breast area on a pedicle (stalk) of muscle, which has not been fully detached from its original position and still contains blood supply. In contrast, free flap reconstruction involves detaching skin, fat and some blood vessels from a donor site, transferring them to the breast area and re-attaching blood supply through microsurgery.
1. Nipple reconstruction
After your reconstructed breast has healed and settled in position, your plastic surgeon may surgically recreate your nipples. This is achieved by raising flaps of tissue from the central area of the reconstructed breast. But if larger nipples are to be created, the surgeon can graft tissue from one side to form a nipple on the other side of the breast. This gives smaller nipples on both sides.
2. Areola tattooing
This procedure is performed to give color to recreated nipples and produce the appearance of an areola around the nipple. The surgeon blends permanent color pigments that match your skin type and then tattoo them on to the skin. The tattooing is done under local anesthesia.
3. Fat grafting
If there is a need to improve your contours, mask implant outline or fill in defects, your plastic surgeon may do so by fat grafting. Fat cells are obtained from another part of your body through liposuction. The fat is processed and re-injected into your reconstructed breasts.
Recovering after breast reconstruction
Flap-based reconstruction usually requires a hospital stay for two to six days. The duration of the hospital stay depends on the type of surgery, how the recovery progresses, and your overall health. While you are in the hospital, nurses will help you in and out of bed and you will be encouraged to move your arms regularly.
Implant-based reconstructions are usually done on an outpatient basis. Plan to have someone drive you home and stay with you for at least 24 hours after the surgery. Your plastic surgeon will provide detailed instructions on normal symptoms, potential signs of complications, wearing compression garments, and caring for drains. Make sure to follow the instructions and attend follow-up sessions every week with your surgeon to monitor your progress.
You will have some pain after the anesthesia wears off. Taking pain-relieving medications regularly will help to control the pain and prescribed antibiotics will prevent infection. If the pain, swelling or redness becomes extreme or long-lasting, contact your surgeon for help.
There will be discomfort as you try to move your arms, but it is critical to continue using your arms and to complete the recommended exercises. Walking every day is encouraged to aid circulation and reduce the risk of clot formation in your legs.
Is the procedure safe?
Breast reconstruction surgery is quite safe and serious complications are rare. However, like all surgical procedures, there are risks of bleeding, infection, scarring, allergic reactions, adverse reaction to anesthesia, hematoma, change in skin sensation, and damage to underlying structures.
You may also have rare complications such as fat necrosis, blood clots, loss of flap, hernia, implant rupture, implant mal-position, and capsular contracture. The risks are significantly minimized by following the instructions and advice of a board-certified plastic surgeon.
Lasting, remarkable results
Initially, your reconstructed breast will be larger due to swelling, but once the swelling subsides, the breast will take the shape you desire. Your breast will have a restored look, and in turn, enhance your overall body image. Although the reconstructed breast will never match the look and feel of your natural breast, it will make you more comfortable with your body after a mastectomy.
At Politis Plastic Surgery, we are committed to a personalized, compassionate, and patient-centered approach to cosmetic surgery. We will support you from consultation, preparation and surgery to post-surgical follow-up. We will discuss available options with you and ensure a personalized reconstruction that achieves your goals and desires. And after your breast reconstruction procedure, we will monitor the changes in your breasts to make sure nothing goes wrong.
Call today to schedule your consultation. For more information on plastic surgery procedures, visit the Politis Plastic Surgery website.