What is breast reconstruction?
The goal of breast reconstruction is to restore one or both breasts to near normal shape, appearance, symmetry and size following mastectomy, lumpectomy or congenital deformities.
Breast reconstruction often involves multiple procedures performed in stages and can either begin at the time of mastectomy or be delayed until a later date.
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 (or autologous) 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:
- Type of mastectomy
- Cancer treatments
- Patient’s body type
A note about symmetry
If only one breast is affected, it alone may be reconstructed. In addition, a breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry of the size, shape and position of both breasts.
Who is a good candidate for breast reconstruction?
You may be a candidate for breast reconstruction if:
- You are able to cope well with your diagnosis and treatment
- You do not have additional medical conditions or other illnesses that may impair healing
- You have a positive outlook and realistic goals for restoring your breast and body image
Although breast reconstruction can rebuild your breast, the results are highly variable:
- A reconstructed breast will not have the same sensation or feel as the breast it replaces
- Visible incision lines will always be present on the breast, whether from reconstruction or mastectomy
- Certain surgical techniques will leave incision lines at the donor site, commonly located in less exposed areas of the body such as the back, abdomen or buttocks
What should I expect during a consultation for breast reconstruction?
During your breast reconstruction consultation, be prepared to discuss:
- Your surgical goals
- Medical conditions, drug allergies and medical treatments
- Current medications, vitamins, herbal supplements, alcohol, tobacco and drug use
- Previous surgeries
Your plastic surgeon will also:
- Evaluate your general health status and any pre-existing health conditions or risk factors
- Examine your breasts and take measurements of their size and shape, skin quality and placement of nipples and areolae
- Take photographs
- Discuss your options and recommend a course of treatment
- Discuss likely outcomes of breast reconstruction and any risks or potential complications
Be sure to ask your plastic surgeon questions. It’s very important to understand all aspects of your breast reconstruction. To help, we have prepared a checklist of questions to ask your breast reconstruction surgeon that you can take with you to your consultation.
It’s natural to feel some anxiety, whether it’s excitement for your anticipated new look or a bit of preoperative stress. Don’t be shy about discussing these feelings with your plastic surgeon.
What are the risks of breast reconstruction?
The decision to have breast reconstruction surgery is extremely personal. You’ll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable.
Your plastic surgeon and/or staff will explain in detail the relevant risks associated with your specific surgery. You may be asked to sign consent forms to ensure that you fully understand the procedures you will undergo and any risks or potential complications. The decision to pursue breast reconstruction does not change your risk of breast cancer recurrence.
The possible risks of breast reconstruction include, but are not limited to, bleeding, infection, poor healing of incisions and anesthesia risks. You should also know that:
Flap surgery includes the risk of partial or complete loss of the flap and a loss of sensation at both the donor and reconstruction site.
The use of implants carries the risk of breast firmness (capsular contracture) and implant rupture.
The development of a type of cancer of the immune system called breast implant- associated anaplastic large cell lymphoma (BIA-ALCL), primarily associated with textured implants.
Breast implants may be associated with systemic symptoms commonly referred to as breast implant illness (BII), which can include fatigue, “brain fog,” muscle or joint pain and rash.
Acellular dermal matrix products may have a higher chance for complications or problems.
You should feel free to ask any questions to help you understand the risks.
What results should I expect after breast reconstruction?
The final results of breast reconstruction following mastectomy can help lessen the physical and emotional impact of mastectomy.
Over time, some breast skin sensation may return, and 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.
Careful monitoring of breast health through self-exam and other diagnostic techniques is essential to your long-term health.
When you go home
If you experience shortness of breath, chest pains or unusual heartbeats, seek medical attention immediately. Should any of these complications occur, you may require hospitalization and additional treatment.
The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure, and additional procedures may be necessary.
Following your physician’s instructions is key to the success of your surgery. It is important that the surgical incisions are not subjected to excessive force, abrasion or motion during the time of healing. Your doctor will give you specific instructions on how to care for yourself.
What if my natural breast does not match my reconstructed breast?
The ultimate goal of reconstruction is to create a breast that is symmetrical with the remaining natural breast. Sometimes, getting the reconstructed and natural breasts to match is difficult unless surgery is performed on the natural breast, too. For some patients, this may involve placing an implant in the natural breast to make it larger (augmentation); making the natural breast smaller or less droopy by reducing the tissue (reduction), or lifting the breast skin (mastopexy). Your surgeon will discuss these options during your consultation. This “balancing procedure” is often done 3-6 months after your first surgery, to make sure the reconstructed breast has healed and is the desired size and shape.
What if I may need chemotherapy?
Breast reconstruction should not delay chemotherapy treatments. Usually your medical oncologist will wait until you have healed from your mastectomy and reconstruction before starting chemotherapy. If you have complications such as wound healing problems or infection, chemotherapy may be delayed.
If you are undergoing tissue expansion at the time of chemotherapy, the surgeon may need to take blood. This is to make sure that your body can fight bacteria that may be introduced from your skin during the expansion process. Once chemotherapy is complete, your surgeon will usually wait at least a month before considering further reconstructive surgery.
Does reconstruction change the risk of my cancer returning? Does it make cancer detection harder?
The risk of breast cancer recurrence depends on the stage of disease, biologic characteristics of the cancer and additional breast cancer treatments. Reconstructive surgery has not been shown to increase the risk of the cancer returning or make it harder to detect if cancer does return. The methods or tests used to screen for recurrence will be decided by your cancer care team.
How long does perforator flap surgery take tor perform?
Typically, reconstruction of one breast takes between four and five hours, while reconstruction of both breasts takes between six and a half and eight and a half hours to perform. Even tough this may seem like a long time to be in surgery, patients generally recover very quickly. Most patients are able to get out of bed after breakfast on the first morning after surgery.