Breast reconstruction is designed to restore the natural shape and volume of breasts following a mastectomy. The procedure is meant to rebuild and restore your breasts to what they once were. Results vary greatly, which is why it’s essential that you know all of the information before proceeding with reconstruction. Talking with us in a personal consultation will assist with this.
It’s important to note that the reconstructed breast will have decreased feeling or sensation compared to the normal, unaffected breast. While breast reconstruction typically is performed to restore one breast, it can also be performed to restore both breasts. This scenario is frequently encountered in the treatment of patients who have a proven genetic predisposition to the development of breast cancer. In single breast surgery, breast reconstruction will attempt to restore the affected breast to the exact shape and appearance of the opposite breast. The opposite breast may require a lift or reduction procedure to improve the symmetry with the reconstructed breast.
Why Have A Breast Reconstruction Procedure?
Breast reconstruction is specifically designed to assist those that have undergone a mastectomy. In some cases, it’s also possible for patients that have undergone a lumpectomy to have the resulting breast defect reconstructed. Breast reconstruction is oftentimes administered in the same setting as the mastectomy or soon thereafter. However, it can still be performed even years after a mastectomy or lumpectomy.
If you have had a mastectomy for the treatment of breast cancer or because you have a high risk for developing the disease at some point in the future, breast reconstruction may be a reasonable option for you. Before proceeding with breast reconstruction, remember that the reconstructed breast will not have normal sensation, and its shape and feel will not be the same as your normal breast. For these reasons, it is important that you weigh the positives and the negatives of breast reconstruction and how the procedure might impact your sense of self and well-being.
Breast Reconstruction Procedure
There are multiple types of breast reconstruction procedures that you can choose from, each of which has its own distinct benefits and risks. The two primary reconstruction methods include tissue-based reconstructions and implant-based reconstructions.
Tissue-based reconstructions involve the transfer of skin, fat, and muscle tissue from various areas of the body, including the thighs, tummy, buttocks, and back. The TRAM, DIEP, and SIEA procedures take tissue from the lower abdomen and are the most commonly used flaps in breast reconstruction. The scars resulting from these abdominal flaps are similar to those following cosmetic “tummy-tuck” procedures and are acceptable to most women. The scars are located in the lower abdomen and, while they fade over time, they don’t disappear completely.
It’s important to remember that healthy blood vessels are essential for the success of the tissue-based breast reconstructions. Conditions (such as smoking) that might affect the health of blood vessels could adversely affect the outcome of tissue-based breast reconstruction. For this reason, it is important to share the details of your past medical and social history with Dr. Walton to optimize your chances for a favorable outcome. The benefits of tissue flaps for breast reconstruction are significant. Tissue-based reconstructions result in soft, warm breasts that have a similar look and feel to normal breasts. As with normal breasts, breasts reconstructed with your own tissues may gain or shrink in size depending on fluctuations in weight. However, the tissue flap procedure is lengthier and the recovery is longer compared to implant-based reconstructions.
For more details on the different Tissue-Based Reconstruction procedures, go to this page.
Implant-based reconstructions involve placing a tissue expander beneath the pectoral muscle at the time of the initial mastectomy and slowly expanding this with salt water injections performed in the office over several weeks until the desired volume is reached. The expander is kept in place for about three months to allow the tissues to stabilize and then it is exchanged for a permanent implant in an outpatient procedure. Two types of implants can be used, saline (salt-water) filled implant with a silicone rubber shell or a silicone gel implant which also has a silicone rubber shell. The saline fill implants may deflate following leakage of the saltwater and require replacement. Saline fill implants also have a tendency to cause rippling in the overlying skin and do not have a soft consistency. (imagine a water-filled balloon under the skin) Silicone gel implants do not deflate, have less rippling effect, and are thought to have a more natural feel compared to saline-filled implants. Saline fill implants demonstrate a decreased incidence of capsular contracture compared to silicone gel implants. And saline-filled implants do not carry a risk for seepage of silicone gel – an issue which was once thought to be a major health concern with silicone gel implants but this has not been substantiated after extensive study. The choice of which implant type to use is generally personal preference. A recent gel-type implant that has been used in breast reconstruction is the cohesive gel, or “gummy bear” implant. These implants have a preformed, teardrop shape that provides for improved contour in the breast reconstruction but they are somewhat firm to the touch.
Nipple/ Areola Reconstruction
After the breast mound has been reconstructed by either of the above techniques, the nipple and areola are reconstructed using a combination of local tissue flaps and tattooing of the involved skin. Dr. Walton utilizes a technique of “pre-tattooing” of the breast site followed by formal nipple/ areola reconstruction. This approach optimizes the retention of nipple shape and projection.
In selected cases, the nipple and areola complex may be spared at the time of the mastectomy – “nipple/areola sparing mastectomy”. In these cases, there is no need to perform nipple/ areola reconstruction after restoring the breast mound.
Are You A Candidate?
There are a variety of factors that determine whether or not you are a candidate for the breast reconstruction procedure. First and foremost to consider is how safe is a particular procedure for you given your particular health status. Procedures that use your own tissues (TRAM, DIEP flaps) may take hours to complete and require extended periods of post-operative recovery. For some patients having certain health problems such as heart, lung, or kidney disease, the risks of doing these extended procedures may be high, favoring a less invasive procedure that may be more conducive to a safe outcome.
There is an emotional component associated with the loss of a breast due to cancer, as it changes body image, and specifically, the way your breasts look and feel. Before proceeding with breast reconstruction, it is important that you have a clear understanding of the expectations for outcome and the risks, so that you may proceed with confidence. A major benefit of breast reconstruction is that it can improve your self-confidence and how you feel about yourself and the way you look.
Breast Reconstruction FAQs
How long will the procedure last?
The length of the procedure depends on the type of reconstruction performed. Breast reconstruction can be performed immediately following the mastectomy, or months or years after the mastectomy. If you elect to have your breast reconstructed immediately following your mastectomy, the entire surgery could take up to seven hours. By itself, the reconstructive procedure can take anywhere from two to five hours depending on the type of reconstruction performed.
What can I expect after the procedure?
Following the procedure, standard bandages or gauze will be applied to the incisions. An elastic bandage or support bra will be placed over the breasts. You will then be provided with information on how to care for your breasts during the recovery process and what to do if you notice any issues. The swelling will decrease and the healing will progress over several weeks following the procedure. Follow up visits with Dr. Walton will be scheduled to assess your progress.
Are there risks?
There are risks inherent to all surgical procedures. The risks for implant-based reconstruction are different from autologous tissue reconstruction. Common risks include bleeding, delayed healing, and infection. With flap surgery, it is possible that a loss of sensation, bulging, or hernia may occur at the abdominal donor site. Breast firmness may also occur with implants.
How soon can I return to work?
For implant surgery, you can return to work after one month, though you may need to take an additional week of work off at the time of the second stage of a two-stage procedure. For flap procedures, you can return to work after six to eight weeks.
For an appointment, please call Chicago Plastic Surgery, LLC office at 312-337-7795, or contact Dr. Walton by filling out our online form. We look forward to meeting you and helping you achieve your breast reconstruction here in Chicago.