Many women seek breast reconstruction after undergoing a mastectomy or surgery to remove a breast lump. A misconception of this procedure is that it will make your breast(s) look normal while nude. In some instances, this is possible if your reconstruction is completed at the same time as your mastectomy. In most circumstances this procedure will make your breast(s) look normal while wearing a bra. No matter which type of reconstruction you choose, your affected breast(s) will differ from your unaffected breast(s).
Two options commonly used for breast reconstruction are: breast implants and muscle flap reconstruction- which sometimes performed in combination with implants.
Saline Breast Implants
This option is usually completed in two phases. The first surgery may last up to an hour and consists of placing a tissue expander in the breast area underneath the skin and chest muscle. Your surgeon will fill the tissue expander (similar to a balloon) with salt-water solution approximately once a week. Once your skin has stretched (usually three to four months), the next surgery will be replace the tissue expander with a permanent saline implant. If you do not need the tissue expander, your surgery consist of inserting the saline implant. About half of saline patients need replacement or modifications of their implants after five to ten years.
Muscle Flap Reconstruction
This procedure involves the use of your tissue to rebuild the breast. Various tissues may be used such as tissue from the back, stomach, or buttock area. Scarring occurs where the tissue was taken as well as the reconstructed breast.
Two additional muscle flap methods include Tansverse Rectus Abdominis Muscle (TRAM) flap and the Latissimus Dorsi flap.
In the Tansverse Rectus Abdominis Muscle procdure, the surgeon uses skin, fat, and small amount of muscle from your abdominal area to contour the reconstructed breast. If you do not have enough tissue to be used in reconstructing a breast, a small saline implant may be inserted.
In a Latissimus Dorsi flap procedure, the surgeon uses muscle and skin from your back and transfers it to the breast area. This helps create a “pocket” so an implant may be inserted and placed. The Muscle flap procedures may take several hours as well as a hospital stay of up to four days. Recovery is a slower process than the breast implant method; however the breast usually looks and feels more natural. Smokers and diabetic patients may not be able to undergo this type of breast reconstruction.
Expander/implant reconstruction usually requires an overnight stay in the hospital after the expander is placed, but the removal of the expander and the insertion of the permanent implant is an outpatient procedure. Generally, several weeks are required for recovery prior to returning to all normal activities. Recovery is quickest with the expander/implants and longest with the TRAM procedure. Nipple recreation can take place two to six months after your initial breast reconstruction surgery. A new nipple is created by using skin from the reconstructed breast, while color is provided by medical tattooing.
Your initial consultation is extremely important. This procedure differs from other breast cosmetic surgeries due to the fact that your surgeon and oncologist may be present at the time of surgery. During your primary consultation, your surgeon may discuss with you implant options, procedure options, as well as whether or not the surgery will be done at the time of your mastectomy (if applicable).
Work: The amount of time it will take for you to return to work may differ if you are having breast reconstruction done right after mastectomy or in the weeks following, but expect to be out of work for approximately four to eight weeks.
Swelling and Bruising: Swelling can range from moderate to significant in the first four weeks following surgery but will become mild soon after. Scars fade between six to twenty-four months and bruising may last up to four weeks.
Showering: Your doctor will discuss what time is best for you to begin showering after your procedure.
Discomfort: Pain after surgery will be controlled with appropriate medications. During the first 48 to 96 hours, your pain medication will be needed regularly. After this time, the medication is needed less frequently. Although pain cannot be fully avoided, it can be minimized by the medication prescribed by your surgeon, however, if you begin to have severe pain, contact your surgeon immediately.
Recovery: You may be released from the hospital in as soon as two days and as long as six days. A surgical drain may be used to remove excess fluids from the surgical sites following the procedure. These may be removed after the first week or two following surgery. The removal of your stitches will follow in approximately ten days. Strenuous as well as sexual activity must not be engaged in until six weeks have passed. It may take up to six weeks to recover from combined surgery. If implants were used without flaps and if surgeries were done separately, your recovery time can be less.
Results: Each patient heals and scars differently. It is vital to keep in mind that the results of this procedure vary from patient to patient. However most patients will enjoy their final result within six to twelve months.