Breast reconstruction restores a natural, symmetrical appearance to the bosom, maintains body proportion, allows clothes to fit better, and most important of all, boosts self-confidence for women who have lost one or both breasts to mastectomy or who lack breasts due to a congenital or developmental abnormality. Reconstructive surgeons strive to create a new breast and nipple that resemble the woman’s natural breast as closely as possible in shape, size and position.
Women whose cancer seems to have been eradicated with mastectomy are the best candidates for breast reconstruction. Those with health problems such as obesity and high blood pressure and those who smoke are advised to wait. Others prefer to postpone surgery as they come to terms with having cancer, consider the extent of the procedure, or explore alternatives.
The reconstruction itself consists of multiple operations, the first of which involves creation of the breast mound and is performed during or after mastectomy in a hospital under general anesthesia. Later surgeries, if necessary, may be done in the hospital or an outpatient facility, with either general or local anesthesia.
There are several ways to reconstruct the breast, both with and without implants; your breast surgeon and plastic surgeon should work together with you in deciding which is best for you.
What Are the Different Types of Breast Reconstruction Procedures?
The most common technique combines skin expansion with implant insertion. First, the surgeon inserts a balloon expander beneath the skin and chest muscle where the reconstructed breast will be located. A saline (salt water) solution is then injected into the expander through a tiny valve beneath the skin over a few weeks or months, eventually filling it and stretching the skin. The expander may then be left in place or replaced with a permanent implant. A final procedure reconstructs the nipple and areola (dark area of skin around the nipple). Some patients do not require tissue expansion and begin with the implant.
Another, more complicated type of implant reconstruction involves the creation of a skin flap using tissue from other parts of the body. If the flap is not large enough to serve as the new breast by itself, an implant is then inserted beneath it. Tissue for the flap consists of skin, fat and muscle from the back, abdomen or buttocks and may either be surgically removed and reattached (free flap, requiring a microvascular surgeon) or remain connected to its original blood supply and “tunneled” through the body to the chest (pedicled flap). Advantages over implant insertion are a more natural look and feel for the breast and abdomen, and elimination of any risks associated with silicone implants; disadvantages are scars at the breast and donor-tissue site, and longer recovery.
Both implant insertion and tissue flap surgery are followed by nipple and areola reconstruction. The reconstructed breast will probably look and feel different from the natural breast. Further surgery may be desired to adjust the natural breast to better match the reconstructed one, although a perfect correspondence in size, shape and height is unlikely.
Who is a Candidate for Breast Reconstruction?
Generally, most women who are interested in restoring natural-looking breast shape after breast cancer treatment are great candidates for a reconstructive procedure. Patients must be in good health, with no conditions that could interfere with healing. The goal of breast reconstruction is to help patients feel most like themselves again after mastectomy or other breast cancer treatment. Treatment techniques are recommended after a thorough consultation in which the doctor understands the patient's goals. Additional factors that influence treatment options include the patient's age, profession, lifestyle, and weight. Candidacy for breast reconstruction may vary slightly depending on the method being considered. Beyond being in good overall health, patients should not smoke and should have realistic expectations about the potential outcome of their procedure based on their discussion with the doctor.
Is Breast Reconstruction Painful?
Breast reconstruction recovery can include some discomfort. Patients should take the pain medication as prescribed. We strongly advise against "toughing it out" to see how long pain medication can be postponed. Post-operative pain can create unnecessary stress that may slow down the healing process. When medication is taken as directed, patients may feel mild to moderate soreness, tenderness, or tightness in the breasts as well as the donor site, if a tissue flap is made. Compression garments may help somewhat with post-surgical discomfort. The compression works to minimize swelling and to support the incisions and breast mound by protecting the area from accidental bumps or friction.
According to studies, women who experience pain after reconstruction are hesitant to speak to their doctors. If you experience more discomfort than you anticipate during your breast reconstruction recovery, contact the office. We can talk with you about your sensations and other symptoms and provide clarification or schedule an appointment to ensure that your surgical site is healing well.
Recovery from breast reconstruction is so nuanced and unique for each patient that it is nearly impossible to outline exactly what to expect in every situation. We work closely with our patients to answer questions if they arise, such as what sensations might occur when, and we hope to provide some degree of confidence through general recovery guidelines as a baseline. If you have questions, please do not hesitate to contact us.
How Can I Maintain My Results?
Studies show that women who complete their breast cancer treatment with reconstruction report greater psychological well-being as a result of their restored appearance. Regardless of the reconstructive method, there is little to do to maintain breast shape. Over time, the effects of aging may cause some deflation or sagging. The speed at which this happens may be mitigated by maintaining a healthy, active lifestyle that involves some upper-body strength training, weight management, and good care of the skin on the chest.
Are There Any Risks to Breast Reconstruction?
Surgical procedures carry inherent risks associated with anesthesia and healing. Because incisions are made, there are risks of infection and poor tissue healing. The level of expertise held by the surgeon, as well as strong adherence to post-operative care instructions, can significantly reduce these risks. While the chances of complications are relatively low for breast reconstruction patients, they may occur during, soon after, or some time after surgery. During your consultation with your breast reconstruction surgeon, discuss the risks that may be relevant to your case, such as:
- Fluid build-up around breast implants or at the donor site for tissue flap surgery
- Pain and infection at surgical sites
- Necrosis of part or all of a tissue flap
- Changes in or loss of breast or nipple sensation
- Skin dimpling
- Irregular contouring at the donor site
Patients whose reconstruction includes the use of breast implants will discuss the risk of capsular contracture. This condition can occur when scar tissue that forms around the implant becomes tight and inflexible. The rigid scar tissue can compress the implant and distort the appearance of the breast. Revision surgery can be performed to remove the scar tissue and either remove or replace the implant.
What is Recovery Like From Breast Reconstruction?
Most patients are tired and sore for a week or two, and recovery can take up to six weeks, but you will be released from the hospital in two to five days. Stitches are taken out in a week to ten days. A surgical drain may be left in place to prevent a build-up of fluid in the reconstructed breast; this will be removed after a week or two.
The reconstructed breast will be numb following surgery, but it is possible that some sensation will return as time passes. Scars will fade, but not disappear. Periodic mammograms with a radiologist trained to examine breasts with implants are recommended.
Regardless of the reconstructive technique used to reconstruct the breasts, patients can expect one to two weeks of active recovery. This means that much of the day will be spent resting and sleeping. Surgical recovery after breast reconstruction takes a lot of physical energy. The pain medication that is taken during this time also contributes to fatigue that is more pronounced than normal. Patients can refer to their post-operative instructions for guidelines regarding bathing, wound care, and physical activity. If drains are placed during surgery, a member of the surgical team will demonstrate for the patient and their home care provider how to empty the small ball that holds the fluid that has drained from the surgical site.
As soon as possible after surgery, patients should start walking. This is necessary to inhibit blood clot formation due to inactivity. Other than walking, physical activity should be kept to a minimum. Patients are advised to avoid strenuous activity, moderate lifting, and overhead arm movements for 4 to 6 weeks after surgery. The surgeon may list specific activities in their post-op instructions, so patients should carefully read through the documents given to them. Following instructions carefully, patients can expect to begin getting back to their normal activities within 6 to 8 weeks.
What Are the Risks Associated With Breast Reconstruction?
Breast reconstruction has not been proven to affect the recurrence of cancer or other diseases, chemotherapy or radiation treatment.
Nevertheless, in addition to the complications possible from any surgical procedure (bleeding, fluid collection, excessive scar tissue, or difficulties with anesthesia), there are some risks inherent in breast reconstruction, including infection around the implant, if an implant is used, and capsular contracture, when the scar (capsule) around the implant tightens, causing the breast to feel hard. Treatment for capsular contracture varies from “scoring” the scar tissue to removing or replacing the implant. Some patients may need time to come to terms emotionally with their new breasts.
Schedule a Consultation With Dr. Smith!
Have you been considering breast reconstruction surgery in Okatie, Hilton Head Island, and Beaufort, SC? Call our office at (843) 705-8940 to schedule a consultation with Dr. Smith today! You can also fill out and submit the Appointment Request Form below, and our staff will help you arrange your consultation. Our practice is located in Okatie, South Carolina, and we look forward to serving you!