What is Breast reconstruction?

Breast reconstruction is a type of surgery for women who have had all or part of a breast removed. The surgery rebuilds the breast mound to match the size and shape of the other breast. The nipple and the darker area around the nipple (areola) can also be added.

Most women who have had a breast removed (mastectomy) are able to have breast reconstruction. Women who have had only the part of the breast around the cancer removed (lumpectomy or breast-conserving surgery) might not need reconstruction, but sometimes they do. Breast reconstruction is done by a plastic surgeon.

For the women who have undergone surgical removal of breasts (mastectomy) because of breast cancer, the long-term prospects of living without breasts or part of the breast is different.

If you’ve had a mastectomy, you may choose to have reconstructive surgery, or you may even skip reconstructive plastic surgery. Having a breast reconstruction surgery is a personal decision, and it’s often not easy to make.

In the recent years, advances in plastic surgery have given superior results than seen previously. You have a choice either to use implants or your tissue for breast reconstruction. This surgery changes your appearance, which has psychological benefits. Outcomes of the surgery can add to a sense of wellness for you and your family.

The amount of breast to be reconstructed will depend on the extent of mastectomy performed, and it also depends on the width, size, and location of the removed tumor.

Breast reconstruction surgery can be performed simultaneously with mastectomy or after complete recovery from mastectomy or any other cancer treatments.

What are the Benefits of breast reconstruction?

Women choose breast reconstruction for many reasons:

• To make their chest look balanced when they are wearing a bra or swimsuit
• To permanently regain their breast shape
• So they don’t have to use a form that fits inside the bra (an external prosthesis)
• To be happier with their bodies and how they feel about themselves

Breast reconstruction often leaves scars that can be seen when you are naked, but they often fade over time. Newer techniques have also reduced the amount of scarring. When you are wearing a bra, the breasts should be alike enough in size and shape to let you feel comfortable about how you look in most types of clothes.

Breast reconstruction after a mastectomy can make you feel better about how you look and renew your self-confidence. But keep in mind that the reconstructed breast will not be a perfect match or substitute for your natural breast. If tissue from your tummy, shoulder, or buttocks will be used as part of the reconstruction, those areas will also look different after surgery

Immediate or delayed breast reconstruction

You may have a choice between having breast reconstruction at the same time as the surgery to treat the cancer (immediate reconstruction) or at a later time (delayed reconstruction).

Immediate breast reconstruction is done, or at least started, at the same time as the surgery to treat the cancer. The benefit of this is that breast skin is often preserved, which can produce better-looking results. Women also do not have to go without the shape of a breast.

While the first step in reconstruction is often the major one, many steps are often needed to get the final shape. If you’re planning to have immediate reconstruction, be sure to ask what will need to be done afterward and how long it will take.

Delayed breast reconstruction means that the rebuilding is started later. This may be a better choice for some women. You might choose to delay breast reconstruction if:

• You don’t want to think about reconstruction while coping with cancer. If this is the case, you might choose to wait until after your breast cancer surgery to decide about reconstruction.
• You have other health problems. Your surgeon may suggest you wait for one reason or another, especially if you smoke or have other health problems. It’s best to quit smoking at least 2 months before reconstructive surgery to allow for better healing.
• You need radiation therapy. Many doctors recommend that women not have immediate reconstruction if they will need radiation treatments after surgery. Radiation can cause problems after surgery such as delayed healing and scarring, and can lower the chances of success. Flap reconstruction surgeries (using other body tissues to create the new breast) are often delayed until after radiation.

Can breast reconstruction hide cancer or make it come back?

Studies show that reconstruction does not make breast cancer come back. If the cancer does come back, reconstructed breasts should not cause problems with chemotherapy or radiation treatment.

If you are thinking about breast reconstruction, either with an implant or flap, you need to know that reconstruction rarely, if ever, hides a return of breast cancer. You should not consider this a big risk when deciding to have breast reconstruction.

What if I choose not to have breast reconstruction?

Many women decide that breast reconstruction is not right for them. Or they might not be able to have more surgery. If you choose not to have breast reconstruction, you can use breast forms or prosthetics that simulate the look and feel of a natural breast. But you can also decide not to use a breast fom.

What are the types of the surgeries?

There are two different techniques by which the breast reconstruction surgery is carried out. After discussing with your surgeon, you can decide upon which type of surgery best suits your needs and expectations. The two types of surgeries include:

• Breast reconstruction using implants: This technique uses breast implants which are prosthetic devices which help to give your breast the perfect shape and size. Saline implants and silicone gel implants are the two types of implants used during breast reconstruction.
• Breast reconstruction using your own tissue: This technique uses your tissue for different sites of your body to replace the lost breast mound. This type of surgery is again sub-divided into two types based on the donor site that is the place from which the tissue is extracted. This includes: using tissue from the abdomen (TRAM transverse rectus abdominis muscle flaps and DIEP deep inferior epigastric perforator flaps) and using tissue from the upper back (Latissimus dorsi flaps)

Nipple and areola reconstruction

Nipple and areola reconstructions are usually the final phase of breast reconstruction. This is a separate surgery done to make the reconstructed breast look more like the original breast. It can be done as an outpatient procedure. It’s usually done after the new breast has had time to heal (about 3 to 4 months after surgery).

Ideally, nipple and areola reconstruction matches the position, size, shape, texture, color, and projection of the new nipple to the natural one (or to the other one, if both nipples are being reconstructed). Tissue used to rebuild the nipple and areola comes from the newly created breast or, less often, from another part of your body. In some cases, doctors build up the areola and nipple area with donor skin that’s had the cells removed. If a woman wants to match the color of the nipple and areola of the other breast, tattooing may be done a few months after the surgery.

Which individuals are suitable for the surgery?

You are suitable for breast reconstruction if you:

• are physically healthy and can cope well with your treatment
• do not have any comorbidities that may interfere with healing process
• have a positive outlook and realistic goals for your breast reconstruction surgery

How should I prepare for the surgery?

Discuss with your surgeon completely about the technique, the type of implant being used, and the risks associated with it before undergoing this procedure.

Your surgeon will give you instructions on consultation before the surgery. Following these instructions before surgery helps you to recover fast with minimum side effects.

• Avoid smoking and alcohol intake.
• Avoid certain vitamins, medicines, and supplements for a period before your surgery.
• Follow the guidelines mentioned on eating and drinking.
• Plan to have someone take you home after your surgery or your stay in the hospital.
• Set realistic expectations about the surgery.

What is the aftercare of the surgery?

Your surgeon will explain you about the aftercare instructions which help you to minimize the risks associated with the breast reconstruction surgery.

• You have to wear an elastic bandage or support bra to minimize the swelling and to provide support.
• Your surgeon may instruct you to use a pain pump to minimize the need for narcotics.
• You have to follow the given specific instructions about the caring the wound, taking medications, specific concerns to look for at the surgical site, and about the follow-up visits.

Possible risks during and after reconstruction surgery

There are certain risks from any type of surgery, and breast reconstruction may pose certain unique problems for some women. Even though many of these are not common, it’s important to have an idea of the possible risks and side effects.

Some of the risks during or soon after surgery include:

• Problems with the anesthesia
• Bleeding
• Blood clots
• Fluid build-up in the breast or the donor site, with swelling and pain
• Infection at the surgery site(s)
• Wound healing problems
• Extreme tiredness (fatigue)

Problems that can occur later on include:

• Tissue death (necrosis)of all or part of a tissue flap, skin, or fat
• Loss of or changes in nipple and breast sensation
• Problems at the donor site, such as loss of muscle strength
• The need for more surgery to fix problems that come up
• Changes in the arm on the same side as the reconstructed breast
• Problems with a breast implant, such as movement, leakage, rupture, or scar tissue formation (capsular contracture)
• Uneven breasts

Risks of infection

Infection can happen with any surgery, most often in the first 2 weeks after surgery. If an implant has been placed, it might have to be removed until the infection clears. A new implant can be put in later. If you have a tissue flap, surgery may be needed to clean the wound.

Risks of capsular contracture

The most common problem with breast implants is capsular contracture. A scar (or capsule) can form around the soft implant. As it tightens, it can start to squeeze the implant, making the breast feel very hard. Capsular contracture can be treated. Sometimes surgery can remove the scar tissue, or the implant can be removed or replaced.

Getting back to normal

You should be up and around in about 6 to 8 weeks. If implants are used without flaps, your recovery time may be shorter. Some things to keep in mind:

• Reconstruction does not restore normal feeling to your breast, but some feeling may return over a period of years.
• It may take up to about 8 weeks for bruising and swelling to go away. Try to be patient as you wait to see the final result.
• It may take as long as 1 to 2 years for tissues to heal and scars to fade, but the scars never go away completely.
• Ask when you can go back to wearing regular bras. Talk with your surgeon about the type of bra to wear – sometimes it will depend on the type of surgery you had. After you heal, underwires and lace might feel uncomfortable if they press on scars or rub your skin.
• Follow your surgeon’s advice on when to begin stretching exercises and normal activities, because it’s different with different types of reconstruction. As a basic rule, you’ll want to avoid overhead lifting, strenuous sports, and some sexual activities for 4 to 6 weeks after reconstruction. Check with your surgeon for specific guidance.
• Women who have reconstruction months or years after a mastectomy may go through a period of emotional adjustment once they’ve had their breast reconstructed. Just as it takes time to get used to the loss of a breast, it takes time to start thinking of the reconstructed breast as your own. Talking with other women who have had breast reconstruction might be helpful. Talking with a mental health professional might also help you sort out anxiety and other distressing feelings.