What is breast reconstruction?
Breast reconstruction is surgery to rebuild the breast after surgery to treat breast cancer. The goal of breast cancer reconstruction is to restore the size, shape and feel of the breast. Breast reconstruction after mastectomy may also involve recreating a nipple and areola. Many women are able to have breast reconstruction surgery at the same time as breast cancer surgery. This is immediate mastectomy reconstruction. However, it may be necessary to delay breast reconstruction depending on surgical risk factors and other post-surgical cancer treatments. Delayed breast reconstruction involves a second surgery.
Breast reconstruction is major surgery. You may have other treatment options following breast cancer surgery. This includes using prostheses and even going flat, or breast-free. Consider getting a second opinion about all of your treatment choices before having breast reconstruction.
Types of breast reconstruction
The types of breast reconstruction after mastectomy include:
Flap reconstruction uses tissue from other parts of the body to rebuild the breast. Common areas include the belly, back, thighs and buttocks. This is also called autologous reconstruction.
Implant reconstruction uses either saline or silicone breast implants.
In some cases, doctors combine implant and flap reconstruction for the best result.
Why is breast reconstruction after mastectomy performed?
Your doctor may recommend breast reconstruction after mastectomy or lumpectomy, including prophylactic mastectomy to reduce a woman’s chances of developing breast cancer. Reconstructive breast surgery may be right for you if you feel it is important to have the appearance of normal breasts.
Who performs breast reconstruction?
A plastic surgeon will perform your breast reconstruction. A plastic surgeon uses reconstructive and cosmetic procedures to repair physical defects that affect a person's appearance and ability to function. If you have breast reconstruction surgery at the same time as your lumpectomy or mastectomy, your plastic surgeon may be working closely with your breast cancer surgeon or surgical oncologist.
How is breast reconstruction performed?
Breast reconstruction is performed in a hospital or surgery center.
Flap reconstruction involves removing a flap of tissue from another body site. The flap contains skin, fat, blood vessels, and sometimes muscle. This will leave two surgical scars—one at the flap site and one at the breast reconstruction site. The surgeon attaches the flap to the breast area to rebuild the breast mound. The flap can also provide enough tissue to cover and support a breast implant. The surgeon will re-establish blood supply using microsurgery if necessary.
Implant reconstruction can sometimes take place at the same time as cancer surgery if enough tissue remains to support the implant. However, it usually requires two surgeries. The first one places an expander to stretch the tissue enough to accommodate the implant. This step can take place at the same time as the mastectomy or lumpectomy. The process of filling the balloon-like device takes place gradually over several weeks or months, depending on the type of expander and healing time. The second step takes place once the tissue has expanded. It involves removing the expander and replacing it with a permanent implant. This step of implant reconstruction is analogous to breast augmentation with saline or silicone implants.
Nipple and areola reconstruction may be an option for women who have not had nipple-sparing mastectomy. It usually takes place after breast reconstruction once the breast mound has stabilized. The surgeon will recreate the nipple using a tissue graft and the areola using tattoo ink. An alternative is to tattoo the entire nipple-areola complex onto the breast mound. This will lack the texture of a reconstructed nipple.
Your doctor will advise you on which procedure is best for you and how long you need to stay in the hospital based on your age, medical history, general health, and possibly your personal preference. Learn about the different types of breast reconstruction surgery and ask why your doctor recommends a particular type for you.
Types of anesthesia that may be used
Your doctor will likely perform breast reconstruction using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep.
You may also have a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of a liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery. It helps reduce the need for narcotic pain relievers.
What to expect the day of your breast reconstruction
The day of your surgery, you can expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. The surgical team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube may be placed in your windpipe to protect and control your breathing during general anesthesia. You will not feel or remember this or the surgical procedure.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of breast reconstruction?
As with all surgeries, there is a risk of complications with breast reconstruction surgery. Complications may become serious and life threatening in some cases, and they can develop during the surgery or your recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Potential complications of breast reconstruction
Complications of breast reconstruction can be serious and include:
Capsule contracture or thickening. Your body normally forms a capsule of scar tissue around the implant. This capsule may become abnormally tight, thick or large causing shape changes, hardening or pain.
Changes in sensation at the reconstruction site
Implant replacement surgery because the implant(s) may not last your entire lifetime
Loss of muscle strength at the flap donor site
Partial or complete loss of sensation at the flap donor site
Rippling of the implant that may be visible
Rupture and leakage of the implant
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery
Informing your surgeon if there is any possibility of pregnancy
Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain
Taking your medications exactly as directed
Telling all members of your care team if you have allergies
Wearing a post-surgical support bra as directed by your healthcare provider
How do I prepare for my breast reconstruction?
The steps you take before surgery can improve your comfort and outcome. You can prepare for breast reconstruction by:
Answering all questions about your medical history, allergies, and medications you take. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before surgery through a healthy diet and exercise plan.
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your specific medications and supplements.
Questions to ask your doctor
The best way to learn about the procedure, your recovery, and expected cosmetic results is to ask your surgeon questions. Facing surgery can be stressful and it’s common for people to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Don’t hesitate to contact your surgeon with concerns and questions before surgery and between appointments. Your plastic surgeon wants you to be completely satisfied with the results.
It is also a good idea to bring a list of questions to your preoperative appointments. Questions can include:
Are there any other options for maintaining the appearance of natural breasts?
What type of breast reconstruction procedure is best for me?
What results can I expect?
What options do I have if I am not satisfied with the results?
How long will the surgery take? When can I go home?
What kind of restrictions will I have after the procedure? When can I return to work and other activities?
What kind of assistance will I need at home?
What medications will I need before and after the surgery? How should I take my medications?
How will you treat my pain?
When should I follow-up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after breast reconstruction?
Knowing what to expect can help make your road to recovery after breast reconstruction as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until your vital signs are stable. You may be able to go home on the same day depending on the specific procedure and how you are recovering. However, a short hospital stay is typical. You may have tubes attached to your breasts to drain fluids. Your doctor will usually remove them within a few days.
Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. You may need to wear a surgical support bra for several weeks after your surgery. Breast reconstruction recovery times range from a couple of weeks to two months. Physical therapy will help you recover. It may take a couple of years for full tissue healing.
Will I feel pain?
Pain control is important for healing and a smooth recovery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Always call your doctor if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after reconstructive breast surgery. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Change in alertness, such as passing out, unresponsiveness, or confusion
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery. It is not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Pain that is not controlled by your pain medication
Unexpected drainage, pus, redness or swelling of your incision
How might breast reconstruction affect my everyday life?
Breast reconstruction surgery can help you feel more comfortable and confident about your body after cancer surgery. However, you may go through a period of adjustment and find it difficult to accept your reconstructed breasts. Many women find comfort in talking to others who have gone through breast reconstruction already.
Keep in mind breast reconstruction surgery will not restore normal sensation to your breasts. You may regain some feeling with time, but it will not be the same as before cancer surgery.
Talk with your doctor about the need for routine mammogram screenings. In general, women who have had skin-sparing or nipple-sparing cancer surgery and reconstruction still need to get mammograms.