Breast Reconstruction After Mastectomy or Lumpectomy

The removal of a breast, usually for treatment of breast cancer, presents both physical and emotional difficulties for women. Plastic surgical procedures are available which can reconstruct the breast following mastectomy or lumpectomy for breast cancer. Reconstruction can be unilateral, in the case of unilateral mastectomy, or bilateral, in the case of bilateral mastectomies. Breast reconstruction is usually performed at the time of the mastectomy or lumpectomy, but may also be performed afterwards.  Breast reconstruction can be performed with implants or with your own tissue. Your surgeon will discuss which option is best suited for you during the consultation stage.

The breast without cancer may need to be lifted or reduced to match the reconstructed breast.

Breast Implants

Implant reconstruction is typically performed as a staged procedure. The first stage is performed at the time of the mastectomy, where a temporary inflatable implant (tissue expander) is placed beneath the chest muscles after the mastectomy is completed. The purpose of this tissue expander is to stretch the skin in order to be able to later place an implant. The tissue expander is filled with saline injections typically performed weekly in the office following the mastectomy. After a period of at least 3 months, a second surgery is performed, where the tissue expander is removed and the permanent implant is placed. The current implants used are designed to be shaped like a natural breast. Both saline and silicone gel implants are available for reconstruction. Your plastic surgeon can discuss with you the various options for implant type, shape, and size.

A novel system of post-mastectomy tissue expansion is also available to patients at NewYork-Presbyterian/Columbia. This method uses an implantable expansion device that can be expanded by the patient at home, eliminating the need for multiple office visits and saline injections.

Read about the Needle-Free Tissue Expansion method.

TRAM Flap

The TRAM flap is the most common breast reconstruction performed with the patient's own tissue (autogenous reconstruction). This procedure is commonly performed at the time of the mastectomy. Tissue from the abdomen, including skin and fatty tissue, is used in the reconstruction of the new breast. The advantage of this procedure is that the breast can be reconstructed to appear and feel quite natural, and that the breast can be immediately reconstructed at the time of the mastectomy. There are different variations to the TRAM flap, including the muscle-sparing free TRAM, and DIEP (deep inferior epigastric perforator flap) which can be discussed with your plastic surgeon. Tissue from your back (latissimus flap) or buttocks (SGAP) may also be used to reconstruct the breast.

Nipple Reconstruction

Nipple reconstruction is performed following completion of the breast reconstruction. It is usually an office procedure and can involve a combination of skin procedures, tattooing, or skin grafts.

Breast reconstruction can also be indicated in cases of lumpectomy, where the shape of the breast is significantly distorted. Options for post-lumpectomy reconstruction can include implant or autogenous reconstruction, such as the TRAM flap or latissimus flap. Your plastic surgeon can discuss these various options with you.

Anesthesia

Reconstruction of the breast mound is performed under general anesthesia.

Nipple and areola reconstruction are usually performed under local anesthesia.

Before surgery

  • Avoid taking aspirin, Advil, Motrin, or other aspirin-containing products for two weeks.
  • If you are a smoker, stop smoking to aid in healing.
  • Medical clearance from your medical doctor may be required.

Recovery After Breast Reconstruction Surgery

Tissue expander/implant reconstruction: You will probably go home 1-2 days after tissue expander surgery. You will have a drain placed in the area of the mastectomy, and another drain in the area of the axillary lymph node dissection, if one was performed. The drains are usually removed 1-2 weeks after surgery. Aftera recovery period following tissue expander placement, you will return to the office every week or every two weeks for inflation of the implant. You can go home the same day after the tissue expanders are replaced with implants.

Discuss return to work and activity limitations with your surgeon.

Autogenous reconstruction: You will probably go home 4-6 days after surgery. You will have drains in the area of the mastectomy and the donor site (abdomen, back, or buttock). These drains are usually removed in 1-2 weeks.

Implant reconstruction is typically performed as a staged procedure.

  • Stage 1: Performed at the time of the mastectomy, a temporary inflatable implant (tissue expander) is placed beneath the chest muscles after the mastectomy is completed. After a series of inflations, with expander will allow the skin to stretch to accommodate the future, permanent implant.
  • Stage 2: After a period of at least 3 months, a second surgery is performed, where the tissue expander is removed and the permanent implant is placed.