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. Occasionally, an implant may also be placed in the breast without cancer to improve symmetry with the reconstructed breast.
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 above or beneath the chest muscles after the mastectomy is completed. The purpose of this tissue expander is to stretch the skin and maintain a breast pocket in order to be able to later place an implant. The tissue expander is filled with saline injections typically performed every two to three weeks 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 implant is placed. The current implants used are round and smooth walled. 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.
Abdominal flaps are the most common breast reconstruction performed with the patient's own tissue (autologous reconstruction). This procedure is commonly performed at the time of the mastectomy but can also be performed at the time of tissue expander exchange. Tissue from the abdomen, including skin and fatty tissue only (DIEP flaps), and sometimes with muscle as well (TRAM flaps), are 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 if performed at the time of mastectomy the breast can be immediately reconstructed. If tissue from your abdomen is not available for use, tissue from your back (latissimus flap), thigh (PAP, DUG) or buttocks (SGAP) may also be used to reconstruct the breast.
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 abdominal flaps or the latissimus flap. Your plastic surgeon can discuss these various options with you.
Autologous Fat Grafting and Skin Revision
Sometimes secondary procedures such as fat grafting to augment volume in different regions of the breast is used to finalize your breast reconstruction. The breast skin envelope or abdominal donor site after flap reconstruction can also be revised at a later date.
Reconstruction of the breast mound is performed under general anesthesia.
Nipple and areola reconstruction are usually performed under local anesthesia.
- Avoid taking herbal supplements, aspirin, Advil, Motrin, or other aspirin-containing, ibuprofen, or NSAID products for two weeks.
- If you are a smoker, stop smoking at least 6-8 weeks before surgery 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 the same day or the day after tissue expander surgery. You will have 1 or 2 drains placed in the area of the mastectomy. The drains are usually removed 1-2 weeks after surgery. After a recovery period following tissue expander placement, you will return to the office every one to three weeks for inflation of the expander. You can go home the same day of surgery when the tissue expanders are subsequently replaced with implants.
Discuss return to work and activity limitations with your surgeon.
Autogenous reconstruction: You will probably go home 3-5 days after surgery. You will have drains in the area of the mastectomy and the donor site (abdomen, back, thigh or buttock). These drains are usually removed in 1-2 weeks.
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 or above the chest muscles after the mastectomy is completed. After a series of inflations of the expander, the skin will be adequately stretched to accommodate the future implant.
- Stage 2: After a period of at least 3 months, a second surgery is performed, where the tissue expander is removed and your own tissue or an implant is placed.
If you are in need of a reconstructive procedure, our team is here to help. Call us at (212) 305-3103 or request an appointment online.