Breast Reconstruction Surgery

Medically Reviewed by Dr. K on 30 March 2021

Breast Reconstruction Surgery

If you’ve undergone a mastectomy due to breast cancer, reconstructive plastic surgery might be an option for you. By replacing skin, breast tissue, and the removed nipple, will restore the balance between the two breasts.

The amount of reconstruction required would be determined by the extent of the mastectomy as well as the depth, height, and position of the tumour removed.

 

Is Breast Reconstruction Right for Me?

Each woman is affected differently by the concept of living without a breast or part of one breast. It’s a personal choice that’s not always easy to make.

You are not required to undergo reconstruction. Wearing external breast structures or pads is an alternative, or even do nothing at all.

Plastic surgery now produces better outcomes than it has in the past. Breast reconstruction may be done with breast implants or your own tissue.

The procedure alters your breast’s appearance, but it can also have psychological benefits. It can improve your and your family’s sense of well-being.

 

Is It Cosmetic Surgery?

Breast reconstruction isn’t regarded as a cosmetic procedure. It’s a reconstructive procedure. Since it is deemed part of the treatment of an illness, the law requires insurance companies to cover it.

When’s the Best Time to Have Breast Reconstruction?

The timing is determined by your expectations, personal needs, and cancer treatment plan. It may be done during the surgery to remove the breast or months or years after a mastectomy.

Reconstruction is normally delayed until after chemotherapy or radiation therapies have completed. Your doctor will assist you in determining the right time for you.

 

What Are the Different Reconstruction Options?

You and your doctor may need to discuss your wants and needs, as well as your medical condition and any previous surgeries, before making a decision.

Implants: The skin is stretched using a tissue expander that goes inside the body, and a silicone gel or saline (saltwater) implant is implanted weeks later. The tissue expander is refilled with saline to a certain volume once a week for a few sessions. Although you may experience some discomfort, most women are delighted with the end result.

Implants have the potential to burst, resulting in pain and infection. It’s likely that you’ll require surgery to remove or replace them.

Tissue flap procedures: Tissue flap procedures create a mound to reconstruct the breast using tissue from a woman’s abdomen or back (or even the thighs and bottom). A TRAM flap is a procedure that involves removing abdominal tissue. A latissimus dorsi flap is a technique for removing tissue from the shoulder.

The tissue that is being transferred is often kept attached to its blood supply. A pedicle or tunneling technique is what this is called. Since the blood flow is intact, the flap has a greater chance of survival, but the breast may not look exactly how you expect it to.

The tissue is disconnected and then attached to a blood source near the new position in a free-flap operation. This is a more difficult operation. The most serious risk is that the blood vessels will become clogged, causing the flap to die. The advantage is that the reconstruction appears more natural.

A breast created from a woman’s own tissue has a similar appearance, texture, and contour to a real breast. Flap surgery, on the other hand, is more involved than implant surgery. You may also experience complications, such as swelling, infection, or slow recovery, as in any major surgery.

Nipple reconstruction: You should also consider nipple reconstruction. During a mastectomy, the nipple and areola (the dark region surrounding the nipple) are usually removed to reduce the risk of cancer returning.

In most instances, nipple reconstruction is performed as an outpatient operation under local anaesthesia. It’s likely that you’ll have it after breast reconstruction. This provides the new tissue opportunity to regenerate and settle in. When the nipple and areola are rebuilt, the doctor will make minor adjustments to the size and location of the breast.

A nipple may be developed using tissue from the back or an abdominal flap. After that, it is tattooed to look like a nipple.

The nipple from the initial breast may be reattached in rare instances, but only if the doctor is certain the tissue is cancer-free. The nipple will not rise or flatten in response to touch or temperature as it normally would, due to the lack of nerve connections.

Prosthetic nipple: Another alternative is to use a prosthetic nipple. The cosmetic surgeon colours the areola after creating a copy of your natural nipple. It may be glued to your breast or re-glued once or twice a week.

 

How Long Does Breast Reconstruction Surgery Take?

It can take up to two hours to prepare for the surgery, including anaesthesia. It will take 1 to 6 hours to complete the reconstruction.

You’ll spend around 2 to 3 hours in recovery following surgery before being moved to a hospital room.

 

Recovery From Breast Reconstruction Surgery

For the first few days afterward, you might experience some pain. If required, you’ll be given pain relief. The nurses will maintain a careful eye on you during your stay in the hospital.

You’ll be allowed to raise your arms soon after treatment, but not for certain strenuous activities such as picking yourself up, getting out of bed, or moving large items. Nurses will assist you with getting in and out of bed. You will be able to sit in a chair by the bed the day after surgery. On the second day, the majority of patients are able to walk without assistance.

For a day or two, you’ll most likely get IV fluids. A urinary catheter can be used overnight or until you are able to move to the toilet independently. You’ll still have drains where the surgeon made cuts (the incision sites). If you take these drains home with you, you’ll be given directions about how to care for them.

The duration of your hospital stay is determined by the type of surgery and how well you recover. The typical hospital stay for implant patients is 1 to 2 days. Flap procedures may necessitate a 5- to 6-day stay.

 

Follow-Up Care for Breast Reconstruction

For the next 2 or 3 weeks after you get home, you should anticipate some soreness, swelling, and bruises. It’s likely that you’ll be advised to apply medications to the suture site or change bandages at home. Showering, bathing, and wound management will be discussed with the plastic surgeon.

Within 6 to 8 weeks of operation, most women are back to their normal routine. You may need to wait several weeks before engaging in strenuous exercise.

The mastectomy and breast reconstruction operation would result in numbness in the regions where the surgery was conducted. You may experience numbness and tightness instead of pain where the tissue was removed. Some sensations in your breasts may return with time. The majority of scars will disappear over time.

Your reconstructed breast can gradually improve in shape.

At first, you’ll need to see a doctor on a regular basis. If you have a temporary expander, it will be saline expanded once a week on average before it reaches the desired size (usually within six to 10 office visits).

Continue to perform monthly self-exams of the breasts and have an annual mammogram.

Breast reconstruction has no effect on the likelihood of cancer recurrence, and it normally doesn’t interfere with treatment. Your medical team will however manage you with surgery, radiation, chemotherapy, and targeted therapy if the cancer recurs.

 

What Side Effects Can I Expect?

  • Infection at the surgery site. Infection is a possibility with any surgery. In certain instances, administering antibiotics will clear the infection.
  • Pain and discomfort. Your doctor will prescribe a pain killer for you. Some women feel greater pain than others.
  • Itching. As the wound recovers, it can itch. However, resist the temptation to scratch it, no matter how difficult it might be. To relieve itching, your doctor can prescribe an ointment or cream.
  • Numbness or tingling. Because the nerves have been affected, you may feel these symptoms. They can last for up to a year after surgery.
  • Fluid collection under the wound. After your drainage tubes are removed several days after the surgery, fluid can accumulate under the wound. It may go away on its own if there isn’t much fluid. If there’s a lot of it, the surgeon may have to use a needle and syringe to drain the region.

If you experience any of the following symptoms, inform the doctor immediately:

  • A fever above 37.5C
  • Fluid leaking from incision sites
  • Any changes in color in your breast or scar areas
  • Increased pain or swelling in the surgical sites

Sources

Referenced on 30.3.2021

  1. American Cancer Society: “Types of breast reconstruction,” "Breast Reconstruction After Mastectomy."
  2. American Society for Plastic and Reconstructive Surgeons: “Breast Reconstruction.”
  3. BreastCancer.org: “Screening After Breast Reconstruction,” “TRAM Flap,” ”TRAM Flap Reconstruction: What to Expect.”
  4. Cancer Research UK: “Breast reconstruction using body tissue.”
  5. https://www.webmd.com/breast-cancer/breast-reconstruction-after-mastectomy

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