Breast Reconstruction
Are You a Candidate for Breast Reconstruction?
About the Operation
What to Expect after the Surgery
Your Recovery
Possible Complications

 

Breast Reconstruction

For many women diagnosed with breast cancer, mastectomy (breast removal) is an unfortunate, yet lifesaving, treatment.  Women who have undergone full or partial mastectomy can choose to have breast reconstruction to restore their natural bust line, renewing her sense of femininity.

Reconstruction of a breast that has been removed due to cancer or other disease is increasingly becoming a more common procedure as medical and cosmetic surgery advances continue. These advances have made it possible for surgeons to create a breast that can come closely resemble in form and appearance a natural breast. In most cases, breast reconstruction is possible immediately following a mastectomy enabling the patient to wake-up with a breast mound already in place, and thus, sparing the patient the unpleasant experience of seeing herself with no breast at all.

Please remember that post-mastectomy breast reconstruction is not a simple procedure and should be given serious consideration. Dr. Javaheri will talk to you about your many options and recommend what will be best for you based upon your medical history and personal expectations.

Are You a Candidate for Breast Reconstruction?

The best candidates are women whose cancer, as far as can be determined, will have been eliminated by the mastectomy, though this does not necessarily exclude other situations.

If you have been diagnosed with breast cancer, and a mastectomy is planned, it is advisable that you begin talking about reconstructive surgery as soon as possible. Dr Javaheri will work with your breast surgeon to develop a strategy that will put you in the best possible condition for reconstruction.

After evaluating your health, Dr. Javaheri will explain which reconstructive options are most appropriate for your age, health, anatomy, tissues, and goals. It is important that you discuss your questions, expectations and concerns honestly with Dr. Javaheri.

About the Operation

Breast reconstruction usually involves more than one operation. The first stage, whether done at the same time as the mastectomy or afterwards, is normally performed in a hospital.

The follow-up procedures can be performed either on an inpatient and outpatient basis depending on the extent of surgery required. The first stage of reconstruction, creation of the breast mound, is almost always performed using general anesthesia. Follow-up procedures may only require a local anesthesia, combined with a sedative.

Techniques of breast can vary from autogenous (using one’s own body tissue), or implant reconstruction.  This can be in the form of a tissue expander (a type of “balloon” implant) which is placed under the skin and periodically inflated until the desired sized is reached.  This expander is then replaced with a permanent implant.  The breast reconstruction can also be performed in one step with an implant, though revisions is not uncommon.  The nipple and the dark skin surrounding it, called the areola, are reconstructed in a subsequent procedure.

Most breast reconstruction involves a series of operations that occur over a period of time. Usually, the initial reconstructive operation is the most difficult. Follow-up surgery may be required to replace a tissue expander with an implant or to reconstruct the nipple and the areola. In addition, further operations to enlarge, reduce, or lift the natural breast to match the reconstructed breast may be necessary.

Radiation, following Mastectomy, will influence the method of reconstruction. Dr. Javaheri will discuss this in detail with you.

What to Expect after the Surgery

For several days after your surgery, you will probably experience some moderate pain, which can be controlled with the use of painkillers. The need for painkillers is normally greatly reduced after four to five days. Depending on the extent of your surgery, you will probably be released from the hospital as an outpatient, or several days in the hospital.   Many reconstruction options require a surgical drain to remove excess fluids from surgical sites immediately following the operation. These drains are normally removed within the first week or two after surgery.

Your Recovery

It is common for most patients take you up to six weeks to recover from a combined mastectomy and reconstruction or from a flap reconstruction alone. If implants are used without flaps, and reconstruction is done apart from the mastectomy, your recovery time may be less.

Reconstruction cannot restore normal sensation to your breast, though in time some feeling may return. Most scars will fade significantly over time, though it may take one to two years. To expedite and facilitate this process, daily massaging of the scars during this period will be advised. Please note that the scars will never completely disappear.

Heavy lifting or other strenuous activity is prohibited in the first six weeks following your surgery. Walking is helpful in the first three to four weeks as this improves circulation and contributes to a reduction of swelling and the development of blood clots.

Possible Complications

Virtually any woman who must lose her breast to cancer can have it rebuilt through reconstructive surgery. But there are risks associated with any surgery and specific complications associated with this procedure.

In general, the usual risks associated with surgery, such as bleeding, fluid collection, excessive scar tissue, or difficulties with anesthesia, can occur although they are relatively uncommon.

If an implant is used, there is a remote possibility that an infection will develop, usually within the first two weeks following surgery. In some of these cases, the implant may need to be removed for several months until the infection clears. A new implant can later be inserted. Implants may change position postoperatively. Should this occur, this may require correction surgery.

Capsular contracture or hardening of the breast is the most common complication of breast implants and occurs when the skin around the scar tissue shrinks around the implant, squeezing it so that it starts to feel unnaturally firm or hard.

The cause of capsular contracture is not completely understood. It is important to realize that there are varying degrees of contracture, and that the majority of women who do experience this hardening do so only to a mild extent. In some cases, it may be severe enough to be uncomfortable, even painful and may cause distortion of the breast. The condition may occur in one or both breasts and to a different degree.  It is possible that capsular contraction could develop at any point following your surgery, sometimes even years later. In most cases, it is most likely to occur in the first three years. Unfortunately at this time there is no effective way to prevent capsular contracture.

Reconstruction has no known effect on the recurrence of disease in the breast. Should your cancer return, reconstruction does not generally interfere with chemotherapy or radiation treatment. Dr. Javaheri may recommend the continuation of regular mammograms on both the reconstructed and the remaining normal breast. If your reconstruction involves an implant, at the time of each mammogram, the radiographer should be informed of the presence of implants in order for the necessary adjustments to the mammogram can be instituted to therefore ensure proper radiological evaluation.

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