Breast Reconstruction

Breast reconstruction surgery can be achieved through a variety of different techniques that can begin when you have your mastectomy, or it can be scheduled at a later time. Breast reconstruction usually requires at least two procedures. The process you and your surgeon ultimately choose will be determined based on your body type, medical history, previous therapy and surgeries, and your discussions with your surgeon. If You Choose Silicone Implants  Breast reconstruction using implants involves surgically placing a breast-shaped silicone pouch— filled with either silicone gel or saline—into your chest following your mastectomy. If you choose silicone implants, your surgeon might recommend a process that involves a single surgery to place the implants at the same time your mastectomy is done. Another possibility is a two-stage process which begins with inserting a balloon-like tissue expander—which stretches the skin and soft tissue in the breast area, making room for the implant—into your chest for a few months and then replacing it with the breast implant in a future procedure.  If You Want to Use Your Own Tissue If you and your surgeon decide to use your own tissue for your breast reconstruction, your surgeon will relocate tissue from your abdomen, back, buttocks, or thigh areas to your chest to form your new breast. Depending upon the surgery that’s right for you, your surgeon might move the tissue by tunneling through your skin to the chest area, keeping it attached to its original blood supply. In other cases, your tissue will be relocated by detaching it from the donor area in your body and then reattaching it in your chest area, forming a new breast. If your tissue is detached, it will be reattached using a technique called microsurgery, when a microscope is used to connect the tiny vessels to a new blood supply.

Two procedures you might want to know about as you consider breast reconstruction are listed below. Nipple reconstruction and tattooing  As part of the reconstruction process, you can also choose to have your nipple reconstructed and tattooed to make the skin darker and more natural looking. Nipple reconstruction is usually an outpatient procedure that uses skin from your new breast to form the new nipple. If you decide to have your nipple reconstructed, get a tattoo, or both, this process is generally the last stage of breast reconstruction and can be done about four months after your breast reconstruction is complete. Fat grafting  Following reconstruction, some women experience abnormalities in the shape of one or both breasts. When this happens, a fat grafting procedure, in which fat is obtained by liposuction and then injected into the breast, can be used.

Breast reconstruction is a good choice if you’ve had surgery to treat breast cancer and want to permanently regain your breast shape. You should understand that a reconstructed breast won’t be exactly like the breast that was removed. 

Some of the possible side effects include infection; blood clots; bleeding; wound healing problems; problems associated with anesthesia; extreme tiredness; fluid build-up in the breast or the donor site; breast pain; changes in breast sensation; breasts that aren’t symmetrical; implant rupture or deflation; increased risk of revision surgery to replace or remove the implants; and the formation of scar tissue that affects the way your new breast looks. 

Some possible side effects of local anesthesia include nausea and vomiting, dizziness, headaches, blurred vision, twitching muscles, drop in blood pressure, continuing numbness, weakness, and tingling. 

The final results of breast reconstruction can help lessen the negative psychological and physical impacts of your breast cancer surgery, though reconstructed breasts shouldn’t be expected to look and feel like the breasts that were removed.

Your health insurance provider may require you to get a referral from your primary care provider to see a surgeon about a breast reconstruction surgery.

You can always get a second or third opinion, but it isn’t required. 

Your health history will be compiled and available to the team before, during, and after surgery. If you’re a Hancock Health patient, we will be able to access your records within our system. If you aren’t, we’ll work with your doctors to get the necessary information. 

Consult the Price Transparency Tool at HancockRegionalHospital.org for an idea of how much breast reconstruction might cost.

Medicare parts A and B will cover the cost of breast reconstruction surgery, but it’s important for your doctor to indicate that the surgery is medically necessary.

Prior to your surgeries you may be asked to get lab tests or a medical evaluation. If you smoke, you’ll probably be asked to stop for several weeks or months, and you’ll also likely be instructed not to take aspirin, anti-inflammatory drugs, and herbal supplements because they can increase bleeding. Your surgeon will also probably tell you not to eat anything after midnight on the day of your surgeries. (Not sure where to go to get your lab tests? Check out Gateway Hancock Health, where you’ll be able to get in and out quickly and pay, on average, 70% less than you’ll pay at a hospital.)

You’ll arrive two to three hours before your surgery and be escorted to the preoperative waiting area.You’ll remove all of your clothing and jewelry, and put on a hospital gown. (Your valuables will be placed in a secure area or may be given to a family member.) You’ll sign any necessary paperwork and a preoperative nurse will take your vital signs, review your medications, and answer any questions.You’ll meet your surgery team and they’ll mark the location for the breast reconstruction  on your body. You’ll meet your anesthesiologist and the members of your surgery team. They will mark the location of your surgery on your body. An I.V. (intravenous line) will be placed in your hand or arm, so medications—including general anesthesia—can be administered. If you’re using a different kind of anesthesia, you’ll receive an injection.When it’s time for your surgery, you will be wheeled into the operating suite on a stretcher.

In addition to the surgeon, you have an anesthesiologist, nurses—some of them specialize in working with patients and others assist the surgeon—and support staff, who will check you in and out, compile your records, and more. They all work together, performing their individual jobs, so your procedures are as successful as possible. 

Since you’ll be staying in the hospital for one to five days, depending upon your procedure, you’ll want to bring the things that will make you more comfortable including your robe and slippers. You’ll also want a pillow from home, entertainment and headphones, earplugs and an eye mask, glasses, face and body wipes, and a large T-shirt (to wear right after your procedure).

The Process for Silicone Implants  If you are having breast reconstruction with a silicone implant or implants, your surgeon might recommend first placing a tissue expander into your chest area to make room for your new breast. The tissue expander, which stretches the skin and soft tissue, is a balloon-like device that your surgeon can place either behind or in front of your chest muscle. Once it’s in place, saline will be injected into the expander through a valve in your skin over the next few months. That will stretch the skin in increments over time. When the tissue is ready, your surgeon will perform a second surgery, replacing the expander with your breast implant, forming your new breast.  But if you are having breast reconstruction with implants only, and no tissue expander, your surgeon will place a breast-shaped silicone pouch, filled with either silicone gel or saline, either behind or in front of your chest muscle and that will form your new breast. The Process for Using Your Own Tissue  There is a separate set of processes your surgeon will follow if you are having a breast reconstruction using your own tissue. The various techniques are listed below. Abdominal Tissue  Abdomen (pedicle transverse rectus abdominis muscle): Your surgeon uses the skin, fat, blood vessels, and muscle from your abdomen and tunnels under your skin, through your body to the front of your chest, where your new breast is created. In this method, the tissue stays attached to its original blood supply.   Abdomen (free transverse rectus abdominis muscle): Your surgeon moves tissue—but less muscle—from the lower abdomen to the front of your chest to create your new breast. In this method, the tissue is detached so your blood vessels must be reattached, which requires microsurgery in which a microscope is used to connect the tiny vessels. Abdomen (deep inferior epigastric perforator): Your surgeon moves fat and skin—but no muscle—from your abdomen to the front of your chest to create your new breast. While this method relocates the same tissue from the lower abdomen as the procedures described above, the tissue is detached so the blood vessels must be reattached. This requires microsurgery to connect the tiny vessels. (There is also a less-invasive version of this technique. It involves using the same abdominal tissue but it uses blood vessels that aren’t as deep in your abdomen.) Back Tissue  Back (latissimus dorsi): Your surgeon uses skin, fat, and muscle from your upper back and tunnels it under the skin to the front of your chest to form your new breast. In this method, the tissue stays attached to its original blood supply. In some cases, this procedure can include a breast implant. Gluteal Tissue Buttocks (gluteal artery perforator or gluteal free): Your surgeon uses tissue—but no muscle—from the buttocks to create your new breast. The skin, fat, and blood vessels are detached from the buttocks and moved to the front of your chest, where your new breast is formed. This also requires the use of microsurgery to connect the tiny vessels. Thigh Tissue Thigh (transverse upper gracilis): Your surgeon uses tissue from your inner thigh to create your new breast. Your skin, muscle, and blood vessels are detached from your thigh and moved to the front of your chest where your new breast is formed. This also requires the use of microsurgery to connect the tiny vessels. (A similar procedure, called a profunda artery perforator flap, does not remove muscle from your thigh.)

Breast reconstruction surgery typically takes one to six hours. 

Following breast reconstruction surgery, you will likely stay in the hospital from one to five days. The length of your stay will depend on your procedure and how quickly your body begins to recover.

You’ll spend about two to three hours in the recovery room before being transferred to your hospital room. 

You’ll be able to talk to your surgeon immediately after your procedure, while you’re in the recovery room.

You will receive pain medication immediately after breast reconstruction surgery.

You might receive a prescription for pain medication, nausea, antibiotics, or all three. You might also have a prescription for antidepressants. 

Ask someone to spend at least the first week after surgery at home with you—especially if you live alone. Prepare to be unable to lift anything that would make you strain. You’ll be instructed to avoid lifting anything, including children, for about six weeks.Prepare to take it easy for at least a week—compile reading material or a list of movies or television shows you’d like to watch.Shop for groceries before your procedure and have lots of hydrating liquids and healthy foods, full of fiber and protein, on hand. You will be advised not to drive for about three weeks.Have dark towels and clothing available. They’ll absorb any leaking fluid.Prepare to wear a special bra, compression garments, and elastic bandages around the treated areas. We will give you exact instructions about which garments to wear and for how long.Know you will probably have one or two small drains at your surgical site. We’ll tell you exactly how to care for them and how long they’ll be in. Prepare to be unable to shower for several days. (You’ll be advised not to take a bath or soak in a hot tub for about a month.)Prepare to sleep on your back, with pillows under your head and knees or in a recliner for the first two weeks after your surgery. After that for the next two weeks, you’ll be asked to sleep on your side or back, but not on your stomach. (After about a month, you’ll be able to resume your normal sleeping position.)

You can expect to have some scarring, which will fade over time, at your surgical sites. Drains are usually removed in the first few weeks following surgery, and stitches are removed five to 10 days afterward.

Call your surgeon’s office, and, if you’re in need of immediate emergency services, go to the nearest emergency room.