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Breast Reconstruction

breast cancerAccording to a recent article posted by the American Society of Plastic Surgeons, a survey, conducted by Harris Interactive, a research and polling company, found that less than a quarter (23%) of women know the wide range of breast reconstruction options available. Only 22% of women are familiar with the quality of outcomes that can be expected. Only 19% of women understand that the timing of their treatment for breast cancer and the timing of their decision to undergo reconstruction greatly impacts their options and results.

Breast reconstruction techniques are multiple and individual. No one technique is appropriate for all patients. The use of implants for reconstructions, have become more popular in the last few years with the advent of ADM (Autologous Dermal Matrix) materials. These will allow for larger submuscular pockets to be made and either immediate reconstruction with implants or secondary reconstructions after tissue expansion are now popular. In addition, nipple sparing mastectomy techniques are limiting scarring and allowing for more ease of reconstruction. The issue of post-radiation changes in skin and underlying muscle is important. Some patients suffer very significant changes to their skin and because of that are poor candidates for implant reconstructions. This skin and muscle does not expand well and scars easily and the chances of doing well with an implant for reconstruction are smaller. These chances have been improved with current techniques of fat transfer, which allow for “padding” around implants with the patient’s autologous fat. While that improvement has been significant it is in general not the case that if skin is significantly changed by radiation that those patients will be best served by implant reconstructions.

Autologous reconstructions take a couple of forms, by far the most popular is the use of the lower abdominal tissue as either a free flap or a pedicle flap called a TRAM flap. Also the latissimus muscle of the back along with overlying skin can be transferred to adjust to provide more cover for underlying implants and bring healthier vascularized tissue to the chest when radiation changes have taken place. Once again, techniques are varied and individualized for patients. We have had a longstanding interest in breast reconstruction in this community performing the first TRAM flaps ever done in Hampton Roads. We have seen a pendulum swing from the popularity of flap reconstructions back to the popularity of implant reconstructions and back again to the current state where both types of reconstructions are favored according to patients’ needs.

Breast reconstruction becomes a viable option for almost all patients, who have had to undergo either full or partial mastectomy. Because every breast reconstruction patient has their own unique experience, health concerns and needs, my partners and I at Associates in Plastic Surgery make every effort to inform patients of their options for reconstruction based on their individual circumstances.

Breast Reconstruction

Breast Reconstruction in Virginia Beach

Regain your confidence and well-being with breast reconstruction at Associates in Plastic Surgery. Our experienced surgeons specialize in helping you restore your natural beauty and self-assurance after breast surgery. Request a consultation today, and let us guide you towards a brighter and more confident future.

Table of Contents

What is Breast Reconstruction?

Breast reconstruction is a surgical procedure performed to rebuild a breast that has been partially or completely removed due to mastectomy (surgical removal of the breast) or trauma. It is typically performed after breast cancer treatment or to correct congenital abnormalities of the breast.
The goal of breast reconstruction is to restore the breast’s shape, size, symmetry, and appearance, as well as to improve body image and self-esteem. Breast reconstruction can be performed using various surgical techniques and approaches, including implants, autologous tissue (flap) reconstruction, or a combination of both.
There are several methods of breast reconstruction, each with its own advantages, considerations, and potential risks. The choice of reconstruction technique depends on factors such as the patient’s anatomy, medical history, cancer treatment plan, aesthetic goals, and personal preferences. The two primary methods of breast reconstruction include:
  1. Implant-Based Reconstruction: In implant-based reconstruction, breast implants are used to recreate the shape and volume of the breast. This approach may involve placing a tissue expander (inflatable implant) beneath the chest muscle to gradually stretch the skin and create a pocket for the permanent implant. Once the desired breast size is achieved, the tissue expander is replaced with a silicone or saline implant.
  2. Autologous Tissue (Flap) Reconstruction: Autologous tissue reconstruction involves using the patient’s own tissue, typically harvested from the abdomen, back, buttocks, or thighs, to reconstruct the breast. Common types of flap reconstruction include:
    • TRAM Flap (Transverse Rectus Abdominis Myocutaneous Flap): Tissue from the lower abdomen, including skin, fat, and sometimes muscle, is transferred to the chest to create a new breast mound.
    • DIEP Flap (Deep Inferior Epigastric Perforator Flap): Similar to the TRAM flap but preserves the abdominal muscles, resulting in less abdominal wall weakness.
    • Latissimus Dorsi Flap: Tissue from the latissimus dorsi muscle in the back is transferred to the chest and combined with a breast implant to reconstruct the breast.
In some cases, a combination of implant-based reconstruction and autologous tissue reconstruction may be used to achieve optimal results, particularly in patients with complex breast anatomy or insufficient tissue for a single reconstruction method.
Breast reconstruction may be performed immediately following mastectomy (immediate reconstruction) or delayed until after completion of cancer treatment (delayed reconstruction). The timing of reconstruction depends on factors such as the patient’s overall health, cancer treatment plan, and preferences.
Breast reconstruction can have significant physical, emotional, and psychological benefits for patients who have undergone mastectomy or experienced breast deformity. It is important for patients to discuss their options, goals, and concerns with a board-certified plastic surgeon experienced in breast reconstruction to determine the most appropriate approach for their individual needs.

Am I an Ideal Candidate? An Ideal Candidate for a Breast Reconstruction

  • Good overall health
  • Completion of breast cancer treatment
  • Realistic expectations
  • Positive attitude and emotional readiness
  • Desire for breast restoration
  • Non-smoker or willing to quit smoking
  • Understanding of reconstruction options
  • Ability to commit to recovery

What Happens During a Breast Reconstruction?

During breast reconstruction surgery, several steps are involved to recreate a breast mound and restore the shape, size, and appearance of the breast following mastectomy or breast deformity. Here’s an overview of what happens during a breast reconstruction procedure:
  1. Preparation: The patient is prepared for surgery, which may include administering anesthesia to ensure comfort throughout the procedure.
  2. Incision: The surgeon makes incisions in strategic locations on the chest, abdomen, back, buttocks, or thighs, depending on the chosen reconstruction method.
  3. Tissue Preparation: If autologous tissue (flap) reconstruction is chosen, the surgeon carefully harvests tissue from the donor site, preserving blood vessels and ensuring adequate blood supply to the transferred tissue.
  4. Tissue Transfer: The harvested tissue is transferred to the chest to create a new breast mound. This may involve microsurgical techniques to reconnect blood vessels and ensure proper blood flow to the transferred tissue.
  5. Implant Placement: If implant-based reconstruction is chosen, the surgeon may place tissue expanders or permanent breast implants beneath the chest muscle to recreate breast volume and shape.
  6. Nipple and Areola Reconstruction: Once the breast mound is formed, the surgeon may perform nipple and areola reconstruction to recreate the natural appearance of the nipple-areolar complex. This may involve techniques such as tattooing or grafting.
  7. Closure: The incisions are closed with sutures or surgical adhesive, and dressings or bandages are applied to the surgical site to promote healing.
  8. Post-operative Care: After surgery, the patient is monitored in a recovery area before being transferred to a hospital room or discharged home. Pain medication may be prescribed to manage discomfort, and patients are given instructions for post-operative care and follow-up appointments.
  9. Recovery: The patient undergoes a period of recovery, during which they may experience swelling, bruising, and discomfort. It’s essential to follow the surgeon’s post-operative instructions and attend all scheduled follow-up appointments for monitoring and wound care. 
  10. Additional Procedures: In some cases, additional procedures such as fat grafting, scar revision, or adjustments to the reconstructed breast may be performed to optimize the aesthetic outcome and symmetry.
Breast reconstruction is a highly individualized procedure, and the specific techniques and approaches used may vary based on factors such as the patient’s anatomy, cancer treatment plan, aesthetic goals, and surgeon’s expertise. Patients should discuss their options and preferences with a board-certified plastic surgeon experienced in breast reconstruction to determine the most appropriate approach for their individual needs.

Recovery Timeline Following Breast Reconstruction

  1. Immediate Post-Operative Period (Day 1-2):
    • Patients are typically monitored in a recovery area immediately after surgery.
    • Pain medication is prescribed to manage discomfort.
    • Surgical dressings or bandages are applied to the incision sites.
    • Patients may experience swelling, bruising, and discomfort in the chest and donor site areas.
  2. First Week:
    • Patients may be discharged from the hospital within a few days of surgery, depending on the type of reconstruction and individual recovery progress.
    • Activities are limited, and patients are advised to avoid strenuous activities and heavy lifting.
    • Pain and discomfort gradually improve with medication and rest.
    • Follow-up appointments with the surgeon may be scheduled to monitor healing and remove any drains or sutures.
  3. Second Week:
    • Swelling and bruising continue to decrease gradually.
    • Patients may begin to resume light activities, but it’s essential to avoid activities that strain the chest muscles or incision sites.
    • Some patients may return to work if their job does not involve strenuous physical activity.
    • Scar care instructions may be provided to promote optimal healing and minimize scarring.
  4. Third Week to Fourth Week:
    • Patients may experience further improvement in pain, swelling, and mobility.
    • Light exercises and activities may be gradually increased, but patients should continue to avoid heavy lifting or strenuous activities.
    • Follow-up appointments with the surgeon may continue to monitor progress and address any concerns.
    • Some patients may begin to feel more comfortable with the appearance of their reconstructed breast as swelling continues to resolve.
  5. One Month to Three Months:
    • Most of the initial swelling and bruising should resolve by this time.
    • Patients may start to feel more comfortable with their reconstructed breast and notice improvements in breast shape and contour.
    • Scar healing continues, and scar management techniques may be continued as advised by the surgeon.
    • Patients may gradually increase their level of physical activity and return to more normal daily routines.
  6. Three Months to Six Months:
    • Patients continue to see gradual improvements in the appearance and feel of the reconstructed breast.
    • Scar maturation continues, and scars may become less noticeable over time.
    • Many patients begin to feel more confident and satisfied with the results of their breast reconstruction.
    • Follow-up appointments with the surgeon may be less frequent but are still important for long-term monitoring and assessment.
  7. Six Months and Beyond:
    • Final results of breast reconstruction become more apparent as swelling resolves and scars mature.
    • Patients may resume all normal activities, including exercise and physical intimacy, as advised by their surgeon.
    • Regular breast self-exams and mammograms may be recommended for ongoing breast health monitoring.
    • Follow-up appointments with the surgeon may be scheduled periodically to monitor long-term outcomes and address any concerns or questions.
It’s important for patients to follow all post-operative instructions provided by their surgeon, attend all scheduled follow-up appointments, and communicate any unusual symptoms or concerns during the recovery process. Each patient’s recovery experience is unique, and the timeline may vary based on individual factors and the specific technique used for breast reconstruction.

Maintaining Results

Maintaining the results of breast reconstruction involves several strategies aimed at preserving the restored breast shape, size, and appearance over time. Here are some tips for maintaining the results of breast reconstruction:
  1. Regular Follow-Up Visits: Attend all scheduled follow-up appointments with your plastic surgeon for ongoing monitoring and evaluation of the reconstructed breasts. Your surgeon can assess the stability of the results, address any concerns or changes, and provide recommendations for long-term care.
  2. Healthy Lifestyle: Maintain a healthy lifestyle with a balanced diet, regular exercise, adequate hydration, and sufficient sleep. A healthy lifestyle can promote overall well-being and help support optimal healing and tissue health.
  3. Avoid Smoking: If you smoke, quit smoking before and after surgery to optimize healing and reduce the risk of complications. Smoking can impair circulation, delay wound healing, and increase the risk of complications, which may affect the long-term results of breast reconstruction.
  4. Sun Protection: Protect the reconstructed breasts from sun exposure by applying sunscreen with SPF 30 or higher to the chest area when exposed to sunlight. Sun exposure can accelerate skin aging and affect the appearance of scars, potentially compromising the results of breast reconstruction.
  5. Scar Care: Follow your surgeon’s instructions for scar care to promote optimal healing and minimize the appearance of scars. This may include applying scar creams, silicone gel sheets, or other topical treatments to the surgical incisions. Protecting the scars from sun exposure and avoiding harsh skincare products can help improve their appearance over time.
  6. Healthy Weight Maintenance: Maintain a stable weight to prevent fluctuations in breast size and shape. Significant weight gain or loss can affect the appearance of the reconstructed breasts and may necessitate additional revisions or adjustments.
  7. Supportive Bras: Wear supportive bras that provide adequate support and minimize breast movement. Choose bras with wide straps and full cups to distribute weight evenly and reduce strain on the chest muscles. Supportive bras can help maintain the shape and position of the reconstructed breasts over time.
  8. Breast Self-Exams: Perform regular breast self-exams to monitor changes in the reconstructed breasts, including lumps, swelling, or changes in appearance. Early detection of any abnormalities can facilitate prompt medical evaluation and treatment if needed.
  9. Breast Health Monitoring: Continue to monitor breast health by scheduling routine mammograms and clinical breast exams as recommended by your healthcare provider. While breast reconstruction can restore the appearance of the breasts, it’s essential to remain vigilant about breast health and undergo regular screenings for early detection of any potential issues.
  10. Communication with Surgeon: Maintain open communication with your plastic surgeon and discuss any concerns or changes in the appearance of the reconstructed breasts. Your surgeon can provide guidance, reassurance, or additional treatment options as needed to address any issues and ensure long-term satisfaction with the results of breast reconstruction.
By following these tips and staying proactive about your breast health and overall well-being, you can help maintain the results of breast reconstruction and enjoy the benefits of restored breast shape, size, and appearance for years to come.

Possible Complications

While breast reconstruction surgery is generally safe, like any surgical procedure, it carries the risk of potential complications. It’s important to discuss these risks with your surgeon before undergoing surgery. Possible complications of breast reconstruction may include:
  1. Bleeding: Excessive bleeding during or after surgery can lead to hematoma (collection of blood) at the surgical site, which may require drainage to prevent complications.
  2. Infection: There is a risk of infection at the surgical site, which may manifest as redness, swelling, warmth, or discharge. Antibiotics may be prescribed to treat or prevent infection.
  3. Delayed Wound Healing: Some patients may experience delayed wound healing, resulting in wound separation, poor scar formation, or skin necrosis. Proper wound care and follow-up with your surgeon can help mitigate this risk.
  4. Fluid Accumulation: Seroma (accumulation of fluid) may occur at the surgical site, leading to swelling and discomfort. Draining the fluid with a needle may be necessary to alleviate symptoms.
  5. Changes in Sensation: Temporary or permanent changes in sensation, including numbness or increased sensitivity, may occur in the breasts or donor sites (if autologous tissue reconstruction is performed). Most patients experience some degree of sensory changes, but it typically improves over time.
  6. Capsular Contracture: In implant-based reconstruction, there is a risk of capsular contracture, where scar tissue forms around the implant and may cause the breast to feel firm, distorted, or painful. Revision surgery may be necessary to address severe cases of capsular contracture.
  7. Implant Rupture or Deflation: Breast implants may rupture or deflate over time, leading to changes in breast shape or size. Revision surgery may be required to replace the implant.
  8. Implant Malposition or Displacement: Breast implants may shift position or become displaced, resulting in asymmetry or an unnatural appearance of the breasts. Additional surgery may be needed to correct implant malposition.
  9. Poor Cosmetic Outcome: Despite the surgeon’s best efforts, some patients may be dissatisfied with the aesthetic outcome of breast reconstruction. Revision surgery or additional procedures may be necessary to achieve the desired results.
  10. Thromboembolism: There is a risk of blood clots forming in the legs (deep vein thrombosis) or traveling to the lungs (pulmonary embolism) following surgery. Measures such as early mobilization and compression stockings may help reduce the risk of thromboembolism.
  11. Anesthesia Risks: General anesthesia carries inherent risks, including allergic reactions, respiratory complications, and adverse reactions to anesthesia medications. Your anesthesiologist will monitor you closely during surgery to minimize these risks.
  12. Psychological Impact: Breast reconstruction surgery may have psychological implications, including adjustment to changes in body image, self-esteem, and emotional well-being. Counseling or support groups may be beneficial for some patients to address psychological concerns.
It’s essential for patients to communicate openly with their surgeon, follow all pre-operative and post-operative instructions, and attend all scheduled follow-up appointments to minimize the risk of complications and ensure a safe and successful recovery from breast reconstruction surgery.

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