Thumbnails / 1 / 2

Breast Reconstruction

(Following Breast Removal)

The goal of breast reconstruction is to create a soft, natural-looking breast for a women who must undergo breast removal due to cancer or other disease.  Whether it is perfomred immediately following mastectomy or at a later time, breast reconstruction can dramatically improve a woman's appearance, self-confidence and overall quality of life.

You will find basic information about breast reconstruction in this brochure.  However, the only way to get complete answers to specific questions that relate to your individual needs is to have a personal consultation with a plastic surgeon certified by the American Board of Plastic Surgery.

In Canada, the Royal College of Physicians and Surgeons or Canada

Is a brest reconstruction right for me?

Almost every women who has lost a breast a cancer can have her body restored with breast reconstruction.  However, the following conditions are desirable:

You clearly understand that although your figure will be markedly improved, your reconstructed breast will not look or feel exactly the same as the breast that was removed.

Your oncologist has advised you that reconstruction is appropriate for you with regard to your stage of cancer or treatment.  (Should cancer recur, your reconstructed breast will not interfere with further treatment.  However, such treatment may affect the appearance of your reconstructed breast.)

You feel that you are able to handle the period of emotional adjustment that may accompany breast reconstruction.  Just as it takes time to get used to the loss of a breast, it may take some time before you begin to think of the reconstructed breast as your own.

You have no additional health concerns that may complicate the procedure, such as obesity or heart disease.

What should I expect form the consultation?

A personal consultation is the first step for every patient considering breast reconstruction.  During this meeting, your surgeon will assess your physical and emotional health and discuss your specific goals for the procedure.  You should arrive at the consultation prepared to provide complete information about:

To help you determine which reconstruction method will give you the best results, your surgeon will perform a physical exam.  Measurements and photographs may be taken for your medical record.

Thanks to the advocacy efforts of the American Society of Plastic Surgeons (ASPS) and several breast cancer support groups, insurance companies are now required by law to cover the cost of reconstructive surgery for women who have undergone a mastectomy.  The law also requires coverage for procedures to restore and achieve symmetry on the opposite breast.

Because regulations related to the law are not yet final, coverage denials still occur.  It's best to let your plastic surgeon know if you are having difficulty getting coverage.  Many insurance companies require a letter of predetermination.  Your surgeon's office staff will help you with this any any other insurance matter related to the procedure.

How is breast reconstruction performed?

There are many options available is breast reconstruction.  Your anatomy, your surgeon's preferences and your desired results will help determine which methods is best for you.

skin expansion with a breast implant.  This is the most common method of reconstructing a breast.  Following mastectomy, a balloon expander is inserted beneath the skin and check muscle.  Over several weeks, the expander balloon is gradually filled with a salt-water solution in the doctor's office, causing the overlying skin to stretch.  When the skin had stretched sufficiently, the expander is surgically replaces with a more permanent implant.  Some expanders are designed to be left in place as the final implant.  The nipple and the skin surrounding it, called the areola, are reconstructed in a later procedure.

In rare cases, when a sufficient amount of skin is available, an implant can be placed without the preliminary skin-expansion step.

Flap reconstruction.  Although flap reconstruction is more involved at the initial procedure than reconstruction with an implant, many women prefer is because it may allow the breast to be rebuilt with natural tissue.  Also, unlike the tissue expander method, the breast mound is completed at the initial operations, without the need for expansion over an extended time period.

In one method, the breast is reconstructed using a tissue flap - consisting of a portion of skin, fat and muscle - that is taken from the back, or abdomen.  The flap, still tethered to its original blood supply, is tunneled beneath the skin to the front of the chest wall.  The transported tissue may be bulky enough to create a new breast mound itself.  However, sometimes an implant will be inserted as well.

In a more complex flap technique, tissue that is removed from the abdomen, is surgically transplanted to the chest by reconnecking the flap's blood vessels to vessels in the chest region.  Although more complicated, this microsurgical reconstruction may provide a more natural and less traumatic reconstruction in many women.

Although recovery from flap reconstruction may take longer than with implant reconstruction at the initial procedure, it does not require a secondary procedure for placing a permanent implant, nor does it require the weekly office visits needed for tissue expansion.  Additionally, a flap procedure may improve the contour of the sire from which the borrowed tissue was taken.  For example, a protruding abdomen may appear trimmer after tissue is taken from the area and used to rebuild the breast.

All of these procedures have advantages and disadvantages, and many times the choice of procedures is limited by other health factors, such as weight, other medical conditions and previous cancer therapy.  Your plastic surgeon will help you to determine which is the best procedure for you.

Follow-up procedures.  Once the breast mound is restored in the initial procedure, one or more follow-up procedures will be performed to replace a tissue expander with a permanent implant or to reconstruct the nipple and areola.  Your surgeon may also recommend an additional operation to lift or reduce the opposite breast to match the appearance of the reconstructed breast.

What are the risks associated with breast reconstruction?

Each year, thousands for women undergo breast reconstruction and experience no major complications.  However, one on the most important parts of your consultation with your plastic surgeon is discussing the risks as well as the potential benefits of surgery.  Certain complications are possible in any type of surgery including; blood loss, infection and others.  Your specific risk should be discussed with your surgeon.

Potential complications specific to breast reconstruction vary with the type of reconstruction you and your surgeon choose.  For instance, with flap reconstruction, thee is a small risk of partial or, very rarely, complete flap loss.  Reconstruction with an implant had the potential for breast firmness (capsular contracture) and implant rupture.  The probability of having one of these or other complications must be thoroughly discussed with your surgeon.

Remember, by carefully following your surgeon's advice and instructions - both before and after surgery - you can do your part to minimize some of the risks.

What can I do to prepare for my surgery?

When the date for our procedure had been set, your oncologist nd plastic surgeon will provide you with specific instructions for the days immediately before and after your surgery.  A number of points will be covered, included:

What can I expect on the day of my surgery?

Breast reconstruction usually involves more than one operations.  The first stage, whether performed at the same time as the mastectomy or later on , is typically performed in a hospital.

Follow-up procedures may be performed in a hospital, an outpatient surgery center or an office-based surgical suite.

Medications are administered to keep you comfortable during the procedure.  Usually a general anesthetic is used in the first procedure to reconstruct the breast mound so that you will sleep throughout the entire surgical procedure.  Follow-up procedures may require only local anesthesia.  You and your surgeon will discuss the types of comfort measures that will work best for you.

How will I look and feel right after surgery?

when surgery is complete, you'll be taken to a recovery area.  Small drainage tubes may have been places beneath the skin near the surgical sites to help prevent fluids from accumulating.

Recovering from a combines mastectomy and reconstruction or from a flap reconstructions typically takes longer than recovery from an implant reconstruction or a reconstructions performed apart  from the mastectomy.  Although everyone heals at a different rate, your recovery may follow this general time line:

Sensation may return to some areas of the breast.  However, a reconstructed breast will never feel completely normal or have normal sensation.

What should I know about my results?

If you are like most women who undergo breast reconstruction, you will find that the procedure provides both physical and emotional rewards.  For many women, breast reconstruction represents a new start, the change to put breast cancer behind them and get on with their lives.

You should expect to go through a period of adjustment to your new look.  However, any concerns about your new shape are likely to pass within a few months as you begin to think of the reconstructed breast as your own.

How long will I continue to see my plastic surgeon?

After the initial healing period, you will return to your plastic surgeon's office for a post-operative follow-up visit so that your healing and progress can be evaluated.  In the following months, you will see your surgeon to schedule your follow-up procedures and for check-ups to monitor your recovery.  It's important to keep these appointments so that your surgeon can assess your long-term results and address any questions or concerns you may have.

Choosing a Qualified Surgeon

No matter what type of plastic surgery you're considering, one of the most important factors in its success is the surgeon you choose.  Although it may seem hard to believe, some of the physicians who are performing cosmetic surgery today have had no formal surgical training at all.

It's advisable to consider the following points before scheduling a consultation:

Find out if he or she is certified by the American Board of Plastic Surgery (ABPS).  Surgeons with this certification have completed a minimum of five years of surgical training following medical school, including a plastic surgery residency program.  During this intensive program, surgeons learn to perform surgical procedures for the entire body and face.  At the same time, they develop their technical skill and aesthetic judgment.  After training, a surgeon must pass comprehensive oral and written exams before being granted certification.  The two professional organizations that have prepared this brochure, the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery, require their members to be certified by the American Board of Plastic Surgery.

Ask about the surgeon's hospital privileges

Even if you are planning to have your surgery in your doctor's office or at a surgery center, it is important to find out if your surgeon had operating privileges in an accredited hospital for the same procedure you would like to have performed.  Before granting privileges, hospital review committees evaluate a surgeon's training and competency for specific procedures.

In Canada the Royal College of Physicians and Surgeons of Canada.

The symbol of Excellence in Plastic Surgery

A public education service of
American Society of Plastic Surgeons
American Society for Aesthetic Plastic Surgery

This brochure, including text, graphics, illustrations, and images is intended to serve educational purposes only, it is not intended to make any representations or warranties about the outcome of any procedure and should not be viewed as a substitute for a thorough, in-person consultation with a board certified plastic surgeon.

The American society of Plastic Surgeons(ASPS) and the American Society of Aesthetic Plastic Surgery (ASAPS) have prepared this educational brochure to supplement your personal consultation with a plastic surgeon who is certified by the American Board of Plastic Surgery (ABPS).  Plastic surgeons  with this certification have completed approved training and examinations is plastic surgery including both cosmetic and reconstructive procedures.

The American Society of Plastic Surgeons, established in 1931, is the largest plastic surgery organization in the world, representing physicians certified by the American Board of Plastic Surgery.  The American Society of Aesthetic Plastic Surgery, founded in 1967, is the only plastic surgery organization devoted entirely to cosmetic surgery education and research.

In Canada, the Royal College of Physicians and Surgeons of Canada.

Copyright © 2006 Dr. Yalamanchi, M.D., F.A.C.S., PA